Stroke: A Silent Killer Among The Elderly

Strokes are a leading cause of death and disability, particularly among females. They occur when the blood supply to the brain is reduced or blocked, causing neurons to die due to a lack of oxygen-rich blood. The brain may lose its ability to perform vital functions, and the severity of the stroke depends on the region of the brain affected, the duration of interrupted blood flow, and the timing of medical treatment. While not all strokes are fatal, they can cause serious disabilities and increase the risk of a second stroke. The chances of survival and recovery are influenced by age, overall health, and the type and severity of the stroke.

The risk of stroke increases with age

Age is the most significant risk factor for strokes, with the risk doubling every decade after the age of 45. Over 70% of all strokes occur over the age of 65, and the risk is higher for women than men. The risk factors for stroke are not equivalent across all age groups. The relative risks of stroke conferred by body mass index, high-density lipoprotein cholesterol, systolic blood pressure, blood glucose, or cigarette smoking decline with increasing age. However, risk factors often cluster among older adults, significantly increasing the occurrence of strokes.

The prevalence of certain stroke risk factors, including diabetes, hypertension, atrial fibrillation, and coronary and peripheral artery disease, steadily increases with age. As the number of people aged 65 and over is projected to grow, the number of strokes in older adults is expected to rise, presenting major challenges for clinicians and policymakers in the foreseeable future.

The effects of a stroke on functional recovery and mortality are mediated by the patient's age, the location of the brain affected, the severity of the damage to the brain tissue, and the presence of other comorbid conditions. Stroke survivors may accrue additional comorbidities during their lifetime, and these comorbidities, single or combined, potentially interact with conventional cardiovascular risk factors to modify the risk of stroke. Comorbidities significantly influence subsequent hospital readmission, functional recovery, and mortality.

Stroke is a leading cause of death and disability, particularly for females. Stroke is the fifth leading cause of death in the United States, and it is the most common life-threatening and disabling neurologic disease to affect elders in the country.

Strokes are a leading cause of death

A stroke occurs when the blood supply to the brain is reduced or blocked, causing neurons to die due to a lack of oxygen-rich blood. The longer the interruption in blood flow, the greater the damage, and the higher the risk of severe brain damage or death. The brainstem, which controls vital functions like breathing and heartbeat, is especially vulnerable. A stroke in this region is more likely to be fatal.

The severity and impact of a stroke depend on several factors, including the region of the brain affected, the duration of the blood flow interruption, and how quickly medical treatment is received. Early medical intervention, ideally within three hours of the first symptom, can significantly improve the chances of survival and reduce the risk of complications.

Certain types of strokes, such as hemorrhagic strokes, carry a higher risk of fatality. Hemorrhagic strokes are caused by bleeding or rupturing of blood vessels in the brain, which puts pressure on and leads to the death of brain cells. Ischemic strokes, the most common type, are caused by a blockage in an artery supplying blood to the brain and can also have serious consequences if not treated promptly.

Age is also a significant factor in stroke recovery and long-term survival. Older individuals, especially those with pre-existing conditions like diabetes or high cholesterol, are at a greater disadvantage when it comes to post-stroke life expectancy. The average reduction in lifespan after a stroke is nine and a half years, but this can vary depending on the individual's age, overall health, and the severity of the stroke.

Strokes are a medical emergency, and recognising the signs and symptoms is crucial. The FAST method can help identify a stroke:

• Face: Drooping eyelid or corner of the mouth
• Arm: Weakness or numbness in one arm
• Speech: Slurred speech or reduced comprehension
• Time: Immediate medical care is necessary if any of these signs are present

The affected region of the brain impacts survival chances

A stroke is a life-threatening medical condition that occurs when the brain does not receive enough blood flow, resulting in brain cells dying due to a lack of oxygen. The affected region of the brain plays a crucial role in determining the chances of survival after a stroke. Here are some key ways in which the location of the stroke impacts the likelihood of recovery:

Brain Stem Strokes

Strokes affecting the brain stem are often life-threatening due to the vital functions controlled by this region. The brain stem is responsible for basic body functions such as breathing, sweating, and consciousness. As a result, a stroke in this area can lead to severe consequences such as coma, difficulty breathing, and swallowing issues. Brain stem strokes can affect both sides of the body and, in the most severe cases, can result in a 'locked-in' state, where the patient is conscious but unable to move or speak due to muscle paralysis.

Left Hemisphere vs. Right Hemisphere Strokes

The effects of a stroke also depend on whether it occurs in the left or right hemisphere of the brain. A stroke on the left side of the brain typically affects the right side of the body, leading to paralysis, sensory changes, speech and language problems, and a slow, cautious behavioural style. On the other hand, a stroke on the right side of the brain affects the left side of the body and can result in paralysis, sensory changes, spatial thinking difficulties, and a quick, inquisitive behavioural style.

Cortical vs. Subcortical Strokes

Cortical strokes occur in the cerebral cortex, which includes the frontal, parietal, occipital, and temporal lobes. These strokes often impact higher-level functions, resulting in effects like aphasia or unilateral neglect. Subcortical strokes, on the other hand, occur in subcortical structures located deep within the brain, such as the thalamus, hypothalamus, and basal ganglia. Subcortical strokes are generally associated with motor symptoms, such as hemiparesis, and can also lead to emotional and cognitive changes.

Parietal Lobe Stroke

The parietal lobe plays a crucial role in sensory interpretation, language skills, and spatial awareness. A stroke in this area can lead to hemineglect, poor body awareness, difficulty writing (agraphia), reading (alexia), and speaking (aphasia).

Occipital Lobe Stroke

The occipital lobe is primarily responsible for vision. Therefore, a stroke in this area often results in vision difficulties, including central vision loss, cortical blindness, and visual hallucinations.

Frontal Lobe Stroke

The frontal lobe is involved in various functions, including motor skills, executive functioning, speech, language, and social skills. A stroke in this region can lead to motor impairments, problem-solving and judgment issues, behavioural changes, and speech difficulties such as aphasia, dysarthria, or apraxia of speech.

The impact of a stroke on an individual's survival chances depends on the specific area of the brain affected and the functions controlled by that region. While some areas are associated with higher mortality rates, early medical intervention can significantly improve the chances of survival and reduce the severity of long-term complications.

Prompt medical treatment is crucial

Stroke is a medical emergency and the faster you receive treatment, the better. Prompt medical treatment is crucial to surviving a stroke and preventing lasting brain damage, long-term disability, or death. Here's why:

Brain Damage and Disability

A stroke occurs when the blood supply to the brain is reduced or blocked, causing neurons to die due to a lack of oxygen-rich blood. The longer the interruption in blood flow goes untreated, the greater the damage to the brain and the higher the risk of severe brain damage. This can lead to lasting brain damage and long-term disabilities such as:

• Cognitive symptoms like memory problems and trouble speaking.
• Physical symptoms such as weakness, paralysis, and difficulty swallowing.
• Emotional symptoms like depression and impulsivity.

Increased Risk of Death

Without prompt medical treatment, the chances of surviving a stroke are significantly reduced. Stroke is a leading cause of death, particularly in females, and the risk of fatality increases with the size of the affected area in the brain. A stroke in the brainstem, for example, is more likely to be fatal. The longer a stroke goes untreated, the greater the chance of severe brain damage and death.

Complications and Recovery

Early medical care can also help prevent complications associated with surviving a stroke, such as weakness on one side of the body, changes in behavior and personality, and depression. Receiving treatment within 3 hours of the first symptom is crucial for improving the chances of recovery and preventing these complications. The sooner treatment begins, the better the chances of recovery and reducing long-term impacts.

Treatment Options

Prompt medical attention allows for a faster diagnosis and more effective treatment options. Treatment for a stroke depends on the type of stroke, the affected area of the brain, and the patient's medical history. For ischemic strokes caused by blood clots, clot-busting medication can be administered to reduce long-term effects, but this must be done within a certain timeframe. Thrombectomies and surgeries may also be required to remove clots or repair blood vessels. For hemorrhagic strokes, caused by bleeding in the brain, treatments focus on stopping the bleeding and saving brain tissue.

Stroke recovery can be challenging

The impact of a stroke on an individual's functional recovery and mortality varies depending on several factors, including age, the location of the brain affected, the severity of the damage to the brain tissue, and the presence of other health conditions. Older individuals, particularly those with pre-existing conditions like diabetes, high cholesterol, or malnutrition, face a more challenging recovery process and are less likely to regain pre-stroke capabilities.

The road to recovery often involves intense physical therapy to improve balance and control over one's body. Occupational therapy is also crucial, as it helps individuals regain the ability to perform everyday tasks such as cooking, bathing, dressing, and eating. Speech therapy is often necessary, as strokes can result in speech and cognitive difficulties.

The emotional toll of a stroke cannot be understated, and many survivors struggle with depression, anxiety, and other mental health issues. Access to therapy or support groups is essential to help individuals come to terms with their prognosis and adjust to a new way of life.

Additionally, the risk of a second stroke is much higher after an initial stroke, and the medical team works diligently to reduce this risk by addressing factors such as blood clotting, high blood pressure, and heart problems.

While stroke recovery is challenging, with good treatment and care, individuals can make the best possible recovery. The support of loved ones and caregivers is also crucial in navigating the difficulties that arise during the recovery journey.

Frequently asked questions