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.

Sunil Munshi, Consultant Physician, Nottingham University Hospitals NHS Trust, Nottingham, UK,Rowan Harwood, Consultant Physician, Consultant Physician, Nottingham University Hospitals NHS Trust , Nottingham, UK

Dr Sunil Munshi is a Consultant Physician and Geriatrician in the Department of Stroke and Acute Medicine at Nottingham University Hospital and an Honorary Clinical Lecturer at Nottingham University School of Medicine. He was awarded "Best Clinical Teacher of Nottingham University Hospitals" in 2007 and nominated again in 2008 and 2011. His research interests include stroke, geriatric medicine, cerebrovascular circulation, stroke thrombolysis, and cerebrovascular disease. Dr Munshi is the Foundation Programme Director at Nottingham city Hospital and was one of the primary investigators for the TARDIS Trial of antithrombotic therapy at NUH. He was presented the Health Innovation and Education Cluster award for Stroke Teaching 2012-2013.


Professor Rowan Harwood is a Consultant Physician and Professor of Geriatric 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.

1. What does it mean to have a stroke?, Ossie Newell
2. Epidemiology and aetiopathogenesis, Timothy J. England
3. Presentation of stroke in the older person, Jagdish Sharma
4. Transient Ischaemic Attack (TIA) in the older person, Marissa Hagan and Ashit K. Shetty
5. Stroke mimics: Transient focal neurological events, Christopher D. Stephen and Louis R. Caplan
6. Diagnostic investigations for stroke in older people: A practical approach, Senthil Raghunathan
7. A practical approach to neuroimaging in stroke, Amy C. Gerrish, Dorothee P. Auer, and Amlyn Evans
8. Atrial fibrillation and stroke in the older person, David Mangion
9. Early management of acute ischaemic stroke, Paul Guyler
10. Intracerebral haemorrhage in older people, Zhe Kang Law and Nikola Sprigg
11. Cerebral small vessel disease: Potential interventions for prevention and treatment, Gordon Blair, Jason P. Appleton, Joanna M. Wardlaw, and Philip M. Bath
12. Nutrition, feeding and dysphagia in the older patient with stroke, Jessica Beavan and Lisa Everton
13. Communication disorders post-stroke, Dee Webster and Sally Knapp
14. Early and late complications of stroke, Ganesh Subramanian
15. Occupational therapy in older people with stroke, Rowena Padamsey and Avril Drummond
16. Physiotherapy of the older stroke patient, Dawn Hicklin and Clair Finnemore
17. Ethical and moral dilemmas including Do Not Attempt Resuscitation orders, advanced care planning, and end of life care, Rowan H. Harwood
18. Assessing capacity and decision making, Thomas McGowan and Adrian Blundell
19. Urinary incontinence after stroke, Amy Hillarious and Sunil K. Munshi
20. Fatigue and the older stroke patient, Ian I. Kneebone and Daniel Kam Yin Chan
21. Visual disorders in stroke, Deborah Plunkett and Sushma Dhar-Munshi
22. Discharge from hospital and early supported discharge, Catherine Gaynor
23. Secondary prevention and revascularisation in the older person, Jatinder S. Minhas, Amit K. Mistri, and Thompson G. Robinson
24. Hypertension in older people, Wayne Sunman
25. Post-stroke cognitive impairment, Sandeep Ankolekar and Michela Simoni
26. Psychological and emotional issues after stroke, Reg C. Morris
27. Stroke care in the community and long-term care facilities, Adam L. Gordon and Phillipa A. Logan
28. Readmission to hospital after stroke, Mohana Maddula and Sunil K. Munshi
29. Research trials in the older stroke patient, Kailash Krishnan and Nikola Sprigg
30. End of life care in stroke, Declan O Kane