Abstract
The population is ageing, with the greatest proportional increase in those >80 years of age. Many of these people will be frail and at risk of stroke. Research has shown that the very old have much to benefit from hyperacute stroke intervention, but at the same time they suffer increased mortality. Their outcome following stroke and intervention is more often predicted by the presence of frailty rather than age alone. Intervention both in primary prevention and hyperacute stroke management needs to allow for preexisting morbidity and frailty in deciding what is and what is not appropriate, rather than an arbitrary decision on age. Frail older people are more likely to develop delirium and dysphagia combined with poor mouthcare and die, yet all of these issues are managed badly. An increased awareness of these complications of stroke in the frail older person is necessary.
Highlights
The population is ageing, with the greatest proportional increase in those >80 years of age
In 2010, Fonarow noted, from the Get With The Guidelines (GWTG) stroke database, that 168,000 stroke patients (33.5%) admitted to hospital were over the age of 80 years [13]
The presence of confounding comorbidities, pre-existing physical and cognitive functioning play a major role on predicting outcome from acute stroke
Summary
The world’s population is ageing, in Western Europe and North America. By 2050 it is predicted that 35% of the European population will be over 65 years of age, albeit with an overall population decrease to 705 million from the present 728 [1,2]. The subset of the population that is increasing most rapidly is those who are deemed old or those over 80 years of age Those who are severely frail have a six-fold increase in mortality [6,9].
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