Prognostic factors of functional recovery in very elderly stroke patients. A one-year follow-up study

Although an advanced age is a factor associated to a poorer functional prognosis following a stroke, the capacity for recovery can be determined by other intercurrent clinical, functional and mental factors. To evaluate the factors that determine the functional prognosis on discharge of very elderly patients who were admitted to hospital for their functional recovery after suffering a stroke. We conducted a longitudinal observational study of 168 patients over 65 years of age, who were hospitalised consecutively over a 15-month period. On admission, data concerning a number of clinical, neurological, functional and mental variables were collected. On being discharged from hospital their functional situation (Barthel index) and institutionalisation were evaluated. The 48 patients aged 85 and above presented a lower degree of overall and relative functional recovery on discharge from hospital. Nevertheless, 52% had gained more than 20 points on the Barthel index on being discharged with respect to their score when they were admitted; on discharge 44% had recovered over 50% of the functional loss they had suffered following the stroke. On including the other basal variables in a logistic regression analysis, a very advanced age was associated in an independent manner to a greater risk of being institutionalised, but not to a poorer functional prognosis at discharge. Severe functional impairment on admission and post-stroke depression were the factors that were independently associated to moderate-severe disability on admission; in addition, the more severe the neurological consequences were, the lower the level of functional recovery was. The capacity for functional recovery in very elderly stroke patients is mainly determined by the degree of functional and neurological repercussion. The functional prognosis should be individualised according to these factors, regardless of the age.