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Stroke as a medical emergency in older people

Published online by Cambridge University Press:  18 October 2010

Davinia Ryan  and
Joseph Harbison
Davinia Ryan
Affiliation:
Acute Stroke Service & Mercers Institute for Successful Ageing, St James's Hospital, Dublin, Ireland
Joseph Harbison*
Affiliation:
Acute Stroke Service & Mercers Institute for Successful Ageing, St James's Hospital, Dublin, Ireland
*
Address for correspondence: Dr Joseph Harbison, Acute Stroke Service & Mercers Institute for Successful Ageing, St James's Hospital, Dublin 8, Ireland. Email: [email protected]
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Summary

In the last 20 years a realization has developed that acute stroke is a condition that benefits from early intensive investigation and treatment. Older people are historically less likely to receive such active management through a combination of limited evidence due to their exclusion from clinical trials and a level of ‘therapeutic nihilism’ regarding older subjects with severe, acute illness.

There is increasing evidence that many acute therapies, including thrombolysis, benefit older stroke patients. Older subjects may not achieve as good results as younger groups but differential benefits are often comparable when expected outcomes are considered. Risk of haemorrhagic complications with thrombolysis is not substantially increased and older subjects are now receiving this therapy despite a dearth of relevant trial data.

Intensive physiological monitoring and stroke unit care has been found to be of benefit to patients of all ages. Surgical options for intracerebral haemorrhage are limited, but there is little difference in the management of intracranial haemorrhage in older people. There is unlikely to be a benefit to surgical hemicraniectomy for cerebral infarction in those >60 years. In conclusion, active management for acute stroke in older people is frequently beneficial and age should not be a barrier to such care.

Keywords

cerebrovascular disordersacute treatmentstroke unitagedthrombolysis
Type
Clinical geriatrics
Information
Reviews in Clinical Gerontology , Volume 21 , Issue 1 , February 2011 , pp. 45 - 54
Copyright
Copyright © Cambridge University Press 2010

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