INTRODUCTION Although an advanced age is a factor associated to a poorer functional prognosis following a stroke, the capacity for recovery can be determined by other intercurrent clinical, functional and mental factors.

AIM To evaluate the factors that determine the functional prognosis on discharge of very elderly patients who were admitted to hospital for their functional recovery after suffering a stroke.

PATIENTS AND METHODS We conducted a longitudinal observational study of 168 patients over 65 years of age, who were hospitalised consecutively over a 15-month period. On admission, data concerning a number of clinical, neurological, functional and mental variables were collected. On being discharged from hospital their functional situation (Barthel index) and institutionalisation were evaluated.

RESULTS The 48 patients aged 85 and above presented a lower degree of overall and relative functional recovery on discharge from hospital. Nevertheless, 52% had gained more than 20 points on the Barthel index on being discharged with respect to their score when they were admitted; on discharge 44% had recovered over 50% of the functional loss they had suffered following the stroke. On including the other basal variables in a logistic regression analysis, a very advanced age was associated in an independent manner to a greater risk of being institutionalised, but not to a poorer functional prognosis at discharge. Severe functional impairment on admission and post-stroke depression were the factors that were independently associated to moderate-severe disability on admission; in addition, the more severe the neurological consequences were, the lower the level of functional recovery was.

CONCLUSIONS The capacity for functional recovery in very elderly stroke patients is mainly determined by the degree of functional and neurological repercussion. The functional prognosis should be individualised according to these factors, regardless of the age.

Introducción Aunque la edad avanzada es un factor asociado a un peor pronóstico funcional tras un ictus, la capacidad de recuperación puede venir determinada por otros factores clínicos, funcionales y mentales intercurrentes.

Objetivo Evaluar los factores que determinan el pronóstico funcional al alta de pacientes muy ancianos ingresados para recuperación funcional tras sufrir un ictus.

Pacientes y métodos Estudio longitudinal de observación de 168 pacientes mayores de 65 años, ingresados consecutivamente durante un período de 15 meses. A su ingreso se recogieron variables clínicas, neurológicas, funcionales y mentales. Al alta se evaluó la situación funcional (índice de Barthel) y la institucionalización.

Resultados Los 48 pacientes de 85 y más años presentaban una menor recuperación funcional global y relativa al alta; pese a ello, el 52% ganaban más de 20 puntos en el índice de Barthel al alta con relación al del ingreso y un 44% recuperaban al alta más del 50% de la pérdida funcional sufrida tras el ictus. Al incluir el resto de variables basales en un análisis de regresión logística, la edad muy avanzada se asociaba de forma independiente a mayor riesgo de institucionalización, pero no a peor pronóstico funcional al alta. El deterioro funcional grave al ingreso y la depresión postictus eran los factores independientemente asociados a la discapacidad moderada-grave al alta y la mayor gravedad neurológica se relacionaba con una menor recuperación funcional y mayor tasa de institucionalización.

Conclusiones La capacidad de recuperación funcional en pacientes con ictus muy ancianos viene determinada principalmente por el grado de repercusión funcional y neurológica. Es necesario individualizar el pronóstico funcional por estos factores, independientemente de la edad.