Strokes in people over 65
Effects of ageing
- Older people who have strokes usually have atheroma and atherosclerosis in other parts of the body, and are likely to have co-existing peripheral vascular disease, and ischaemic heart disease.
- Because older people often have a variety of health problems, older people with stroke are more likely to have COPD (chronic obstructive pulmonary disease), eyesight difficulties, osteo-arthritis and other conditions, which increases their general frailty and vulnerability.
General points
Stroke risk increases as a person gets older, and 2/3 of stroke victims are over 60 years of age. The same risk factors operate as for those of younger people, however the risk of atrial fibrillation (which causes one sort of stroke – embolic stroke) doubles with each additional decade of age.
An older person with stroke is more likely to have suffered previous stroke or transient ischaemic attack (TIA). Older people, as long as they are fit, benefit from procedures such as carotid endarterectomy, which is a preventative measure in people who have suffered TIA’s or strokes, and reduces the risk of further TIA/ stroke by around 75%.
In general, the presentation of a stroke will be the same in older people as for the younger population, but in some elderly people, the severity of the stroke may be hard to assess because of existing cognitive deficit, communication difficulties, or musculo-skeletal disorders.
Diffuse, small vessel disease is very common in older people, particularly over the age of 70. Because a series of small strokes occurs, there is a gradual and insidious deterioration, rather than a dramatic change, which occurs with other strokes, and it causes problems with gait, speech, or vascular dementia (multi- infarct).
Another preventative measure - warfarin (to prevent embolic stroke from atrial fibrillation), may not be possible in the elderly, if the person has a history of falls, or takes other medication which could interact.
Older people may therefore be at a disadvantage in these circumstances.
Though age should not prevent recovery from a stroke, full recovery and rehabilitation may not be possible, and the person’s needs may not be fully met, if the person is frail, has other disabling physical and mental conditions, social isolation, and transport difficulties.
