Clinical profile and outcomes of acute ischemic stroke in older persons: A prospective age-group comparative study
DOI:
https://doi.org/10.54029/2026uicKeywords:
acute ischemic stroke, older persons, thrombolysis, conservative treatment, functional outcomesAbstract
Background & Objective: With a global population aging, understanding stroke characteristics in older persons becomes increasingly critical for optimising care strategies. This study investigated clinical profiles, risk factors, and treatment outcomes in older persons with acute ischemic stroke across different age groups.
Methods: This prospective observational study enrolled 310 patients aged ≥60 years with acute ischemic stroke over 12 months. Patients were categorized into younger older persons (60-80 years, n=212) and older-old persons (>80 years, n=98) groups. Clinical characteristics, risk factors, stroke severity using NIHSS, treatment modalities, and functional outcomes using modified Rankin Scale were analyzed.
Results: Older-old persons (>80 years) presented with more severe strokes (mean NIHSS 18.7±6.1 vs. 12.4±5.2, p<0.001) and higher rates of watershed infarcts (14.3% vs. 0.5%). Conservative management was used in 74.2% of patients, more frequently in the older-old persons (81.6% vs. 70.8%, p=0.042). Good functional outcomes (mRS 0-2) at 3 months were achieved in 66.5% overall but less in older-old patients (58.2% vs. 70.3%, p=0.042). IV thrombolysis showed the highest good recovery rate (77.2%) and lowest mortality (8.8%). Independent predictors of good outcome were younger age (OR 0.92), lower baseline NIHSS (OR 0.84), and early presentation ≤3 hours (OR 2.28), while atrial fibrillation was a negative predictor (OR 0.58). The older-old patients more likely to have AF (57.1% vs 29.2%, p<0.001). Mortality was significantly higher in older-old persons (>80 years) compared to younger older persons (26.5% vs 14.2%; OR 2.19, p=0.012).
Conclusion: Both conservative management and interventional therapies demonstrate effectiveness in older-old persons with stroke when appropriately selected. Age-based treatment restrictions appear unjustified, supporting individualized clinical decision-making over chronological age considerations.
