Stroke in the Older Person

ISBN : 9780198747499

Sunil Munshi; Rowan Harwood
488 ページ
171 x 171 mm

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.


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


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.