Unaddressed palliative care needs of ischemic stroke patients treated with reperfusion therapies after age 80

The implementation of acute stroke care programs with dedicated multidisciplinary stroke teams has revolutionized access to care and improved survival among older adults. However, the integration of specialized palliative support within acute stroke services remains uncommon in many developing countries. This study highlights the emerging challenges faced by patients with ischemic stroke aged ≥ 80 years treated with reperfusion therapies, identifies early palliative care needs, and underscores the importance of comprehensive support in the acute setting.

We selected consecutive patients with ischemic stroke aged ≥ 80 years who received reperfusion therapies (intravenous thrombolysis or mechanical thrombectomy) at the time of stroke unit admission. Clinical and demographic data were prospectively collected and analyzed.

A total of 52 patients aged ≥ 80 years received reperfusion therapies. The in-hospital mortality rate was 5/52 (9.6%). Key challenges identified during hospitalization included dysphagia in 32 patients (61.5%), dyspnea in 7 patients (13.5%), delirium in 14 patients (26.9%), and mobility impairment and/or speech disturbance in 22 patients (42.3%).

Despite the increasing use of reperfusion therapies in patients aged ≥ 80 years, symptoms requiring comprehensive support and early palliative interventions persist in the acute stroke setting. Our findings emphasize the need for early palliative assessments to address stroke-related symptoms such as dysphagia, delirium, and mobility or speech disturbances, ultimately enhancing patient comfort. Future research is necessary to better understand stroke-specific symptom burden in the aging population and to develop strategies for integrating palliative care into acute stroke management.