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Vol. 29, No. 2, 2010
Issue release date: January 2010
Cerebrovasc Dis 2010;29:111–121
(DOI:10.1159/000262306)

Stroke in the Very Old: Incidence, Risk Factors, Clinical Features, Outcomes and Access to Resources – A 22-Year Population-Based Study

Béjot Y. · Rouaud O. · Jacquin A. · Osseby G.-V. · Durier J. · Manckoundia P. · Pfitzenmeyer P. · Moreau T. · Giroud M.
aStroke Registry of Dijon (Inserm et Institut de Veille Sanitaire), EA4184, University Hospital and Faculty of Medicine and Department of Neurology, and bDepartment of Geriatrics, University Hospital and Faculty of Medicine of Dijon, Dijon, France

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Abstract

Background: For several years, the burden of stroke in very old patients has been increasing in western countries. Nevertheless, we have little information about this new challenge in individuals ≧80. Methods: We ascertained all first-ever strokes in the population of Dijon, France (150,000 inhabitants), from 1985 to 2006. The incidence of stroke, risk factors, clinical presentation, resource mobilization and 1-month outcome were evaluated in individuals ≧80 and compared to the data obtained in younger patients. Results: We collected 1,410 first-ever strokes in people ≧80 years (39%) versus 2,130 in those <80 years. The incidence was 997/100,000, and 68/100,000, respectively. Over the 22 years, the incidence of stroke in individuals ≧80 years rose significantly. A lower prevalence of diabetes, hypercholesterolemia and alcohol intake, as well as a higher prevalence of hypertension, atrial fibrillation, previous myocardial infarction and use of prestroke antiplatelet agents were noted in patients ≧80 years. The clinical presentation was severer and the 1-month outcome in terms of case fatality and handicap was worse, despite improvements observed over time. Finally, in patients ≧80 years, the use of CT scan, MRI, cervical Doppler, angiography and carotid surgery were significantly lower than for younger patients. Length of stay >30 days was more frequent, and discharge to prestroke residence was less common. However, all these improved between the first and the last study periods. Conclusions: Our findings have important implications not only for clinical management but also for initiating preventive strategies and health policy.



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References

  1. Saposnik G, Cote R, Phillips S, Gubitz G, Bayer N, Minuk J, Black S; Stroke Outcome Research Canada (SORCan) Working Group: Stroke outcome in those over 80: a multicenter cohort study across Canada. Stroke 2008;39:2310–2317.
  2. Di Carlo A, Lamassa M, Pracucci G, Basile AM, Trefoloni G, Vanni P, Wolfe CD, Tilling K, Ebrahim S, Inzitari D; European Biomed Study of Stroke Care Group: Stroke in the very old: clinical presentation and determinants of 3-month functional outcome: a European perspective. Stroke 1999;30:2313–2319.
  3. Rothwell PM, Coull AJ, Giles MF, Howard SC, Silver LE, Bull LM, Gutnikov SA, Edwards P, Mant D, Sackley CM, Farmer A, Sandercock PA, Dennis MS, Warlow CP, Bamford JM, Anslow P; Oxford Vascular Study: Change in stroke incidence, mortality, case-fatality, severity, and risk factors in Oxfordshire, UK, from 1981 to 2004 (Oxford Vascular Study). Lancet 2004;363:1925–1933.
  4. Feigin VL, Lawes CM, Bennett DA, Anderson CS: Stroke epidemiology: a review of population-based studies of incidence, prevalence, and case-fatality in the late 20th century. Lancet Neurol 2003;2:43–53.
  5. Benatru I, Rouaud O, Durier J, Contegal F, Couvreur G, Bejot Y, Osseby GV, Ben Salem D, Ricolfi F, Moreau T, Giroud M: Stable stroke incidence rates but improved case-fatality in Dijon, France, from 1985 to 2004. Stroke 2006;37:1674–1679.
  6. Wenger NK: Enrollment and maintenance of elderly patients in cardiovascular clinical trials. Am J Geriatr Cardiol 2006;15:352–356.
  7. Wolfe CD, Tilling K, Beech R, Rudd AG; European Biomed Study of Stroke Care Group: Variations in case fatality and dependency from stroke in western and central Europe. Stroke 1999;30:350–356.
  8. Saposnik G, Black S; Stroke Outcome Research Canada (SORCan) Working Group: Stroke in the very elderly: hospital care, case fatality and disposition. Cerebrovasc Dis 2009;27:537–543.
  9. Sudlow CL, Warlow CP: Comparing stroke incidence worldwide: what makes studies comparable? Stroke 1996;27:550–558.
  10. WHO: The World Health Report 2000: Health Systems Improving Performance. Geneva, WHO, 2000.
  11. National Institute of Neurological Disorders and Stroke Ad Hoc Committee: Classification of Cerebrovascular Diseases III. Stroke 1990;21:637–676.
  12. Bamford J, Sandercock PA, Dennis MS, Burn J, Warlow CP: Classification and natural history of clinically identifiable subtypes of brain infarction. Lancet 1991;337:1521–1526.
  13. Bonita R, Beaglehole R: Modification of Rankin Scale: recovery of motor function after stroke. Stroke 1988;19:1497–1500.
  14. Gavrilov LA, Heuveline P: Aging of population; in Demeny P, Mac Nicoll G (eds): The Encyclopedia of Population. New York, MacRillan Reference USA, 2003.
  15. Avendano M, Kawachi I, Van Lenthe F, Boshuizen HC, Mackenbach JP, Van den Bos GA, Fay ME, Berkman LF: Socioeconomic status and stroke incidence in the US elderly: the role of risk factors in the EPESE study. Stroke 2006;37:1368–1373.
  16. Ellekjaer H, Holmen J, Vatten L: Blood pressure, smoking and body mass in relation to mortality from stroke and coronary heart disease in the elderly: a 10-year follow-up in Norway. Blood Press 2001;10:156–163.
  17. Kaplan RC, Tirschwell DL, Longstreth WT Jr, Manolio TA, Heckbert SR, Lefkowitz D, El-Saed A, Psaty BM: Vascular events, mortality, and preventive therapy following ischemic stroke in the elderly. Neurology 2005;65:835–842.
  18. Gueyffier F, Bulpitt C, Boissel JP, Schron E, Ekbom T, Fagard R, Casiglia E, Kerlikowske K, Coope J; INDANA Group: Antihypertensive drugs in very old people: a subgroup meta-analysis of randomised controlled trials. Lancet 1999;353:793–796.
  19. Beckett NS, Peters R, Fletcher AE, Staessen JA, Liu L, Dumitrascu D, Stoyanovsky V, Antikainen RL, Nikitin Y, Anderson C, Belhani A, Forette F, Rajkumar C, Thijs L, Banya W, Bulpitt CJ; HYVET Study Group: Treatment of hypertension in patients 80 years of age or older. N Engl J Med 2008;358:1887–1898.
  20. Smith NL, Psaty BM, Furberg CD, White R, Lima JA, Newman AB, Manolio TA: Temporal trends in the use of anticoagulants among older adults with atrial fibrillation. Arch Intern Med 1999;159:1574–1578.
  21. Mant J, Hobbs FD, Fletcher K, Roalfe A, Fitzmaurice D, Lip GY, Murray E, BAFTA investigators; Midland Research Practices Network (MidReC): Warfarin versus aspirin for stroke prevention in an elderly community population with atrial fibrillation (the Birmingham Atrial Fibrillation Treatment of the Aged Study, BAFTA): a randomised controlled trial. Lancet 2007;370:493–503.
  22. Schulz UG, Rothwell PM: Differences in vascular risk factors between etiological subtypes of ischemic stroke: importance of population-based studies. Stroke 2003;34:2050–2059.
  23. Sharma JC, Fletcher S, Vassallo M: Strokes in the elderly – higher acute and 3-month mortality – an explanation. Cerebrovasc Dis 1999;9:2–9.
  24. Palnum KD, Petersen P, Sørensen HT, Ingeman A, Mainz J, Bartels P, Johnsen SP: Older patients with acute stroke in Denmark: quality of care and short-term mortality: a nationwide follow-up study. Age Ageing 2008;37:90–95.
  25. Rudd AG, Hoffman A, Down C, Pearson M, Lowe D: Access to stroke care in England, Wales and Northern Ireland: the effect of age, gender and weekend admission. Age Ageing 2007;36:247–255.
  26. Saposnik G, Jeerakathil T, Selchen D, Baibergenova A, Hachinski V, Kapral MK; Stroke Outcome Research Canada Working Group: Socioeconomic status, hospital volume, and stroke fatality in Canada. Stroke 2008;39:3360–3366.
  27. Saposnik G, Fang J, O’Donnell M, Hachinski V, Kapral MK, Hill MD; Investigators of the Registry of the Canadian Stroke Network (RCSN) for the Stroke Outcome Research Canada (SORCan) Working Group: Escalating levels of access to in-hospital care and stroke mortality. Stroke 2008;39:2522–2530.
  28. Mysiw WJ, Beegan JG, Gatens PF: Prospective cognitive assessment of stroke patients before inpatient rehabilitation: the relationship of the Neurobehavioral Cognitive Status Examination to functional improvement. Am J Phys Med Rehabil 1989;68:168–171.
  29. Nakayama H, Jørgensen HS, Raaschou HO, Olsen TS: The influence of age on stroke outcome: The Copenhagen Stroke Study. Stroke 1994;25:808–813.
  30. Pohjasvaara T, Erkinjuntti T, Vataja R, Kaste M: Comparison of stroke features and disability in daily life in patients with ischemic stroke aged 55 to 70 and 71 to 85 years. Stroke 1997;28:729–735.
  31. Adams HP Jr, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, Marsh EE 3rd: Classification of subtype of acute ischemic stroke: definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke 1993;24:35–41.
  32. Amarenco P, Bogousslavsky J, Caplan LR, Donnan GA, Hennerici MG: Classification of stroke subtypes. Cerebrovasc Dis 2009;27:493–501.


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