Monitoring risk and preventing ischemic stroke in the very old

ABSTRACT

Introduction

Stroke is a significant cause of death, and the leading cause of severe long-term disability for individuals over 80 (the very old), yet few studies of such risk factors for ischemic stroke, or the known mitigation techniques, in this population, and the evidence base regarding risk modification strategies in this susceptible population can be inconsistent and incomplete. This article examines current guidelines and evidence regarding medical management, lifestyle changes, and psychosocial interactions that can contribute to the primary and secondary prevention of ischemic stroke in the very old.

Areas covered

The authors conducted a literature search for ischemic stroke prevention and risk assessment in the elderly via PubMed. Furthermore, they describe current strategies for monitoring risk and preventing ischemic stroke in the elderly population.

Expert opinion

Ischemic stroke poses a significant health risk to the elderly, with prevention relying on managing modifiable risk factors such as hypertension, atrial fibrillation, diabetes, and high cholesterol, as well as promoting healthy lifestyle choices like quitting smoking, regular physical activity and a heart-healthy diet. Healthcare providers must adopt a multifaceted approach, addressing individual and population-level factors while remaining vigilant in monitoring and managing risk factors to reduce the incidence and impact of stroke in older adults.

KEYWORDS:

• cerebral ischemia
• cerebrovascular disease
• geriatrics
• ischemic stroke
• mental health
• prevention
• risk factors
• the very old

Article highlights

• There is a gross lack of evidence-based treatments for strokes in the very old (>80) population, which is particularly concerning given the fact that the consequences of stroke in this population are often more fatal

• Comorbidities that can lead to an increased likelihood of stroke differ in the very old, and prevention strategies must be tailored toward the risk factors that exist in this population

• The multi-drug regimens that exist in a large proportion of the very old population potentially negate the morbidity and mortality benefits associated with the current therapeutic agents used in the medical management of stroke

• Benefits associated with aspirin treatment in early secondary prevention of stroke in the in-patient setting have no significant interaction with age, suggesting equal benefit for younger and older patients

• Carotid endarterectomy (CEA) with the best medical therapy provides greater rates of freedom for the very old with asymptomatic severe carotid stenosis from cerebral ischemic events compared to best medical therapy alone

• Lifestyle modifications such as increasing exercise, monitoring diet, and smoking cessation have been shown to be protective against ischemic stroke

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This manuscript was not funded.