Stroke Recovery: Older Adults' Resilience And Challenges

Strokes are a medical emergency that can happen at any age, but the risk increases as you get older. The average age of stroke is in the 70s, though strokes are most common among people in their 90s. The risk of a stroke increases most after the age of 60, with the mean age of 74.3. The majority of people who suffer a stroke are older adults.

Strokes occur when blood flow to an area in the brain is cut off, resulting in brain cells being deprived of the oxygen and glucose they need to survive. If a stroke is not caught early, it can lead to permanent brain damage or even death. The most common symptoms of a stroke include weakness or numbness of the face, arm, or leg on one side of the body, loss of vision, and slurred speech.

There are two types of strokes: ischemic and hemorrhagic. Ischemic strokes are similar to heart attacks and occur when blood vessels in the brain are blocked by clots. Hemorrhagic strokes happen when a blood vessel in the brain breaks or ruptures, causing blood to seep into the brain tissue.

Older adults can protect themselves from strokes by maintaining a healthy weight, getting regular physical exercise, and managing health conditions such as high blood pressure and cholesterol through regular check-ups with a healthcare professional.

Causes of strokes in older people

Age is a significant risk factor for strokes, with around 75% of strokes occurring in people aged 65 or older. The chance of having a stroke doubles every decade after the age of 55. While strokes can occur at any age, they become increasingly common as people get older.

The main cause of strokes is the blockage of blood vessels in the brain, often by a blood clot or thrombus. This is known as an ischemic stroke, the most common type of stroke. Ischemic strokes can also be caused by thrombosis (a clot in a blood vessel of the brain or neck), embolism (a clot that moves from another part of the body to the neck or brain), or stenosis (narrowing of a blood vessel in the brain due to fatty deposits).

Another type of stroke is a hemorrhagic stroke, which occurs when a blood vessel bursts and leaks blood into or around the brain. This type of stroke is less common but can be more severe, as it increases pressure inside the skull and can cause damage to surrounding brain tissue.

There are several factors that can increase the risk of strokes in older people, including:

• High blood pressure (hypertension)
• Smoking
• Diabetes
• Heart disease, including atrial fibrillation and carotid artery disease
• High cholesterol
• Obesity
• Physical inactivity
• Excessive alcohol consumption
• Family history and genetics
• Race and ethnicity

It is important to note that some of these risk factors can be controlled or minimized through lifestyle changes and medical treatment. For example, regular exercise, a healthy diet, and smoking cessation can significantly reduce the risk of stroke. Additionally, managing medical conditions such as high blood pressure, diabetes, and high cholesterol through proper medical care and medication can also lower the risk.

By understanding the causes and risk factors of strokes in older people, individuals can take preventive measures to reduce their chances of experiencing a stroke and improve their overall health and well-being.

Symptoms of strokes in older people

Strokes are a neurologic disturbance caused by a lack of proper blood flow to the brain. As the brain requires a constant supply of blood and oxygen to survive, strokes can cause harm to brain cells and result in permanent disability or even death. The risk of having a stroke doubles every decade after the age of 55, with over 70% of all strokes occurring in people over the age of 65.

There are two primary types of strokes: ischemic strokes and hemorrhagic strokes. Ischemic strokes are the most common and happen when a blood clot or the narrowing of a blood vessel (artery) reduces blood flow to the brain. Hemorrhagic strokes are marked by a burst blood vessel that causes blood to leak into or around the brain.

The symptoms of a stroke include:

• Sudden numbness or weakness in the face, arm, or leg, especially on one side of the body.
• Sudden confusion, trouble speaking, or understanding speech.
• Sudden problems with vision in one or both eyes.
• Sudden dizziness, loss of balance or coordination, or trouble walking.
• A sudden, severe headache with no known cause.

Other danger signs that may indicate a stroke include double vision, drowsiness, nausea, and vomiting.

In addition to these symptoms, a mini-stroke, or transient ischemic attack (TIA), may occur. Mini-strokes are characterised by impaired blood circulation and a lack of oxygen supply to certain areas of the brain. They only last a few minutes and usually don't result in permanent damage. However, they can be followed by more severe strokes, so it's important to recognise the symptoms, which include confusion, tingling sensations, and dizziness.

If you suspect that someone is having a stroke, it is important to act quickly and call for emergency medical help. The longer someone waits to receive treatment, the greater the risk of permanent damage or death.

Treatment of strokes in older people

Strokes are a life-threatening condition that occurs when the blood and oxygen supply to the brain is blocked or cut off. Older people are more likely to experience strokes, and the impact can vary from minor to life-changing. Prompt treatment is crucial to reduce the risk of brain damage and other health complications.

Types of Strokes

There are two main types of strokes: ischaemic and haemorrhagic. Ischaemic strokes are the most common type, occurring when a blood clot blocks blood flow to the brain due to narrowed or blocked arteries. This can be caused by factors such as smoking, high blood pressure, obesity, high cholesterol, diabetes, and excessive alcohol intake.

Haemorrhagic strokes, on the other hand, happen when a blood vessel in the skull bursts and bleeds into and around the brain. High blood pressure is the leading cause of this type of stroke, often resulting from obesity, smoking, excessive alcohol consumption, stress, and lack of exercise.

Treatment Options

The treatment for a stroke depends on its type. In the first 24 hours after an ischaemic stroke, treatment may include thrombolysis, which involves injecting a medicine called alteplase to dissolve blood clots and restore blood flow to the brain. This treatment is most effective when administered immediately after a stroke. Additionally, aspirin or other medications may be given to reduce blood clot formation.

For haemorrhagic strokes, surgery is usually required to remove blood from the brain and repair burst blood vessels. Procedures may also be performed to treat fluid build-up in the brain, which can cause vomiting, sickness, headaches, and drowsiness.

Short-Term Treatments

Short-term treatments focus on managing the effects of a stroke. These may include a feeding tube for those with swallowing difficulties, intravenous fluids to prevent dehydration, oxygen therapy for low oxygen levels, and compression stockings to prevent blood clots in the legs.

Long-Term Care and Recovery

Older patients may require extra support from healthcare professionals during their recovery. Physiotherapists can assist with motor skills and mobility issues, while speech therapists address any speech impairments. Occupational therapists also play a crucial role in helping individuals regain their ability to perform daily activities.

Lifestyle changes are an important aspect of long-term care and can improve recovery. These changes include controlling cholesterol and diabetes, maintaining a healthy and active lifestyle, and managing weight, blood pressure, and cholesterol levels.

Prevention

While prevention is not always possible, making healthy lifestyle choices can lower the risk of strokes. This includes regular exercise, a nutritious diet, and avoiding alcohol and smoking.

Prevention of strokes in older people

Strokes are a serious health concern for older people, with about 75% of strokes occurring in people aged 65 or older. The risk of having a stroke doubles every decade after the age of 55, and it is the third leading cause of death among Americans. Therefore, prevention is crucial to reduce the likelihood of this life-threatening event.

Risk Factors

There are several risk factors for strokes, some of which are controllable or treatable. These include:

• Tobacco use
• Physical inactivity and obesity
• Carotid and other arterial diseases
• Atrial fibrillation and other heart diseases
• Certain blood disorders, such as sickle cell disease
• Excessive alcohol consumption
• Drug abuse, especially cocaine

Prevention Strategies

• Assess your stroke risk: Use tools like the American Heart Association's website to calculate your personal stroke risk and discuss the results with your doctor.
• Physical activity: Engage in moderate to vigorous physical activity for at least 40 minutes per day, 3 to 4 days a week.
• Medication: Take prescribed "statins" if your stroke risk is high. Daily baby aspirin may also be recommended if your 10-year risk is greater than 10%.
• Diet: Reduce sodium intake, increase potassium and consume plenty of fruits and vegetables. Follow a diet recommended by the American Heart Association or a Mediterranean diet supplemented with nuts.
• Blood pressure control: Maintain blood pressure below 140/90 mm Hg.
• Weight management: Achieve and maintain a healthy weight with a BMI between 25 and 29 kg/m2.
• Anticoagulants: If you have atrial fibrillation or certain heart valve lesions, your doctor may prescribe anticoagulants to prevent blood clots.
• Carotid artery evaluation: If you experience transient ischemic attacks, consult a physician or surgeon to evaluate the internal carotid artery for stenosis.
• Migraine management: Reduce the frequency of migraine headaches with medication.
• Influenza vaccination: Get an annual flu shot to reduce the risk of stroke-related complications.

Complications of strokes in older people

Stroke is a leading cause of death and disability worldwide, with approximately 50% of all strokes occurring in people over 75 and 30% in those over 85. Elderly patients are at higher risk of mortality, poorer functional outcomes, longer hospital stays, and institutionalisation.

• Motor impairment is the most common deficit after a stroke, which can lead to a higher risk of falling and fall-related injuries.
• Post-stroke cognitive impairment can affect up to one-third of survivors and is more common in those with recurrent strokes. It often coexists with language disorders, fatigue, depression, and apathy.
• Bladder and bowel dysfunction are common after a stroke and can cause significant distress. Urinary incontinence, in particular, is linked to functional dependency, increased risk of institutionalisation, and mortality.
• Infection is a serious complication after a stroke, with a reported prevalence of 5-65% depending on the study. It is associated with higher mortality rates, especially in patients with pneumonia and urinary tract infections.
• Pressure sores and deep vein thrombosis (DVT) are common complications due to impaired mobility and immobility. DVT can lead to pulmonary embolism, a life-threatening condition.
• Pain is a frequent but often neglected complication of stroke, ranging from irritating headaches to debilitating limb pain. It is associated with an increased risk of cognitive impairment, functional dependence, and reduced quality of life.
• Aphasia or other speech disorders may occur due to damage to parts of the brain responsible for language.
• Trouble swallowing (dysphagia) is common and can lead to aspiration pneumonia if food or liquids enter the lungs.
• Seizures or epilepsy may occur, especially after hemorrhagic strokes or those located in the cerebral cortex.
• Limb contracture and shoulder pain can develop due to extended immobility and muscle weakness.
• Depression or other mood changes are common after a stroke, and depression is often underdiagnosed.

These complications can significantly impact an older person's recovery, daily living activities, and quality of life. Therefore, it is crucial to seek medical attention and support to manage and prevent these complications.

Frequently asked questions