%0 Journal Article
%T Stroke in the Very Old: A Systematic Review of Studies on Incidence, Outcome, and Resource Use
%A Tommasina Russo
%A Giorgio Felzani
%A Carmine Marini
%J Journal of Aging Research
%D 2011
%I Hindawi Publishing Corporation
%R 10.4061/2011/108785
%X Background and Purpose. Stroke incidence increases with age and is likely to increase in the aging populations. We investigated incidence, outcome, and resource use in very old subjects with stroke. Methods. We performed a systematic review of available data through electronic search of the literature databases and manual search of reference lists. Data were extracted for the age groups of over 80, 80 to 84 years old, and over 85. Overall incidence rates, expressed as the number of first strokes per 1000 person-years, were estimated using Poisson regression analysis. Odds ratios for the comparisons between subjects over and under 80 were calculated with the Mantel-Haenszel method. Results. We found a high incidence of stroke in the very old. The estimated incidence rates were 20.78 (95% CI 19.69 to 21.87) in subjects over 80, 17.23 (95% CI 15.97 to 18.49) for those 80 to 85 years old, and 20.78 (95% CI 16.74 to 23.78) for those over 85. Subjects over 80 contributed 29.95% of strokes; rates were similar among genders. Thirty-day case fatality rate and occurrence of dependency were higher in subjects over 80, although associated with less frequent hospital and stroke unit admission and less diagnostic resource use. Conclusions. The contribution of very old subjects to the global burden of stroke is relevant and may require efficient dedicated stroke services. 1. Introduction In many Western countries, subjects in the oldest age classes, usually referred as the oldest old or very old, represent the fastest to growing segment of the population and make a huge contribution to health care costs [1]. Stroke is one of the leading causes of death and of severe disability in most countries, and its incidence increases steeply with age [2]. Thus, in the forthcoming years, stroke may represent a massive epidemic, causing many disabled patients and deaths in Western countries [2¨C5]. The availability of data on incidence, classification, and prognosis of stroke in the very old and information on resource use is important to plan health services and to focus treatment strategies. However, studies in the very old are sparse, small, and differing in methodology [4, 6¨C35]. We performed a systematic review of the available evidence on incidence, outcome, and resource use of very old people with stroke. 2. Materials and Methods In the present paper, data were identified by search of Medline and from the references of relevant articles published after 1980. Different subsets of studies were potentially eligible for different parts of this paper. The search terms ˇ°strokeˇ±,
%U http://www.hindawi.com/journals/jar/2011/108785/