Stroke medicine for the geriatrician

Abstract

The overall burden of stroke is well known. It is the third commonest cause of death in developed societies, and the commonest cause of severe acquired physical disability in old age. The incidence of stroke is approximately 1–2 per 1000 population per year in the United Kingdom, that approximates to a ‘stroke a day’ in most typical district general hospitals. As such, it is something all who take part in emergency medicine should know a great deal about, even more so for geriatricians as stroke becomes increasingly common with old age. Recent work from Oxford, England has demonstrated that although the age-specific incidence of stroke has fallen by 30% in the last 20 years, the overall incidence of stroke in the population has remained constant due to the increasing proportion of the population in the stroke-prone age. This suggests that the types of patient who have stroke will differ in time, as the population ages, and stroke will be seen more frequently in frailer older people. This could have profound influence for the organization and management of patients, as treatments that appear beneficial for a younger, more robust patient may have a different balance of risk and benefit in the frailer older person. Geriatricians must continue to contribute their patients to stroke research (or collaborate very closely with their neurological colleagues) if we are to keep an appropriate evidence base for the older patient with stroke.