Sahakyan Greta, Orduyan Mira, Adamyan Ani, Koshtoyan Karen, Hovhannisyan Gurgen, Karapetyan Aleksandra, Manvelyan Hovhannes
Department of Neurology, Yerevan State Medical University, Yerevan, 0025, Armenia.
Department of Neurology, Astghik Medical Center, Yerevan, 0028, Armenia.
BMC Palliat Care. 2025 May 7;24(1):130. doi: 10.1186/s12904-025-01773-8.
The implementation of acute stroke care programs with dedicated multidisciplinary stroke teams has revolutionized access to care and improved survival among older adults. However, the integration of specialized palliative support within acute stroke services remains uncommon in many developing countries. This study highlights the emerging challenges faced by patients with ischemic stroke aged ≥ 80 years treated with reperfusion therapies, identifies early palliative care needs, and underscores the importance of comprehensive support in the acute setting.
We selected consecutive patients with ischemic stroke aged ≥ 80 years who received reperfusion therapies (intravenous thrombolysis or mechanical thrombectomy) at the time of stroke unit admission. Clinical and demographic data were prospectively collected and analyzed.
A total of 52 patients aged ≥ 80 years received reperfusion therapies. The in-hospital mortality rate was 5/52 (9.6%). Key challenges identified during hospitalization included dysphagia in 32 patients (61.5%), dyspnea in 7 patients (13.5%), delirium in 14 patients (26.9%), and mobility impairment and/or speech disturbance in 22 patients (42.3%).
Despite the increasing use of reperfusion therapies in patients aged ≥ 80 years, symptoms requiring comprehensive support and early palliative interventions persist in the acute stroke setting. Our findings emphasize the need for early palliative assessments to address stroke-related symptoms such as dysphagia, delirium, and mobility or speech disturbances, ultimately enhancing patient comfort. Future research is necessary to better understand stroke-specific symptom burden in the aging population and to develop strategies for integrating palliative care into acute stroke management.
由专门的多学科卒中团队实施急性卒中护理项目，彻底改变了老年人获得护理的途径并提高了生存率。然而，在许多发展中国家，急性卒中服务中整合专门的姑息治疗支持仍然不常见。本研究强调了接受再灌注治疗的80岁及以上缺血性卒中患者面临的新挑战，确定了早期姑息治疗需求，并强调了在急性期提供全面支持的重要性。
我们选择了在卒中单元入院时接受再灌注治疗（静脉溶栓或机械取栓）的连续80岁及以上缺血性卒中患者。前瞻性收集并分析临床和人口统计学数据。
共有52例80岁及以上患者接受了再灌注治疗。住院死亡率为5/52（9.6%）。住院期间发现的主要挑战包括32例患者（61.5%）出现吞咽困难，7例患者（13.5%）出现呼吸困难，14例患者（26.9%）出现谵妄，22例患者（42.3%）出现行动障碍和/或言语障碍。
尽管80岁及以上患者越来越多地使用再灌注治疗，但在急性卒中环境中，仍存在需要全面支持和早期姑息干预的症状。我们的研究结果强调了早期进行姑息评估以解决与卒中相关症状（如吞咽困难、谵妄以及行动或言语障碍）的必要性，最终提高患者舒适度。未来有必要开展研究，以更好地了解老年人群中卒中特异性症状负担，并制定将姑息治疗纳入急性卒中管理的策略。
