Aging & Health A to Z

An older person with coronary artery disease (CAD) often suffers also from risk factors that raise the risk for stroke, such as: 

• Obesity
• Diabetes
• A smoking habit
• Sedentary lifestyle
• Drug or alcohol abuse
•  Hypertension 

Whether the CAD is a long-term (chronic) condition or an immediate emergency (for example, a heart attack), Healthcare professionals usually prescribe  antiplatelet agents or blood thinner drugs to prevent blood clots from developing or to help dissolve any clots that have already formed. 

One side effect of medications used to prevent stroke (for example: aspirin, warfarin, heparin, clopidogrel) is that they increase the risk of harmful, uncontrolled internal bleeding. If this bleeding occurs in your brain, you may suffer a hemorrhagic stroke. Depending on your risk factors, your own medical history, and your current condition (such as, whether you have kidney disease, which increases your chances of bleeding), your healthcare professional will weigh the risks and benefits in choosing a blood thinner and the appropriate dosage.  

Blood pressure tends to get higher as you get older, particularly systolic blood pressure (the first or top number in your blood pressure reading). High blood pressure raises your risk of having a stroke. Treating high blood pressure lowers your chance of having a stroke, so it is important that your Healthcare professional keeps track of your blood pressure as your age increases, and treats it if it gets too high. 

The first choice drug for uncomplicated high blood pressure in older people is often a thiazide-type diuretic (water pill), unless contraindicated by other medical conditions. These pills only need to be taken once a day, and are very safe, effective, and inexpensive. They usually do not interfere or interact with other medicines. Your healthcare professional may also prescribe a second medicine, such as a calcium channel antagonist or ACE inhibitor to take along with the diuretic. If you take two medicines, your dosages can be lowered for each drug, with the result that your risk of side effects is reduced, while the effectiveness in preventing strokes may be greater. Sometimes, a simple non-drug approach such as a low-salt diet makes all the difference. 

It is important to have your blood pressure monitored frequently if you have begun to take hypertension medications. This will avoid complications, such as a sudden drop in blood pressure. If blood pressure gets too low, the risk of falls and other serious consequences rises. Even a low-salt diet may not be beneficial in frail elderly people who need tasty foods to encourage them to eat. 

A high cholesterol level is known to be linked to an increased chance of having a stroke. For this reason, older adults who have had a transient ischemic event or a stroke should have a blood test to check their cholesterol levels. Your healthcare professional will ask you to skip breakfast before the test. 

For some older adults, however, cholesterol risk patterns change. For example, if you are past the age of 80, the risk of high cholesterol as a factor leading to  an ischemic stroke (the type of stroke caused by a blood clot) decreases. 

Atrial fibrillation refers to the rapid and irregular beating of the upper two chambers of your heart, the “atria”. Many people describe this common condition as heart “palpitations” or a heart “flutter”.  Atrial fibrillation occurs more frequently in older people, and about half of older adults diagnosed with it are over 75 years of age. 

If atrial fibrillation occurs very often and for extended periods, you may be at increased danger of having a stroke. About 25% of strokes in people more than 80 years old are caused by atrial fibrillation. Women have almost double the risk compared to men. You may also feel short of breath and less able to exercise with this condition. 

Your healthcare professional will evaluate your heart rate—most likely with a simple electrocardiogram  (ECG or EKG), and possibly blood tests or other tests—and decide if you should take a medication to control the fibrillation. You may receive anticoagulation therapy (a blood thinner such as warfarin or dabigatran), or antiplatelet therapy (such as aspirin), a beta blocker, or antiarrhythmic medications, depending on how serious your condition is and your stroke risk. For some people, a surgical approach may be appropriate. 

About five million Americans are living with heart failure. This condition can increase  your chance of having a stroke. Severe heart failure can increase the likelihood for blood clots to form in the heart. If these clots travel to your brain, they can block blood vessels and result in an ischemic stroke in which brain cells die due to lack of oxygen. This type of stroke, when it is associated with heart failure, has a worse chance of recovery than if heart failure is not present. 

With heart failure it is very important to begin taking medications to control your heart failure and  prevent stroke as soon as possible. 

People of all ages who arrive at the emergency department with symptoms of heart attack usually receive aspirin immediately.  Other treatments such as blood thinners (warfarin, heparin) and anti-clotting medications are likely to be administered also. A side effect of these drugs is they can increase the risk of an internal hemorrhage (bleed) that could occur in the brain and result in a stroke. 

If you are over 75 years of age, or if you have chronic kidney disease, the risk of internal bleeding is even higher, so your healthcare professional may adjust  the dose of blood thinners and anti-clotting drugs in such cases to reduce the risk of stroke. Fibrinolytic agents, often used to treat heart attacks, are especially linked to brain hemorrhage and this risk gets higher the older the patient. 

After a heart attack, drugs to keep the blood thin and eliminate clots have to be taken for at least a few months. Close monitoring of your blood with regular blood tests is needed to make sure the drug dosages are correct. 

In adults aged 60 and higher, the most common risk factor for a hemorrhagic stroke is hypertension. However, a condition known as cerebral amyloid angiopathy may occur even without hypertension and becomes more common with increasing age. Amyloid angiopathy refers to a build-up of proteins called amyloid on the walls of the arteries in the brain, which increases your likelihood of suffering a hemorrhagic stroke. It may also result in dementia. The cause is unknown. 

Cerebral amyloid angiopathy may produce bleeding in the brain, particularly in the outer lobes of that organ. This can result in symptoms, often appearing suddenly, such as:

• Sleepiness
• Headache
• Confusion or delirium
• Vision problems (such as double vision or poor vision)
• Trouble speaking
• Changes in sensing
• Vomiting
• Weakness in some parts of your body
• Paralysis – loss of movement
• Seizures
• Coma (unusual). 

Your healthcare professional will ask you questions about your medical history and check you for neurological (brain function) changes. Further tests such as a CT scan or MRI may reveal bleeding in the brain. The management for cerebral amyloid angiopathy is mainly symptomatic. 

Most older people have the degenerative changes of osteoarthritis—the most common form of arthritis—in at least a few joints. The likelihood of having arthritis, and of worsening symptoms, increases with age. Arthritis causes pain and stiffness, often accompanied by warmth, swelling, and tenderness in the affected joints. Arthritis is one of the major sources of disability in older people. Overweight and obesity make arthritis worse which can increase your risk of having a stroke. 

There are many safe, drug-free approaches for controlling arthritis pain. These include:

• cold and heat applications
• physiotherapy and exercise
• massage
• acupuncture
• transcutaneous electrical nerve stimulation (TENS). 

Capsaicin cream or patches, which contains a hot pepper derivative, is sometimes helpful and is used only externally. 

When symptoms are severe, or non-drug strategies fail, many turn to pain medications. Some of these can have serious side effects in the older population. Acetaminophen (Tylenol) is the most common medicine recommended for arthritis, but it has to be used in moderation in older people because of the risk of liver and kidney damage, especially if you already have liver disease. It does not relieve the swelling in arthritic joints. 

If acetaminophen is inadequate for controlling your pain, your Healthcare professional may prescribe an NSAID (non-steroidal anti-inflammatory drug). NSAIDs include:

• aspirin
• choline magnesium trisalicylate
• ibuprofen 

These are effective for pain and, in higher doses, swelling.  However, they may have serious side effects, especially for older adults, in particular kidney problems,  internal bleeding (hemorrhage) and stroke. 

The COX-2 inhibitors (Bextra, Celebrex), newer NSAIDs that are much more expensive, are associated with an increased chance of stroke, especially in older people. Some have already been removed from the market for this reason, and should be avoided. 

Your healthcare provider may recommend other types of medications, such as steroids or narcotic painkillers in very severe cases for short-term use. However, these must be carefully managed and monitored. 

Obesity—defined as at least 20% heavier than your ideal weight—can shorten your life and is a risk factor in many serious diseases such as cardiovascular disease, diabetes, and some kinds of cancer. In particular, it raises your chance of having a stroke. The heavier you are, the greater your risk for having a stroke. 

This increase in stroke risk is probably linked to higher blood pressure, high cholesterol levels, and more severe atherosclerosis (fatty deposits in the arteries)—all of which are more prevalent in obese people.  Obesity is also associated with angina, which is chest pain caused by inadequate oxygen available to the heart. Angina is linked to sudden death from stroke and heart disease. 

Type 2 diabetes mellitus is the most common form of diabetes in older people. It is a serious chronic disease that in older adults can decrease life expectancy by an average of about 10 years. In addition, it causes many serious disabilities including blindness, amputations, higher risk of infection, kidney and nerve damage, problems in mental functioning, and many others problems. If you have diabetes, your ability to keep your blood sugar levels controlled is impaired. 

Your risk of stroke doubles if you have this disease. Most older diabetic people have atherosclerosis which raises the risk of clots and ischemic stroke. Many also have high blood pressure, which in itself raises your chance of having a stroke. To complicate matters, if you do have a stroke, it will be more difficult to control your blood sugar. 

If you are an older person who has been diagnosed with diabetes, the risk factors that you should try to control include

• high blood pressure
• high cholesterol
• smoking
• blood sugar levels
• aspirin intake
• diet. 

Treatment strategies must be tailored to the individual. For certain older patients who may be near the end of life and have many other medical conditions, very strict control of sugar levels, blood pressure, and cholesterol may not be beneficial. 

Of the 70-80% of people who survive a stroke every year, about half become depressed and about one-fifth suffer a major depression requiring immediate intensive treatment. The vast majority of these patients never experienced a depression before the stroke occurred. It is not yet known whether the depression is caused by the challenge of sudden disabilities, or if the stroke itself causes changes in the brain that bring on a depression. 

Your healthcare professional should check you for symptoms of depression within three months of your stroke, although symptoms of depression might not start for up to a year or more. If you become depressed after a stroke, you will find it more difficult to recover —both physically and mentally—from the effects of the stroke. An untreated post-stroke depression may persist for years, and is linked to an increased risk of death after a stroke. 

If you are caring for someone who has had a stroke, make sure that he or she is evaluated for depression, and receives effective treatment if depression is present. A stroke survivor may be depressed if several of the following symptoms last for more than two weeks:

• feelings of sadness and hopelessness
• loss of interest in activities that used to be enjoyed
• inability to concentrate
• no appetite
• sleep problems
• loss of energy
• thoughts of suicide

Antidepressant medications, including some of the selective serotonin reuptake inhibitors (SSRIs) are the most usual treatment for depression following a stroke. Talk therapy, including cognitive behavioral therapy with a trained counselor, in combination with medication, is the best way to resolve the depression. 

Dementia refers to symptoms of abnormal brain function that may include:

• memory loss
• language difficulties
• problems with judgment, reasoning, decision-making, and thinking in general
• abnormal perception (hallucinations)
• loss of emotional control
• behavior and personality changes, confusion, that impact on social function
• loss in ability to carry out daily functions 

Vascular dementia, or post-stroke dementia is the second most common type of dementia, after Alzheimer’s disease. Symptoms may appear right after a stroke, or may slowly develop gradually over a period of years. A healthcare professional will diagnose post-stroke dementia by carrying out neurological tests, asking simple questions, and using brain scans, such as a CT scan. 

There is no cure and it usually gets worse over time. Having a stroke doubles your likelihood of eventually suffering from dementia, and the risk increases as you get older. People with post-stroke dementia usually need to have caregiver help eventually, or require placement in a long-term care residence. 

Some of the risk factors that underlie post-stroke dementia can be controlled, such as:

• high blood pressure
• high cholesterol
• smoking
• diabetes
• atherosclerosis  (“hardening of the arteries”). 

Drug therapy focuses on the control of high blood pressure and the prevention of blood clots, management of other risk factors like diabetes if it is present, and treatment of other common complications like depression if they appear. A healthcare professional  may prescribe:

• antiplatelet agents
• blood thinners and anti-clotting drugs
• blood pressure drugs
• cholesterol-lowering medications
• drugs for heart disease, diabetes, or other conditions, if present
• antidepressants if needed
• sometimes Alzheimer’s disease may be present with vascular dementia,   drugs which are approved for the use of Alzheimer’s disease such as cholinesterase inhibitors or memantine may be prescribed by your physician 

Non-drug therapies include the following:

• Behavior training
• Education for caregivers.
• Environmental support (calendars, clocks, exposure to daylight, regular schedules, nutritious diet). 

Treatment approaches for post-stroke dementia include medication, behavioral interventions, and   occasionally surgery to improve blood flow to the brain. 

Delirium is a medical emergency, and refers to several symptoms that appear together, including:

• Confusion and disorientation
• A short attention span and ability to focus that comes and goes
• Short-term memory problems
• Poor insight and judgment. 

Delirium is extremely common right after a stroke, especially the hemorrhagic type of stroke. Up to 40% of patients become delirious during the first post-stroke week. Unfortunately, when delirium develops after a stroke, it is often the sign of worse mental consequences, longer hospitalization, and a higher risk of death. Post-stroke rehabilitation is much more difficult. Older patients are more likely to suffer from delirium after a stroke. 

Delirium differs from dementia in the way it develops suddenly—within hours or days—rather than gradually.  Symptoms of delirium tend to fluctuate, while dementia is progressive over months to years. However, post-stroke delirium may progress to true dementia after a few months. 

After a stroke, up to 60% of hospitalized older people suffer from urinary incontinence—an inability to control urination. Urinary incontinence usually occurs with large strokes that have caused other serious disabilities such as loss of speech, impaired thinking abilities (cognition), or dementia. 

All stroke survivors should be evaluated for urinary incontinence during their rehabilitation, so that the best type of therapy can be started. Early attention to this disability is more likely to bring positive results. Assessments and treatments for urinary incontinence are often very effective, especially when carried out on an individual basis by trained specialists. Treatment approaches include:

• Behavioral approaches (scheduled voiding, pelvic floor muscle training, biofeedback)
• Medications ( anticholinergic medication such as oxybutinin)
• Complementary approaches (acupuncture). 

Aphasia is the technical name for the inability to use language. It may affect speech, understanding of speech, reading or writing. Aphasia is caused by brain damage in particular language locations of the brain, and affects about one-third of stroke patients. It is especially common in older people. Aphasia can be very severe, making it impossible to understand speech or to be understood, or it can be mild, causing difficulties only in remembering names. Aphasia is one of the most distressing and frustrating complications of stroke, because it prevents communication between patient and loved ones. 

Your healthcare professional will refer you for speech therapy within the first month after a stroke if you are having language problems. A speech or language therapist will evaluate your particular difficulties, individualize your treatment, and train caregivers in treatment strategies. 

Most of the spontaneous recovery of language skills occurs in the first year after a stroke. More improvements may take place for many years, however. New types of intensive speech therapy that have proved particularly effective use several hours daily of speech training for a short length of time. But if symptoms last longer than two or three months after the stroke occurs, you will probably continue to have some long-term speech problems. 

If you are caring for a post-stroke loved one with aphasia, remember that the patient’s intelligence has not changed. Be sure to:

• Allow plenty of time for the person to finish speaking

• Not finish his or her sentences
• Turn off radios, TV or other sources of background noise
• Use any other means of communicating – gestures, drawings, facial expressions. 

If you or a loved one is unable to move limbs or feel sensation because of brain damage from a stroke, the risk of pressure ulcers – sometimes known as decubitus ulcers or “bed-sores” – becomes an issue. A pressure ulcer develops if there is unrelieved pressure from a bone lying against a surface without moving for a long period of time. The skin or soft tissue caught between the bone and the surface (such as a mattress) begins to break down. This is particularly problematic in older people because the blood circulation becomes less efficient as we age and our skin tissues are weaker. Pressure ulcers are linked to a worse outcome and greater risk of death after a stroke. 

After a stroke, your skin should be assessed when you arrive at the hospital, and every couple of days thereafter. Regular evaluations should also be done if you are in a long-term care or home care facility after a stroke. 

The most common and dangerous complication of pressure ulcers is infection. Bacteria can thrive when skin breaks down and blood does not circulate to the area. The infection may start locally, but eventually move to the blood stream or bones, causing sepsis, cellulitis and osteomyelitis – dangerous infections of the blood, skin tissues, and bones. 

Other complications of pressure ulcers are pain and depression, which need prompt treatment. 

To prevent pressure ulcers from developing, stroke patients who are unable to move their limbs freely or sense pain and pressure in affected limbs must be identified quickly. The nursing staff will change your position regularly to make sure that pressure is not always applied at the same part of your body and your blood is encouraged to circulate. 

Good nutrition is also very important in this situation. Eating well and getting all the vitamins and minerals you need helps to ensure that your skin stays as healthy as possible. 

To treat a pressure ulcer, it must be evaluated for its depth, size and stage.  Appropriate cleaning and debridement are necessary to remove dead and infected tissue when present. Pain must also be monitored and treated with painkillers.  A dressing is placed over the ulcer and kept moist with gels or foams. 

If the healthcare provider has found signs of infection (fever, increased white blood cell levels, confusion), an antibiotic will be prescribed.

You may suffer from increasing numbers of chronic medical conditions as you get older, for which you have probably received prescriptions. In general, older people take many more drugs every day than younger people – often more than 12 different medications each day. But many drugs interact or interfere with each other, to produce unexpected and often unwanted effects. Also, your ability to break down and eliminate drugs from your body decreases as you get older, leading to the risk of higher drug levels in your blood stream and tissues than was intended. This is particularly true if you have kidney or liver impairments. 

Drug interactions can effect the clotting ability of warfarin which can decrease its efficacy of preventing strokes in an individual with atrial fibrillation, or increase the risk of internal bleeding. Drug interactions may also increase the sedative properties of psychiatric medications impairing an individual’s ability to rehabilitate after a stroke. 

Many older people also take herbal or alternative remedies, without realizing that these may also interact dangerously with prescription drugs. For instance, gingko biloba and St. John’s Wort can increase the risk for stroke and vascular dementia if combined with blood thinning drugs. Drinking alcohol can also increase the impact of many types of drugs. 

Have your medications reviewed carefully. Make sure that:

• You are not taking any unnecessary drugs
• You are taking appropriate drugs for your condition
• The dose is the lowest effective dose
• The drugs do not interact in any unwanted way
• You are taking the drugs the right way and at the right time
• You know what possible side effects to watch out for. 

If you or an older loved one use alcohol, especially if the consumption is excessive, remember that it can interact with medications, increasing health risks. Also, overuse of alcohol can cause hypertension  which  is a risk factor for stroke, among other conditions, in older people. 

For an older person, having more than seven drinks per week is considered “at risk” drinking. This level is associated with internal bleeding and hemorrhagic stroke. In addition, alcohol may cause potentially harmful interactions between prescription and over-the-counter drugs. For example, the blood thinner warfarin can build up dangerously in the presence of alcohol, because the alcohol delays warfarin’s elimination from the body. Excess warfarin may cause hemorrhagic stroke. 

If you have four drinks per day or more, you are drinking excessively and should seek treatment. Do not attempt to withdraw suddenly from alcohol dependence. Your healthcare professional will help you gradually reduce your intake, thereby avoiding possible brain injury from hypertension, and other consequences of sudden withdrawal. 

Specialized clinics or support groups can be invaluable in successful alcohol withdrawal. These include Alcoholics Anonymous, Alcoholics Victorious, and Rational Recovery.

Stroke may be associated with a sudden loss of vision in one or both eyes. If your stroke affects your vision, you may only be able to see certain parts of your field of vision. Your perception of ordinary objects may be altered, or you may mistake the distances between objects. Reading may become difficult because you can only see part of the page. You may experience single-side “neglect” particularly when the brain damage from your stroke is localized to the right side of your brain. 

Hearing loss occasionally may occur suddenly as a result of a stroke, or as a warning sign that a stroke is about to happen. This type of hearing loss is much more abrupt than the gradual hearing loss associated with aging. It can eliminate hearing immediately in one or both ears, but is usually milder and sometimes temporary. 

Most older people who have difficulty walking—or a “gait disorder —are suffering from some underlying condition that is causing the problem. One of these is a previous stroke, which is linked to severe disturbance of walking ability, including spasticity. 

Gait disorders may cause a fall, which can be life-threatening for an older person. Falls result in fractures and a high risk of disability and loss of independence in the older age group.  In primary care practices, one of the most common conditions contributing to walking difficulties is stroke. If a stroke has affected your vision, sense of touch, or balance, or has left you with paralyzed limbs, risk of falling and walking problems will be much worse. Vascular dementia or other cognitive effects of stroke will also impact negatively on your gait. 

You may develop a gait disorder for no obvious reason. If this occurs, you should be evaluated for stroke risk. Difficulty walking may be a warning that you have diseased blood vessels in your brain (cerebrovascular disease). Blood pressure control, blood thinners, cholesterol control, and similar types of preventive strategies may protect against further decline. 

For stroke patients, treatments to improve walking ability include:

• strength training
• balance training
• electromyographic biofeedback
• functional electrical stimulation
• repetitive task-specific training. 

Assistive devices such as a cane or walker may allow an older person to maintain independent living, when trained to use them properly. 

Osteoporosis is the loss of bone mass usually associated with aging. Osteoporosis can be a serious disease that results in fractures and higher mortality in older people. Recently, scientists have found that having a stroke puts you at higher risk of developing osteoporosis and of having a fall. 

The risk of falling and breaking a hip is two to four times higher after a stroke, and the risk of death after a hip fracture is higher in stroke patients. Most of the osteoporotic fractures in stroke patients occur on the side of the body that has been disabled by the stroke. Because of these increased hazards, stroke survivors should consider osteoporosis treatment to strengthen bones and prevent further bone loss. 

Some osteoporosis treatments that might be started soon after a stroke include:

• Medicines such as bisphosphonates
• Increased exercise and physical activity
• Calcium and vitamin D supplements. 

Parkinson's disease, in which progressive brain damage causes jerky, uncontrolled movements, abnormal posture, muscle weakness, and difficulty walking, usually occurs spontaneously. But when the brain is damaged by a series of small strokes or a sudden larger stroke, symptoms very similar to those of Parkinson’s disease may develop. If the brain damage is the result of a single stroke event, the symptoms may occur very suddenly. This condition is called “secondary Parkinson’s disease,” “vascular parkinsonism,” or “multi-infarct parkinsonism.” 

Your Healthcare professional can make the diagnosis by evaluating symptoms and ordering brain imaging studies such as a CT scan or MRI. There may also be other symptoms that appear along with the uncontrolled movements, including dementia. Older people who suffer from vascular parkinsonism often have many stroke risk factors, including

• obesity
• high blood pressure
• elevated cholesterol and triglyceride levels
• sedentary lifestyle (not enough exercise)
• a smoking habit. 

Treatments for secondary Parkinson’s disease are similar to the approach taken to treat the spontaneous form of the disease, and include medicines such as levodopa (L-dopa).. Attention to any stroke risk factors that are present may prevent further brain damage, or even make some symptoms better. A neurologist must be consulted to help manage symptoms and try to control the progression of the disease. Close monitoring by your healthcare provider is important. 

Up to 70% of people who experience a stroke will have trouble swallowing (dysphagia) as a result. This serious problem needs to be carefully evaluated by a specially trained healthcare professional. Attention to diet and nutrition, tube feeding if needed, management and treatment are critical. Care is necessary to prevent aspiration (inhaling food), pneumonia, airway blockage, dehydration, malnutrition and weight loss, particularly in frail, older people. 

Your healthcare provider will examine you and may send you for tests to identify which aspects of eating are causing the difficulty. For example, you may be able to chew your food but not push it to the back of your mouth normally. Alternately, your swallowing reflex may not be functioning properly due to damaged nerves in your brain. Once the trouble is diagnosed, your Healthcare professional will choose appropriate treatments tailored to your individual needs. 

A healthcare professional will assess your swallowing pattern by observing your ability to eat and drink. You may also be evaluated by means of a videofluoroscope, laryngoscopy or other imaging technique. 

Common treatment approaches include:

• change to foods with easily swallowed textures, such as pureed foods
• swallow therapy (exercises done alone or while swallowing, head-lift exercises, changes in position while eating)
• breathing exercises to reduce the risk of inhaling food
• high-calorie and high-protein supplemental beverages (Boost, Ensure). 

Your healthcare professional may also consider:

• electrical stimulation of the swallowing muscles
• tongue and palate stimulation techniques
• heat and cold stimulation inside the mouth
• positional changes, such as tucking the chin under, tilting or turning the head to the side, or lying on the back
• biofeedback. 

If you cannot recover the ability to swallow food enough to keep you well-nourished, or for patients who are not sufficiently alert or who have other severe feeding problems, feeding may have to be done by tube. This may be a temporary or long-term approach. Tube feeding, also called “enteral feeding”, can be carried out short term using a nasogastric tube (a tube entering a nostril and going directly to the stomach), or long term a  tube inserted surgically directly into the stomach. 

Stroke often brings on many disabilities in addition to swallowing difficulties. Weakness in arms and legs, and loss of muscle control in the face are also frequent consequences of stroke. These frustrations can have a severe impact on the intake of food and fluids and may lead to dehydration. Even without stroke, older people tend to be less aware that they are thirsty, particularly if there are cognitive (thinking) abnormalities. Conversely, dehydration itself has been implicated as a cause of stroke. It also leads to constipation, kidney dysfunction, and mental problems such as confusion and seizures. There is a greater chance of death after a stroke if the patient is dehydrated. 

If you or someone in your care has had a stroke, fluid intake must be carefully monitored. Records of fluid intake and urine passed must be kept. Also, healthcare professionals need to check physical indicators like mucus membranes, skin, and urine color regularly. Lab tests should be ordered periodically to keep track of the fluid concentration of the blood. 

Choose foods that have a high liquid content (pureed fruits and vegetables, puddings). Intravenous (IV) fluids may be needed until fluids can be taken by mouth or feeding tube.

Frailty is a term used to describe the loss of reserves in the organs of your body so that many of your body’s systems are close to failure. If a person has reached this vulnerable state, a minor external stress such as an injury or infection may result in death or serious disability. Chronic illness, such as the disabled state that follows stroke for many people, may accelerate the development of frailty. 

Criteria that indicate potential frailty, and that occur often in patients who have had a stroke, include

• Poor function of bones and muscles
• Weak aerobic capacity (endurance)
• Impaired cognition (thinking) and brain function
• Low nutritional reserves (being underweight)
• Records of frequent falls, incontinence, confusion
• Poor capacity to interact with the environment. 

Healthcare professionals can evaluate the level of frailty with simple tests that are known to be reliable indicators, such as:

• Grip strength
• Treadmill capacity (a six minute walk)
• Balance test
• Standing from a sitting position in a chair
• Cognitive testing (the MMSE or Mini-Mental State Examination)
• Nutritional state – body mass index (BMI), measurement of arm muscle.