Stroke in the very elderly: hospital care, case fatality and disposition.

BACKGROUND: The worldwide growing number of older people represents a new phenomenon. Considering that the prevalence of stroke increases with age and higher life expectancy, the prevalence of stroke will likely rise in the next decade. However, limited information is available about the burden of stroke in individuals over 90.

METHODS: This is a subgroup analysis from a multicenter cohort study including individuals admitted with an ischemic stroke to a broad range of hospitals across Canada. Patients were identified from the Canadian Hospital Morbidity database (HMDB), which is a national database that contains patient-level sociodemographic, diagnostic and administrative information. Multivariable analysis was performed using logistic regression. Outcomes measures include risk-adjusted stroke fatality, ICU admissions, medical complications, length of hospital stay and discharge disposition.

RESULTS: Among 26,676 patients with ischemic stroke admitted to 606 hospitals, 2,015 (7.6%) were aged 90 years or older. Risk-adjusted fatality at discharge was 6.3% (age <69), 12.5% (age 70-79), 22.0% (age 80-89) and 36.1% (age >or=90) (p < 0.001). Patients aged 90 and over were more likely admitted on weekends (28.1 vs. 24.6; p < 0.001), and less likely to be admitted to the ICU (4.3 vs. 13.0%, p < 0.001) and discharged to their pre-stroke residence (39.9% for those over 90 vs. 57.3% for patients younger than 90, p < 0.001). In the multivariable analysis, nonagenarians and older were 5-8 times more likely to die after adjusting for covariates.

CONCLUSION: In our study, stroke patients over 90 had higher risk-adjusted mortality, longer hospitalization, and were less likely to be discharged to their original place of residence. In view of these findings, strategies need to be implemented to facilitate equal access to specialized stroke care for the elderly.