Stroke in an Elderly Population: Incidence and Impact on Survival and Daily Function

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Abstract
Background: Epidemiological data are essential to estimate the burden of stroke.We evaluated stroke incidence in older Italians and the effect of first-ever stroke on survival and activities of daily living (ADL). Methods: The analysis was performed in the Italian Longitudinal Study on Aging (ILSA) sample, consisting of 5,632 individuals aged 65–84. The ILSA aims at major cardiovascular and neurological age-associated diseases. The baseline survey was performed in 1992 to detect prevalent diseases. The longitudinal examination started on September 1995 aiming at incidence, function and survival. Results: Complete follow-up data were achieved for 77% of the baseline stroke-free cohort (4,164 persons; 50.9% males; mean age 74.5 ± 5.7 years). Incidence for first-ever stroke was 9.51 (95% CI: 7.75–11.27) per 1,000 person years and 12.99 (95% CI: 10.99–14.98) including recurrent stroke (total incidence). Crude mortality was 49.2% among first stroke patients and 15% among persons without stroke. The first-ever stroke mortality risk ratio, adjusted for demographics and comorbidity, was 2.40 (95% CI: 1.62–3.54). In survivors, impairment of at least one ADL was present in 67.6% of first-ever stroke patients vs. 31.6% of individuals without stroke. The comorbidity-adjusted OR was 2.63 (95% CI: 1.20–5.78) in the total cohort, and 4.00 (95% CI: 1.39–11.46) in individuals without disability at baseline. Conclusions: The ILSA provides the first data on stroke incidence in Italy on a national basis. Overall, 153,000 new cases can be expected annually in the Italian elderly population. First-ever stroke still has a strong effect on survival and function of older persons.