Geriatrics

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220 KiB

Open AccessFeature PaperArticle

Management of Acute Stroke in the Older Person

by Emma Parr, Phillip Ferdinand and Christine Roffe

Geriatrics 2017, 2(3), 27; https://doi.org/10.3390/geriatrics2030027 - 15 Aug 2017

Cited by 25 | Viewed by 11615

Abstract

The majority of people who suffer a stroke are older adults. The last two decades have brought major progress in the diagnosis and management of stroke, which has led to significant reductions in mortality, long-term disability, and the need for institutional care. However, [...] Read more.

The majority of people who suffer a stroke are older adults. The last two decades have brought major progress in the diagnosis and management of stroke, which has led to significant reductions in mortality, long-term disability, and the need for institutional care. However, acute, interventional and preventative treatments have mostly been trialled in younger age groups. In this article we will provide an overview of the evidence for acute stroke treatments in relation to age, discuss special considerations in the older person, and contemplate patient choice, quality of life, and end-of-life-decisions. Full article

(This article belongs to the Special Issue Stroke in Ageing)

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226 KiB

Open AccessFeature PaperArticle

Determinants of Length of Stay Following Total Anterior Circulatory Stroke

by James P. Curtain, Man Yu, Allan B. Clark, Nicholas D. Gollop, Joao H. Bettencourt-Silva, Anthony Kneale Metcalf, Kristian M. Bowles, Marcus D. Flather, John F. Potter and Phyo Kyaw Myint

Geriatrics 2017, 2(3), 26; https://doi.org/10.3390/geriatrics2030026 - 4 Aug 2017

Cited by 4 | Viewed by 5857

Abstract

Identification of factors that determine length of stay (LOS) in total anterior circulatory stroke (TACS) has potential for targeted intervention to reduce the associated health care burden. This study aimed to determine which factors predict LOS following either ischaemic or haemorrhagic TACS. The [...] Read more.

Identification of factors that determine length of stay (LOS) in total anterior circulatory stroke (TACS) has potential for targeted intervention to reduce the associated health care burden. This study aimed to determine which factors predict LOS following either ischaemic or haemorrhagic TACS. The study sample population was drawn from the Norfolk and Norwich Stroke and Transient Ischemic Attack (TIA) Register (1996–2012), a prospective registry. 2965 patients admitted with TACS verified by a stroke specialist team were included. Primary analysis identified predictors of length of stay (LOS) in either haemorrhagic or ischaemic TACS. Secondary analyses identified predictors of LOS in patients who were discharged alive or who died during admission separately. Moderate (p = 0.014) to severe disability (p = 0.015) and history of congestive heart failure (p = 0.027) in the primary analysis and pre-stroke residence in a care facility among patients who survived to discharge (p = 0.013) were associated with a shorter length of stay. Factors associated with increased length of stay included presence of neurological lateralisation in the primary analysis (p = 0.004) and amongst patients who died (p = 0.003 and p = 0.014 for ischaemic and haemorrhagic stroke, respectively). Patients with advanced age (≥85 years) with haemorrhagic stroke had longer LOS regardless of mortality outcome. Patients with low pre-morbid disability (modified Rankin score ≤2 who died following haemorrhagic TACS also had longer LOS. Our study found predictors of LOS following TACS include neurological lateralisation, pre-stroke disability status, congestive heart failure, pre-morbid residence and age. The identification of such factors would assist in resource allocation and discharge planning. Full article

(This article belongs to the Special Issue Stroke in Ageing)

198 KiB

Open AccessFeature PaperCommunication

Risk Prediction Models for Post-Stroke Dementia

by Eugene Yee Hing Tang, Louise Robinson and Blossom Christa Maree Stephan

Geriatrics 2017, 2(3), 19; https://doi.org/10.3390/geriatrics2030019 - 22 Jun 2017

Cited by 11 | Viewed by 6096

Abstract

A strong association exists between stroke and dementia with both diseases linked to ageing. Survival rates from stroke are improving which would equate to an ever-expanding population of patients at risk of future dementia. Early or timelier identification of dementia has become a [...] Read more.

A strong association exists between stroke and dementia with both diseases linked to ageing. Survival rates from stroke are improving which would equate to an ever-expanding population of patients at risk of future dementia. Early or timelier identification of dementia has become a priority in many countries, including the UK. Although screening for dementia is not advocated, targeting at risk populations could be used to reduce an individual’s risk via intervention (i.e., personalised medicine), where available. One approach to improving identification of high-risk dementia individuals is using risk prediction models. Such models could be applied to stroke survivors. Dementia risk prediction models specific to stroke survivors have recently been developed and will be discussed here. Full article

(This article belongs to the Special Issue Stroke in Ageing)

216 KiB

Open AccessArticle

Racial Differences in Patient-Reported Post-Stroke Disability in Older Adults

by Charles Ellis, Gayenell Magwood and Brandi M. White

Geriatrics 2017, 2(2), 16; https://doi.org/10.3390/geriatrics2020016 - 23 May 2017

Cited by 6 | Viewed by 5984

Abstract

Longstanding disparities have been reported in stroke-related outcomes with blacks experiencing more post-stroke disabilities. Little is known about long-term disability outcomes among older stroke survivors. This study was a retrospective analysis of data from the 2015 National Health Interview Survey (NHIS). A group [...] Read more.

Longstanding disparities have been reported in stroke-related outcomes with blacks experiencing more post-stroke disabilities. Little is known about long-term disability outcomes among older stroke survivors. This study was a retrospective analysis of data from the 2015 National Health Interview Survey (NHIS). A group of 655 stroke survivors (541 white and 114 black) age 65 and older were asked to rate their ability to complete 10 functional tasks without special equipment. Univariate comparisons were completed using t-tests and chi-square statistics for racial comparisons of disability reports. Multinomial logistic regression was used to determine odds of reporting disability after controlling for relevant covariates. The mean age of the sample was 76.6 years. After controlling for relevant covariates, white stroke survivors were less likely to report the following tasks being “very difficult/can’t do at all” without using special equipment compared to blacks: reach overhead (OR = 0.39, 95% CI 0.23–0.65; p = 0.000) and grasp small objects (OR = 0.42, 95% CI 0.25–0.73; p = 0.002). Both black and white older stroke survivors experience significant post-stroke disability across a range of functional tasks. Slightly greater long term post-stroke disability appears to exist among older blacks. Full article

(This article belongs to the Special Issue Stroke in Ageing)

Review

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1743 KiB

Open AccessReview

Brain Atrophy Estimated from Structural Magnetic Resonance Imaging as a Marker of Large-Scale Network-Based Neurodegeneration in Aging and Stroke

by Michele Veldsman

Geriatrics 2017, 2(4), 34; https://doi.org/10.3390/geriatrics2040034 - 10 Nov 2017

Cited by 6 | Viewed by 5420

Abstract

Brain atrophy is a normal part of healthy aging, and stroke appears to have neurodegenerative effects, accelerating this atrophy to pathological levels. The distributed pattern of atrophy in healthy aging suggests that large-scale brain networks may be involved. At the same time, the [...] Read more.

Brain atrophy is a normal part of healthy aging, and stroke appears to have neurodegenerative effects, accelerating this atrophy to pathological levels. The distributed pattern of atrophy in healthy aging suggests that large-scale brain networks may be involved. At the same time, the network wide effects of stroke are beginning to be appreciated. There is now widespread use of network methods to understand the brain in terms of coordinated brain activity or white matter connectivity. Examining brain morphology on a network level presents a powerful method of understanding brain structure and has been successfully applied to charting the course of brain development. This review will introduce recent advances in structural magnetic resonance imaging (MRI) acquisition and analyses that have allowed for reliable and reproducible estimates of atrophy in large-scale brain networks in aging and after stroke. These methods are currently underutilized despite their ease of acquisition and potential to clarify the progression of brain atrophy as a normal part of healthy aging and in the context of stroke. Understanding brain atrophy at the network level may be key to clarifying healthy aging processes and the pathway to neurodegeneration after stroke. Full article

(This article belongs to the Special Issue Stroke in Ageing)

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327 KiB

Open AccessFeature PaperReview

iPad Use in Stroke Neuro-Rehabilitation

by Khalid Ameer and Khalid Ali

Geriatrics 2017, 2(1), 2; https://doi.org/10.3390/geriatrics2010002 - 6 Jan 2017

Cited by 20 | Viewed by 12220

Abstract

Neuro-rehabilitation services are essential in reducing post-stroke impairments, enhancing independence, and improving recovery in hospital and post-discharge. However these services are therapist-dependent and resource intensive. Patients’ disengagement and boredom in stroke units are common which adversely affect functional and psychological outcomes. Novel techniques [...] Read more.

Neuro-rehabilitation services are essential in reducing post-stroke impairments, enhancing independence, and improving recovery in hospital and post-discharge. However these services are therapist-dependent and resource intensive. Patients’ disengagement and boredom in stroke units are common which adversely affect functional and psychological outcomes. Novel techniques such as use of iPads™ are increasingly researched to overcome such challenges. The aim of this review is to determine the feasibility, effectiveness, acceptability, and barriers to the use of iPads™ in stroke neuro-rehabilitation. Four databases and manual literature search were used to identify published studies using the terms “iPad”, “Stroke”, and “neuro-rehabilitation”. Studies were included in accordance with the review selection criteria. A total of 16 articles were included in the review. The majority of the studies focused on iPads use in speech and language therapy. Although of small scale, the studies highlighted that iPads are feasible, have the potential to improve rehabilitation outcomes, and can improve patient’s social isolation. Patients’ stroke severity and financial limitations are some of the barriers highlighted in this review. This review presents preliminary data supportive for the use of iPad technology in stroke neuro-rehabilitation. However, further research is needed to determine impact on rehabilitation goals acquisition, clinical efficacy, and cost-efficiency. Full article

(This article belongs to the Special Issue Stroke in Ageing)

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309 KiB

Open AccessReview

Stroke and Falls—Clash of the Two Titans in Geriatrics

by Kit Mun Tan and Maw Pin Tan

Geriatrics 2016, 1(4), 31; https://doi.org/10.3390/geriatrics1040031 - 30 Nov 2016

Cited by 34 | Viewed by 10195

Abstract

Both stroke and falls are common conditions affecting the older adult. Despite stroke being considered a well-established major risk factor for falls, there remains no evidence for effective prevention strategies for falls specifically for stroke survivors. Previous observational studies evaluating falls risk factors [...] Read more.

Both stroke and falls are common conditions affecting the older adult. Despite stroke being considered a well-established major risk factor for falls, there remains no evidence for effective prevention strategies for falls specifically for stroke survivors. Previous observational studies evaluating falls risk factors in stroke have mainly been uncontrolled and found similar risk factors for stroke populations compared to general older populations. Specific risk factors, however, are likely to play a greater role in stroke survivors including unilateral weakness, hemisensory or visual neglect, impaired coordination, visual field defects, perceptual difficulties and cognitive issues. In addition, individuals with stroke are also more likely to have other associated risk factors for falls including diabetes, falls risk increasing drugs, atrial fibrillation, and other cardiovascular risk factors. While anticoagulation is associated with increased risk of intracranial bleeding after a fall, the risk of suffering a further stroke due to atrial fibrillation outweigh the risk of bleeding from a recurrent fall. Similarly, while blood pressure lowering medications may be linked to orthostatic hypotension which in turn increases the risk of falls, the benefit of good blood pressure control in terms of secondary stroke prevention outweighs the risk of falls. Until better evidence is available, the suggested management approach should then be based on local resources, and published evidence for fall prevention. Multicomponent exercise and individually tailored multifactorial interventions should still be considered as published evidence evaluating the above have included stroke patients in their study population. Full article

(This article belongs to the Special Issue Stroke in Ageing)

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Other

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957 KiB

Open AccessFeature PaperCommentary

Stroke in Frail Older People

by David G. Smithard

Geriatrics 2017, 2(3), 24; https://doi.org/10.3390/geriatrics2030024 - 15 Jul 2017

Cited by 18 | Viewed by 9814

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 [...] Read more.

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. Full article

(This article belongs to the Special Issue Stroke in Ageing)

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237 KiB

Open AccessFeature PaperPerspective

Stroke in Older Survivors of Ischemic Stroke: Standard Care or Something Different?

by Isobel J. Hubbard, Suzanne Wass and Elizabeth Pepper

Geriatrics 2017, 2(2), 18; https://doi.org/10.3390/geriatrics2020018 - 19 Jun 2017

Cited by 8 | Viewed by 7446

Abstract

Stroke is one of the leading causes of death and disability and it is more likely to occur in those who are older. Because people are living longer, the definition of “old” continues to evolve. Age alone should not influence the healthcare that [...] Read more.

Stroke is one of the leading causes of death and disability and it is more likely to occur in those who are older. Because people are living longer, the definition of “old” continues to evolve. Age alone should not influence the healthcare that a patient receives, however, evidence indicates that this does occur, especially in older patients. On the basis of the available evidence, it is time to reconsider whether or not stroke care should differ in older survivors of stroke and if so, why. This is a narrative review of stroke-related health care in those with a recent ischemic stroke. It seeks to answer the following question: Should patients aged ≥80 years who have experienced a recent ischemic stroke receive standard care or something different, and if they should receive something different, what should they receive and why? The review focusses on long-term survival, hyper-acute care, secondary prevention, and rehabilitation. The authors propose a number of recommendations in relation to stroke care in older survivors of a recent ischemic stroke. Full article

(This article belongs to the Special Issue Stroke in Ageing)

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