Hospital admissions for stroke among the very old in the USA

We sought to describe the proportion of acute ischemic stroke admissions for very old patients (> or =85 years), compare the characteristics of very old versus younger patients and identify factors among very old patients associated with adverse outcomes.

The 2000 Healthcare Cost and Utilization Project data included acute ischemic stroke hospitalizations for patients > or =45 years. The combined outcome was in-hospital mortality or discharge to a long-term care facility.

Among 15,020 stroke hospitalizations, 20.4% were for very old patients. The outcome rate was higher in hospitalizations for very old patients (2,176/3,058, 71.2%; versus 5,748/11,962, 48%; p < 0.0001). More hospitalizations for very old patients were for women (73.5 versus 55.1%; p < 0.0001), fewer for Blacks (6.1 versus 12.3%; p < 0.0001) and fewer at teaching hospitals (30.4 versus 36.2%; p < 0.0001). Among very old patients, factors that were independently associated with the outcome included: age [years; adjusted OR = 1.02 (95% CI = 1.000-1.05)], female gender [1.4 (1.18-1.68)], atrial fibrillation [1.37 (1.15-1.63)], acute myocardial infarction [1.68 (1.20-2.35)], respiratory failure [3.59 (1.60-8.05)] and teaching hospital admission [0.82 (0.69-0.98)]. Similar results were observed in the hospitalizations for younger patients. The adjusted OR for the outcome displayed geographic disparities in both age groups, but the pattern of the geographic variation was not similar between the two age groups.

The very old constitute a substantial proportion of stroke hospitalizations. Hospitalizations for very old patients are more likely to end in death or discharge to a long-term care facility than hospitalizations for younger patients. The pattern of geographic disparity in poststroke adverse outcomes differs between younger and very old patients.