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The Poor Outcome of Ischemic Stroke in Very Old People: A Cohort Study of Its Determinants

Authors

  • Licia Denti MD, PhD,

    1. From the *Geriatric and Rehabilitation Department, Neuroscience Department, Third Internal Medicine Department, and §Epidemiology Section, University Hospital of Parma, Parma, Italy.
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  • Umberto Scoditti MD,

    1. From the *Geriatric and Rehabilitation Department, Neuroscience Department, Third Internal Medicine Department, and §Epidemiology Section, University Hospital of Parma, Parma, Italy.
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  • Claudio Tonelli MD,

    1. From the *Geriatric and Rehabilitation Department, Neuroscience Department, Third Internal Medicine Department, and §Epidemiology Section, University Hospital of Parma, Parma, Italy.
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  • Marsilio Saccavini MD,

    1. From the *Geriatric and Rehabilitation Department, Neuroscience Department, Third Internal Medicine Department, and §Epidemiology Section, University Hospital of Parma, Parma, Italy.
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  • Caterina Caminiti PhD,

    1. From the *Geriatric and Rehabilitation Department, Neuroscience Department, Third Internal Medicine Department, and §Epidemiology Section, University Hospital of Parma, Parma, Italy.
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  • Rita Valcavi MD,

    1. From the *Geriatric and Rehabilitation Department, Neuroscience Department, Third Internal Medicine Department, and §Epidemiology Section, University Hospital of Parma, Parma, Italy.
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  • Mario Benatti MD,

    1. From the *Geriatric and Rehabilitation Department, Neuroscience Department, Third Internal Medicine Department, and §Epidemiology Section, University Hospital of Parma, Parma, Italy.
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  • Gian Paolo Ceda MD

    1. From the *Geriatric and Rehabilitation Department, Neuroscience Department, Third Internal Medicine Department, and §Epidemiology Section, University Hospital of Parma, Parma, Italy.
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Address correspondence to Licia Denti, Clinica Geriatrica—Azienda Ospedaliero-Universitaria, Via Gramsci 14, 43100 Parma, Italy. E-mail: ldenti@ao.pr.it

Abstract

OBJECTIVES: To assess how much of the excess risk of poor outcome from stroke in people aged 80 and older aging per se explains, independent of other prognostic determinants.

DESIGN: Cohort, observational.

SETTING: University hospital.

PARTICIPANTS: One thousand five hundred fifty-five patients with first-ever ischemic stroke consecutively referred to an in-hospital Clinical Pathway program were studied.

MEASUREMENTS: The relationship between age and 1-month outcome (death, disability (modified Rankin Scale 3–5), and poor outcome (modified Rankin Scale 3–6)) was assessed, with adjustment for several prognostic factors.

RESULTS: Six hundred twelve patients aged 80 and older showed worse outcome after 1 month than those who were younger, in terms of mortality (19% vs 5%, hazard ratio (HR)=3.85, 95% confidence interval (CI)=2.8–5.4) and disability (51% vs 33%, odds ratio (OR)=3.16, 95% CI=2.5–4.0), although in multivariate models, the adjusted HR for mortality decreased to 1.47 (95% CI=1.0–2.16) and the ORs for disability and poor outcome decreased to 1.76 (95% CI=1.32–2.3.) and 1.83 (95% CI=137–2.43), respectively. Stroke severity, the occurrence of at least one medical complication, and premorbid disability explained most of the risk excess in the oldest-old.

CONCLUSION: Stroke outcome is definitely worse in very old people, and most of the excess risk of death and disability is attributable to the higher occurrences of the most-severe clinical stroke syndromes and of medical complications in the acute phase. These represent potential targets for preventive and therapeutical strategies specifically for elderly people.

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