Stroke prevention in the elderly

Stroke is a common, devastating and frightening event among older persons, often resulting in death or major loss of independence. Professional and lay attitudes of the past have assumed an inevitable and immutable course of stroke risk progression with age. Although stroke is strongly age-associated, recent data have accumulated demonstrating reduction in stroke rate by preventive interventions in older patients with risk factors. Statistically significant stroke reduction has been achieved by 1) antihypertensive treatment of patients with elevated systolic blood pressure, even beyond age 80; 2) anticoagulation with warfarin for patients with chronic or intermittent non-valvular atrial fibrillation; 3) use of low-dose aspirin in patients with TIA or nondisabling stroke; and 4) carotid endarterectomy for patients with symptoms and ipsilateral serve stenosis. Clinical strategies to prevent stroke in older adults are now tested and proven useful; they should be used as indicated in older persons at risk.