Navigating the Gray Zones of Stroke Management for a Graying Population

The world is rapidly graying [1]. This global shift in age structure towards very elderly populations (≥ 80 years) is primarily due to improvements in living standards and healthcare resulting in greater disease-free and disease-specific survival [1]. Since stroke occurrence is most pronounced in the elderly population, there are increasingly higher numbers of these individuals presenting to hospitals for acute stroke treatment, as well as rising prevalence rates of elderly stroke survivors living with stroke-related disability [1]. Furthermore, even with better life expectancy and greater rates of stroke survival, the likelihood of dying tends to rise with increasing age after an index stroke [2], and so these evolving demographic patterns have led to projections that stroke will be the leading cause of death in developed nations within 30 years [3]. In light of the immense burden associated with stroke among the elderly, it is not surprising that the financial costs attributable to stroke in the elderly are extremely high, with most of the total expenditure for stroke being in persons aged ≥65 years [4]. To meet these burgeoning challenges, healthcare providers, research funding agencies and policy makerswill increasingly need to explore avenues for providing systematic evidence-based stroke care that optimizes favorable outcomes for the very elderly [1].