Spotlight on Aging: Strokes

After a stroke, older people are more likely to have problems, such as pressure sores, pneumonia, permanent shortening of muscles that limits movement (contractures), and depression. Older people are also more likely to already have disorders that limit treatment of stroke. For example, they may have very high blood pressure or gastrointestinal bleeding that prevents them from taking anticoagulants to reduce the risk of blood clots. Some treatments, such as endarterectomy (surgical removal of fatty deposits in arteries), are more likely to cause complications in older people. Nonetheless, treatment decisions should be based on the person’s health rather than on age itself.

Some disorders common among older people can interfere with their recovery after a stroke, as in the following:

• People with dementia may not understand what is required of them for rehabilitation.

• People with heart failure or another heart disorder may risk having another stroke or a heart attack triggered by exertion during rehabilitation exercises.

A good recovery is more likely when older people have the following:

• A family member or caregiver to help

• A living situation that facilitates independence (for example, a first-floor residence and nearby shops)

• Financial resources to pay for rehabilitation

Because recovery after stroke depends on so many medical, social, financial, and lifestyle factors, rehabilitation and care for older people should be individually designed and managed by a team of health care professionals (including nurses, psychologists, and social workers as well as a doctor or therapist). Team members can also provide information about resources and strategies to help people who have had a stroke and their caregivers with daily living.