Stroke in the Older Person

Stroke is a condition that predominantly affects older people, often leading to death, disability and dependency as well as occupancy of hospital and nursing-home beds. Older stroke patients are similar in many ways to their younger counterparts, but at the same time exhibit several key differences. Their outcome and care are complicated by delayed diagnosis, polypharmacy, difficult rehabilitation, ageism, false assumptions of poor outcome, multiple co-morbidity, social issues including implications for independent living, ethical dilemmas, and many others. The proportion of older people is increasing every day and with it the burden of disease and disability. The implications this has for health services are immense, especially for long-term conditions. Despite this there is limited literature available to clinicians on stroke with a particular focus on this age group. Traversing the whole stroke pathway, Stroke in the Older Person brings together key discussions on every aspect of the disease as it affects the older person, including its general aspects and those very specific to the older populations. All chapters are written by highly experienced clinicians that offer up-to-date evidence-based information as well as practical tips to promote excellent, empathetic care to older patients. Over 30 chapters, this resource addresses the epidemiology, aetio-pathogenesis, clinical presentation, diagnostic work-up (including imaging), primary and secondary prevention, and rehabilitation of older people. There is a special focus on intracerebral haemorrhage, carotid re-vascularisation, transient ischaemic attack, cognitive impairment, research, ethical and moral dilemmas including DNAR, advanced directives and end-of-life care.

Dr Sunil Munshi is a Consultant Physician and Geriatrician in the Department of Stroke and Medicine at Nottingham University Hospital at Nottingham University School of Medicine. He was awarded "Best Clinical Teacher of Nottingham University Hospitals" and his education programme in stroke was nominated for the BMJ Education Award in 2017. His research interests include stroke, geriatric medicine, cerebrovascular circulation, stroke thrombolysis, and cerebrovascular disease He was presented the Health Innovation and Education Cluster award for Stroke Teaching. Professor Rowan Harwood is a Consultant Physician and Geriatrician, and Professor of Palliative Medicine at Nottingham University Hospital NHS Trust. His research interests include delirium, dementia, continence, rehabilitation, clinical ethics, and end of life care. For a decade, Professor Harwood worked as a stroke physician. He has co-authored 4 books on stroke and dementia care and authored and co-authored 100 academic papers. In 2019, Professor Harwood was appointed editor-in-chief of Age and Ageing.