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Stroke in Elderly Adults: Signs, Symptoms, Prognosis

This is the first in the series and presents an overview of several types of strokes, their effects and prognosis for stroke victims. Later entries will delve into such topics as stroke survival, recovery, rehabilitation, general tips for caring for older stroke patients, and how to care for and cope with stroke patients at home. It is our sincere hope to better educate older adults and their loved ones about the devastating effects a stroke can have and help to prevent or minimize damage done.

The American Stroke Association (ASA) notes that stroke is the fourth leading cause of death in the U.S. Stroke mortality rates among women are slightly higher (60%) than among men (40%). Despite its position as one of the leading causes of death, stroke mortality rates have actually declined since the year 2000, falling from 60 per every 100,000 instances of stroke in 2000 to a mortality rate of 40 for every 100,000 stroke victims in 2010.

Additionally, when it comes to life expectancy after strokes, research indicates that over 75% of stroke victims survive a first stroke during the first year. Stroke is prevalent in elderly individuals, with 66% of hospitalized cases being people over the age of 65. Many stroke survivors are able to recover functional independence over time, but 25% are left with a minor disability and 40% experience moderate-to-severe disabilities. Stroke patients are scored on several functions in order to help predict and determine how severe the symptoms will be. These predictors are described in the stroke prognosis section that follows.

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Although a stroke comes with its own warning signs, they do not offer much advance warning. Rather, these signs manifest within minutes of an actual stroke.

Signs of Stroke in Elderly Adults

  • Numbness in the face and limbs, most commonly on one side of the body
  • Sudden vision problems in one or both eyes
  • Severe headaches
  • Difficulty with communication
  • Lack of coordination

These symptoms of stroke in elderly adults can be red flags. If you experience any signs or you are with someone who has a change in behavior like those mentioned, call 911 immediately. Speed is critical to lessen brain damage and have a positive outcome.

Stroke Symptoms in Men versus Stroke Symptoms in Women

Women have different stroke symptoms, and they also have a higher rate of fatality when it comes to strokes. 60% of women will die from stroke compared to 40% of men. Stroke kills up to twice as many women per year as breast cancer. Below is a list of symptoms that women should look out for in addition to the list above:

  • Sudden hiccups.
  • Sudden nausea.
  • Sudden general weakness.
  • Sudden chest pain.
  • Sudden shortness of breath.
  • Sudden palpitations.

A great way to remember the signs of a stroke is to remember the acronym F.A.S.T.:

F(ace) – Have the person attempt to smile. If one side of the face does not move as well as the other, it is a sign of stroke.

A(rms) – Have the person attempt to raise both of their arms. Notice if one of their arms doesn’t move as high as the other.

S(peech) – Give the person a sentence that they can repeat. Check if there are any slurred words.

T(ime) – If you notice any of these stroke warning signs, act quickly and dial 911 to ensure your elderly loved one receives immediate treatment.

If someone present in the room at the time of stroke takes action based on those signs, it can help save the life of the stroke victim.

Types of Stroke in Elderly Patients and Prognosis

There are various types of strokes that affect patients in different ways. Here are a few of the different types:

Ischemic Stroke

The process of ischemia involves the blood clotting in a dangerous way that blocks arteries and halts the flow of blood to the vital organs. These strokes can be a result of fatty buildup and cholesterol in the blood vessels. As these buildups occur over time, the body views them as a sort of injury to the blood vessels themselves and forms clots to try to “heal” them. When these clots break away and lodge in a vital organ, a stroke can occur. There are two types of ischemic strokes: embolic and thrombotic.

  • Embolic – Embolic strokes begin with a blood clot forming in the body (typically in the heart) and making its way through the bloodstream to a person’s brain. From there, the clot can become stuck in a small blood vessel and cause a stroke.
  • Thrombolic – A clot that forms on a blood vessel is called a thrombus. Like embolic strokes, thrombolic strokes also involve blood clots, however, in this case, an arterial blockage impacts the flow of blood to the brain.

Hemorrhagic Stroke

Hemorrhagic strokes are caused by the sudden and violent breaking of a blood vessel in the brain, called a hemorrhage. High blood pressure and aneurysms (weak spots on blood vessel walls) are among some of the known causes of this type of stroke. An aneurysm can build over several years and may not be able to be detected until it breaks. This type of stroke kills brain cells and brings additional health problems, including painful blood vessel spasms, and pressure on the brain.

Prognosis for Stroke Victims: Elderly Patients

An Ischemic stroke has a much higher survival rate when compared to hemorrhagic stroke. However, elderly patients who have had hemorrhagic stroke and survived have a much higher rate of regaining normal functions.

Overall, 25% of stroke victims have some small measure of disability with 40% left with moderate-to-extensive disability. These complications can affect simple, everyday functions such as eating, dressing, walking or standing up, among others. Another result of a stroke is a condition known as aphasia, defined by the National Aphasia Association as “an acquired communication disorder that impairs a person’s ability to process language, but does not affect intelligence.”

Health care professionals evaluate the severity of a stroke and recovery / prognosis based on the National Institute of Health’s stroke scale. This scale takes 11 factors into account to “score” the severity of a stroke and stroke prognosis in victims.

The 11 factors used to determine a stroke victim’s long-term prognosis are:

  • consciousness
  • gaze
  • field of vision
  • facial movement
  • motor function of the extremities
  • coordination
  • loss of senses
  • language problems
  • ability to speak / speak clearly / find the correct words to verbalize thoughts
  • attention

Training on the NIH stroke scale is available only to professionals as to how to properly assess the condition of a stroke victim. However, loved ones and caregivers outside the medical profession can gain a better understanding of how the stroke scale is scored with this resource:

Tips for Stroke Victims on the Road to Recovery

Surviving a stroke is a life-changing experience. It takes work and knowledge to surpass and overcome these challenges. Here are some key tips to help improve health after a stroke:

  • Healthy eating and exercise are a great way to help strengthen the body.
  • Alcohol and nicotine should be avoided as these chemicals directly affect the brain and nervous system.
  • There are also several rehabilitation options that can help stroke patients recover:
    • For patients having trouble with movement and motor skills, physical therapists can help strengthen balance, coordination, and movement functions.
    • Speech therapists can work with patients to help restore typical speech patterns.
    • Occupational therapists can help patients relearn basic life skills that they may have lost.

Ongoing home care and treatment following a stroke can help your loved one to recover and live a fulfilling life.

For more information, please review our Stroke Resources.