Acute stroke in persons 85 years or older - clinical characteristics, impact of frailty and predictors of outcome

Johan Sanner^1,2*Bente Thommessen³Mia von Euler⁴Jakob O. Ström^1,5Brynjar Fure^1,6

• ¹School of Medical Sciences, Örebro University, 702 81, Örebro, Sweden
• ²Department of Neurology and Rehabilitation, Centralsjukhuset i Karlstad, Karlstad, Sweden
• ³Akershus Universitetssykehus Nevroklinikken, Lørenskog, Norway
• ⁴Sophiahemmet University, Stockolm, Sweden
• ⁵Department of Neurology, Universitetssjukhuset Orebro, Örebro, Sweden
• ⁶Department of Internal Medicine, Centralsjukhuset i Karlstad, Karlstad, Sweden

Introduction: Stroke cases among older people will increase due to demographic changes, necessitating an optimalization of care strategies for this population. We aimed to examine clinical characteristics, prognostic factors and the impact of frailty in an older stroke cohort. Patients and methods: We consecutively included 120 patients aged ≥85 years with acute ischemic or hemorrhagic stroke at a regional hospital in Sweden. Baseline characteristics, etiological subclassification, National Institutes of Health Stroke Scale (NIHSS) on admission, pre-and post-stroke functional level and frailty, measured by modified Rankin Scale (mRS), Barthel ADL Index (BI) and Clinical Frailty Scale (CFS) were recorded. Regression analyses were conducted to evaluate predictors of death or poor functional outcome, defined as mRS ≥4, at three months. Results: Mean age was 89.1 years and 57.5% were women. Ischemic strokes accounted for 90.8% and atrial fibrillation was diagnosed in 55.8%. Overall, 26,6% received reperfusion therapy. At three months, the mortality and poor functional outcome were 35.8 % and 54.2% respectively. Multivariate regression analysis identified age ≥89 years, BI ≤70, CFS ≥7 prior to stroke, total anterior circulation infarction, NIHSS ≥15 on admission and post-stroke dysphagia as independent predictors of death or poor outcome. Discussion and conclusion: We found a high prevalence of cardioembolic disease in older people with stroke, emphasising the importance of diagnosing atrial fibrillation and optimizing anticoagulant treatment. In addition to well-known predictors, severe frailty prior to stroke and post-stroke dysphagia predicted poor outcome. In the growing older stroke population, assessment of frailty may be beneficial in decision-making regarding interventions and direction of care.