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Rehabilitation Of The Older A... Health Article

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Abstract

Stroke is an increasing public health concern throughout the world as the leading cause of long-term disability. It is well known that there exist differences related to epidemiology, pathophysiology, comorbidity, and functional outcome of stroke patients with advanced age compared with the young. Factors that have been suggested to influence this disparity include age-related complications, availability of resources, lack of aggressive management, and possible diminished capacity for neuroplasticity. This article reviews the current medical and rehabilitative aspects of stroke and the possible disparities related to advanced age.

Stroke is an increasing public health concern throughout the world as the leading cause of long-term disability. There is estimated to be over 3.5 million survivors of stroke in the United States. It is responsible for 10% to 12% of all deaths in industrialized countries. Almost 90% of these deaths are among people aged over 65 years. It is well known that there exist differences related to epidemiology, pathophysiology, comorbidity, and functional outcome of patients with advanced age compared with the young. Factors that have been suggested to influence this disparity include age-related complications, availability of resources, lack of aggressive management, and possible diminished capacity for neuroplasticity. Despite these differences across age groups, there is compelling evidence that good outcomes can be achieved after comprehensive stroke rehabilitation [1–4]. The number of individuals aged >65 years is projected to increase from 39 million in 1995 to 69 million, or 20% of the total population, in 2030. The fastest growing age group will be the population aged >85 years, doubling its 1995 size by 2025 and increasing fivefold by 2050. This article reviews the current medical and rehabilitative aspects of stroke and the possible disparities related to advanced age.

Stroke Subtypes

Cerebrovascular disease is divided into ischemic or hemorrhagic lesions. Ischemic lesions comprise 80% of strokes and are caused by thrombotic (60%) or embolic (20%) mechanisms. Hemorrhagic strokes have an incidence of approximately 15% and are divided into intracerebral (10%) or subarachnoid (5%). Other causes (5%) of stroke include tumor, aneurysm, and arteriovenous malformation. The incidence of each stroke subtype and its etiology vary with age. Overall, cerebral infarction accounts for most strokes across all age groups. There is an increased incidence of hemorrhagic stroke with younger age when compared with the elderly primarily because of the differences in risk factors. Strokes are classified further by the brain's anatomic blood supply and related neurologic structures. They can be divided generally into anterior, middle, and posterior cerebral artery distributions (Table 1 ).