Stroke in older adults: exploring the intersections of comorbidity, disability, and frailty

Although the epidemiology of cerebrovascular disease is changing, stroke remains predominantly a disease of older adults. Clinicians, researchers, and policy makers should, therefore, be familiar with the key contextual factors of older age and how these factors might affect stroke care. Arguably, the three overarching manifestations of complexity in ageing are: comorbidity, disability, and frailty. These conditions are all common in stroke and, alone or in combination, have important consequences for stroke care and outcomes. In a bidirectional relationship, each factor can also have modifying effects on stroke and the response to interventions. In this Review, we consider each of these factors in turn, providing a definition, guide to assessment, and implications for stroke care. We also describe the consequences of ageing across the entire stroke journey, from prevention through acute care to life after stroke. At each stage we offer examples of novel approaches or innovations in stroke care for older adults. Even though comorbidity, disability, and frailty are distinct, we observed common themes, namely that current stroke pathways do not adequately assess for these conditions and that the stroke community can learn from research in other aspects of older adult care.