Clarify characteristics, mortality, morbidity, resource utilization, and patient-centered outcomes in the nonagenarian ischemic stroke population

An estimated 18-22% of strokes are in those older than 85. Although the oldest of the old may represent the fastest growing population, relatively little is known about them. The oldest state by median age, Maine has a large population of nonagenarians, and reviewing its largest center’s nonagenarian hospitalizations offers insight into the unique challenges facing these patients.

A retrospective observational study with a convenience sample of all patients aged 90 and older presenting to Maine Medical Center with acute ischemic stroke between the years 2013-2018. Simple descriptive statistics for patient demographics, risk factors, stroke characteristics, therapeutic characteristics, and outcomes were calculated.

107 patients were identified. The mean age was 93 and 72% of patients female. 42% had atrial fibrillation (80% of these unanticoagulated), with an average CHADSVasc of 5 points and a mean INR of 2.3 on presentation. Mean NIHSS on admission was 9.25 and upon discharge 5.27 (p=0.008). 8% received tPA; 4% received thrombectomy; 0% received both, and 88% received neither--with no statistically significant difference in outcomes. Average length of stay was 4.4 days. 15% suffered in-hospital complications of pneumonia, deep vein thrombus, pulmonary embolism, renal failure, congestive heart failure, atrial fibrillation, symptomatic intracranial hemorrhage, or stroke. 1% underwent mechanical-ventilation, and 3% underwent PEG-tube placement. 2% were readmitted within 180 days. Only 28% of patients living independently, 29% living with family, 20% in assisted living, and 66% in SNF were discharged to the same functional living circumstances. 5% expired during hospitalization, 23% by 30 days, and 56% by 90 days.

Despite comparable intensity of care, the minority of community-dwelling patients were not discharged to their previous functional disposition, and 90-day mortality was extremely high. These outcomes are pertinent to goals of care discussions.