Last Updated: 2008-08-12 13:17:50 -0400 (Reuters Health)

NEW YORK (Reuters Health) – Among stroke patients, case fatality rates are higher and the likelihood of being discharged home is lower for those over age 80 than for their younger counterparts, according to a study in the August issue of Stroke.

"Stroke incidence rates increase steeply with age," Dr. Gustavo Saposnik, of the University of Toronto, Ontario, Canada, and colleagues write. "Therefore, we would also expect a rise in the number of elderly patients with stroke in the future," they note. "Unfortunately, limited information is available on stroke care in patients over age 80."

In a multicenter cohort study, the researchers examined differences in clinical outcomes in Canadians over 80 years of age versus younger age who were hospitalized for an acute ischemic stroke over a 1-year period.

A total of 26,676 ischemic stroke patients admitted to 606 hospitals across Canada were included in the study. The subjects had a mean age of 74 years, and 10,171 of them (38%) were 80 years of age or older.

The investigators report that stroke fatality at discharge was 5.7% among subjects younger than 59 years of age, 8.6% among those between the ages of 60 and 69 years, 13.4% among those 70 to 79 years old, and 24.2% among those 80 years of age and older (p < 0.001).

Patients older than 80 years had a longer length of hospital stay than younger patients (10 days versus 7 days, respectively; p < 0.0001), and were less likely to be admitted to the intensive care unit (7.7% versus 15.3%, respectively; p < 0.001).

Overall, 47.2% of subjects over 80 years of age and 61.6% of those younger than 80 years were discharged to their pre-stroke residence (p < 0.001).

In multivariate analysis focusing on patients older than 80 years, factors associated with higher 7-day stroke fatality included intensive care unit admission, low socioeconomic status, and admission to a non-academic institution. Similar results were observed for stroke fatality at discharge.

"Our study should encourage further research to identify potentially remediable factors related to delivery of care to reduce morbidity and mortality in more elderly patients with stroke," Dr. Saposnik and colleagues conclude. "The recognition of this growing problem may help to implement strategies aimed at involving more elderly subjects in clinical trials and other research, facilitating access to specialized stroke care, and improving survival and quality of life in the elderly."

Stroke 2008;39:2310-2317.

Copyright Reuters 2008.