Stroke in the very old - Clinical presentation and determinants of 3-month functional outcome: A European perspective

被引:195
作者
Di Carlo, A
Lamassa, M
Pracucci, G
Basile, AM
Trefoloni, G
Vanni, P
Wolfe, CDA
Tilling, K
Ebrahim, S
Inzitari, D
机构
[1] Univ Florence, Dept Neurol & Psychiat Sci, I-50134 Florence, Italy
[2] CNR, Italian Longitudinal Study Aging, Florence, Italy
[3] Guys Kings Coll & St Thomas Hosp, Sch Med & Dent, Dept Publ Hlth Sci, London, England
[4] Univ Bristol, Dept Social Med, Bristol BS8 1TH, Avon, England
关键词
disability evaluation; elderly; stroke outcome;
D O I
10.1161/01.STR.30.11.2313
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Background and Purpose-The oldest old represent the fastest-growing segment of the elderly population in developed countries. Knowledge of age-specific aspects of stroke is essential to establish diagnostic and therapeutic pathways and to set up prevention and rehabilitation programs. We sought to evaluate stroke features and functional outcome in patients aged greater than or equal to 80 years compared with the younger age groups. Methods-In a European Union Concerted Action involving 7 countries, 4499 patients hospitalized for first-in-a-lifetime stroke were evaluated for demographics, risk factors, clinical presentation, resource use, and 3-month disability (Barthel Index) and handicap (Rankin Scale). Results-Overall, 3141 patients (69.8%) were aged <80 years, and 1358 (30.2%) were aged greater than or equal to 80 years. At baseline, female sex, prestroke institutionalization, and a worse prestroke Rankin score were significantly more frequent in the older patients, as were coma, paralysis, swallowing problems, and urinary incontinence in the acute phase (all P values <0.001). Brain imaging and other diagnostic tools were significantly less used in the older patients. Paralysis, swallowing problems, and incontinence during hospitalization independently predicted 3-month disability or handicap in both groups. For the older patients, prestroke institutionalization proved a further strong and independent determinant of 3-month disability (odds ratio, 2.33; 95% CI, 1.22 to 4.45) and handicap (odds ratio, 7.04; 95% CI, 1.62 to 30.69), Conclusions-In the very old, both medical and sociodemographic factors may significantly influence stroke outcome, showing peculiar characteristics. Knowledge of these determinants may reduce the burden on health systems, improving quality of care.
引用
收藏
页码:2313 / 2319
页数:7
相关论文
共 47 条
  • [1] STROKE REHABILITATION - IS AGE A DETERMINANT
    ADLER, MK
    BROWN, CC
    ACTON, P
    [J]. JOURNAL OF THE AMERICAN GERIATRICS SOCIETY, 1980, 28 (11) : 499 - 503
  • [2] ANDERSON TP, 1990, STROKE, V21, P43
  • [3] [Anonymous], 1993, WORLD DEV REP 1993
  • [4] [Anonymous], 1980, International classification of impairments, disabilities and handicaps
  • [5] A PROSPECTIVE-STUDY OF ACUTE CEREBROVASCULAR-DISEASE IN THE COMMUNITY - THE OXFORDSHIRE-COMMUNITY-STROKE-PROJECT 1981-86 .1. METHODOLOGY, DEMOGRAPHY AND INCIDENT CASES OF 1ST-EVER STROKE
    BAMFORD, J
    SANDERCOCK, P
    DENNIS, M
    WARLOW, C
    JONES, L
    MCPHERSON, K
    VESSEY, M
    FOWLER, G
    MOLYNEUX, A
    HUGHES, T
    BURN, J
    WADE, D
    [J]. JOURNAL OF NEUROLOGY NEUROSURGERY AND PSYCHIATRY, 1988, 51 (11) : 1373 - 1380
  • [6] CLASSIFICATION AND NATURAL-HISTORY OF CLINICALLY IDENTIFIABLE SUBTYPES OF CEREBRAL INFARCTION
    BAMFORD, J
    SANDERCOCK, P
    DENNIS, M
    BURN, J
    WARLOW, C
    [J]. LANCET, 1991, 337 (8756) : 1521 - 1526
  • [7] Hospital services for stroke care - A European perspective
    Beech, R
    Ratcliffe, M
    Tilling, K
    Wolfe, C
    [J]. STROKE, 1996, 27 (11) : 1958 - 1964
  • [8] Prevalence of stroke and stroke-related disability - Estimates from the Auckland stroke studies
    Bonita, R
    Solomon, N
    Broad, JB
    [J]. STROKE, 1997, 28 (10) : 1898 - 1902
  • [9] CHANGES IN STROKE INCIDENCE AND CASE-FATALITY IN AUCKLAND, NEW-ZEALAND, 1981-91
    BONITA, R
    BROAD, JB
    BEAGLEHOLE, R
    [J]. LANCET, 1993, 342 (8885) : 1470 - 1473
  • [10] Stroke and incontinence
    Brittain, KR
    Peet, SM
    Castleden, CM
    [J]. STROKE, 1998, 29 (02) : 524 - 528