Factors Associated with Ischemic Stroke Survival and Recovery in Older Adults

DIvya Thekkethala Winovich, William T. Longstreth, Alice M. Arnold, Ravi Varadhan, Adina Zeki Al Hazzouri, Mary Cushman, Anne B. Newman, Michelle C. Odden

Research output: Contribution to journalArticle

Abstract

Background and Purpose - Little is known about factors that predispose older adults to poor recovery after a stroke. In this study, we sought to evaluate prestroke measures of frailty and related factors as markers of vulnerability to poor outcomes after ischemic stroke. Methods - In participants aged 65 to 99 years with incident ischemic strokes from the Cardiovascular Health Study, we evaluated the association of several risk factors (frailty, frailty components, C-reactive protein, interleukin-6, and cystatin C) assessed before stroke with stroke outcomes of survival, cognitive decline (≥5 points on Modified Mini-Mental State Examination), and activities of daily living decline (increase in limitations). Results - Among 717 participants with incident ischemic stroke with survival data, slow walking speed, low grip strength, and cystatin C were independently associated with shorter survival. Among participants <80 years of age, frailty and interleukin-6 were also associated with shorter survival. Among 509 participants with recovery data, slow walking speed, and low grip strength were associated with both cognitive and activities of daily living decline poststroke. C-reactive protein and interleukin-6 were associated with poststroke cognitive decline among men only. Frailty status was associated with activities of daily living decline among women only. Conclusions - Markers of physical function - walking speed and grip strength - were consistently associated with survival and recovery after ischemic stroke. Inflammation, kidney function, and frailty also seemed to be determinants of survival and recovery after an ischemic stroke. These markers of vulnerability may identify targets for differing pre and poststroke medical management and rehabilitation among older adults at risk of poor stroke outcomes.

Original languageEnglish (US)
Pages (from-to)1818-1826
Number of pages9
JournalStroke
Volume48
Issue number7
DOIs
StatePublished - Jul 1 2017

Fingerprint

Stroke
Survival
Hand Strength
Activities of Daily Living
Cystatin C
Interleukin-6
C-Reactive Protein
Rehabilitation
Myocardial Infarction
Inflammation
Kidney
Health
Walking Speed

Keywords

  • aging
  • mortality
  • recovery of function
  • risk factors
  • stroke

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing

Cite this

Winovich, DI. T., Longstreth, W. T., Arnold, A. M., Varadhan, R., Zeki Al Hazzouri, A., Cushman, M., ... Odden, M. C. (2017). Factors Associated with Ischemic Stroke Survival and Recovery in Older Adults. Stroke, 48(7), 1818-1826. https://doi.org/10.1161/STROKEAHA.117.016726

Factors Associated with Ischemic Stroke Survival and Recovery in Older Adults. / Winovich, DIvya Thekkethala; Longstreth, William T.; Arnold, Alice M.; Varadhan, Ravi; Zeki Al Hazzouri, Adina; Cushman, Mary; Newman, Anne B.; Odden, Michelle C.

In: Stroke, Vol. 48, No. 7, 01.07.2017, p. 1818-1826.

Research output: Contribution to journalArticle

Winovich, DIT, Longstreth, WT, Arnold, AM, Varadhan, R, Zeki Al Hazzouri, A, Cushman, M, Newman, AB & Odden, MC 2017, 'Factors Associated with Ischemic Stroke Survival and Recovery in Older Adults', Stroke, vol. 48, no. 7, pp. 1818-1826. https://doi.org/10.1161/STROKEAHA.117.016726
Winovich DIT, Longstreth WT, Arnold AM, Varadhan R, Zeki Al Hazzouri A, Cushman M et al. Factors Associated with Ischemic Stroke Survival and Recovery in Older Adults. Stroke. 2017 Jul 1;48(7):1818-1826. https://doi.org/10.1161/STROKEAHA.117.016726
Winovich, DIvya Thekkethala ; Longstreth, William T. ; Arnold, Alice M. ; Varadhan, Ravi ; Zeki Al Hazzouri, Adina ; Cushman, Mary ; Newman, Anne B. ; Odden, Michelle C. / Factors Associated with Ischemic Stroke Survival and Recovery in Older Adults. In: Stroke. 2017 ; Vol. 48, No. 7. pp. 1818-1826.
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