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

## TL;DR

This study examines stroke in people aged 85 or older, finding that severe frailty and certain medical conditions predict poor outcomes.

## Contribution

The study identifies new predictors of poor outcomes in very elderly stroke patients, including pre-stroke frailty and post-stroke dysphagia.

## Key findings

- A high prevalence of cardioembolic disease was found in older stroke patients.
- Severe frailty prior to stroke and post-stroke dysphagia were identified as independent predictors of poor outcomes.
- Assessing frailty could improve decision-making for elderly stroke care.

## Abstract

Stroke cases among older people will increase due to demographic changes, necessitating an optimization of care strategies for this population. We aimed to examine clinical characteristics, prognostic factors, and the impact of frailty in an older stroke cohort.

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 the modified Rankin Scale (mRS), the Barthel ADL Index (BI), and the Clinical Frailty Scale (CFS), were recorded. Regression analyses were conducted to evaluate predictors of death or poor functional outcome, defined as an mRS of ≥4, at 3 months.

The 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 3 months, the mortality and poor functional outcomes were 35.8 and 54.2%, respectively. A 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.

We found a high prevalence of cardioembolic disease in older people with stroke, emphasizing 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.