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Stroke in the Older Person

Edited by Sunil k. Munshi and Rowan Harwood

The complete book on stroke that traverses the whole stroke pathway
The only book that focuses specifically on strokes in older patients
Written by experts with decades of experience in geriatric medicine
Provides up to date, evidence-based information and practical tips to promote excellent, empathetic care for older patients
An essential for anyone practising stroke medicine

Stroke in the Older Person

Edited by Sunil k. Munshi and Rowan Harwood

Description

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.

Stroke in the Older Person

Edited by Sunil k. Munshi and Rowan Harwood

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

Stroke in the Older Person

Edited by Sunil k. Munshi and Rowan Harwood

Author Information

Sunil Munshi, Consultant Physician, Nottingham University Hospitals NHS Trust, Nottingham, UK,Rowan Harwood, Consultant Physician, Nottingham University Hospitals NHS Trust , Nottingham, UK

Dr Sunil Munshi is a Consultant Physician and Geriatrician in the Department of Stroke and Medicine at Nottingham University Hospital at Nottingham University School of Medicine. He was awarded "Best Clinical Teacher of Nottingham University Hospitals" and his education programme in stroke was nominated for the BMJ Education Award in 2017. His research interests include stroke, geriatric medicine, cerebrovascular circulation, stroke thrombolysis, and cerebrovascular disease He was presented the Health Innovation and Education Cluster award for Stroke Teaching.

Professor Rowan Harwood is a Consultant Physician and Geriatrician, and Professor of Palliative 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.

Contributors:

Sandeep Ankolekar, Consultant Neurologist, Kingâs College Hospitals NHS Foundation Trust, London, UK

Jason P. Appleton, Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK

Dorothee P. Auer, Sir Peter Mansfield Imaging Centre, School of Medicine, University of Nottingham, Nottingham, UK

Philip M. Bath, Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK

Jessica Beavan, Department of Stroke Medicine, Royal Derby Hospital, Derby, UK

Gordon Blair, Brain Research Imaging Centre, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK

Adrian Blundell, Consultant Geriatrician, Nottingham University Hospitals NHS Trust, Nottingham, UK

Louis R. Caplan, Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, USA

Daniel Kam Yin Chan, University of New South Wales, Sydney, Australia

Avril Drummond, Professor of Healthcare Research and Occupational Therapist, University of Nottingham, Nottingham, UK

Timothy J. England, Clinical Associate Professor of Stroke and Honorary Consultant Physician, University of Nottingham and Royal Derby Hospital, Derby, UK

Amlyn Evans, Nottingham University Hospitals NHS Trust, Nottingham, UK

Lisa Everton, Speech and Language Therapy Department, Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK

Clair Finnemore, Clinical Specialist Stroke: Physiotherapist, Sandwell and West Birmingham Hospitals NHS Trust, UK

Catherine Gaynor, Nottingham University Hospital, Nottingham, UK

Amy C. Gerrish, Consultant Neuroradiologist, Nottingham University Hospitals NHS Trust, Nottingham, UK

Adam L. Gordon, Professor of the Care of Older People, University of Nottingham, Nottingham, UK

Paul Guyler Lead Consultant in Stroke Medicine Southend University Hospital NHS Foundation Trust Southend-on-Sea UK

Marissa Hagan, Senior Registrar Geriatric Medicine, Queen's Medical Centre, Nottingham, UK

Rowan H. Harwood, Professor of Palliative and End of life care, School of Health Sciences University of Nottingham, honorary consultant geriatrician (formerly consultant stroke physician) Nottingham University Hospitals NHS Trust, Nottingham, UK

Dawn Hicklin, Therapy Lead Stroke/Neurology Rehabilitation: Physiotherapist, Sandwell and West Birmingham Hospitals NHS Trust, UK

Amy Hillarious Registrar of Health care of the Elderly Nottingham University Hospital, Nottingham, UK

Sally Knapp, Speech and Language Therapy Stroke Pathway Lead Nottinghamshire Healthcare NHS Foundation Trust Nottingham, UK

Ian I. Kneebone, Discipline of Clinical Psychology, Graduate School of Health, Sydney, Australia

Kailash Krishnan, School of Medicine, Nottingham City Hospital, UK

Zhe Kang Law, Clinical Research Fellow, University of Nottingham, Nottingham, UK

Phillipa A. Logan, Queen's Medical Centre, Nottingham, UK

David Mangion, Pilgrim Hospital, United Lincolnshire Hospitals NHS Trust, Boston, UK

Mohana Maddula, Consultant Stroke Physician & Geriatrician, Tauranga Hospital, Tauranga, New Zealand

Thomas McGowan, Geriatric Medicine Registrar, Royal Derby Hospital, Derby, UK

Jatinder S. Minhas, Postdoctoral Fellow, University of Leicester and Specialist Registrar in Geriatric (Stroke) Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK

Amit K. Mistri, Consultant in Stroke Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK

Reg C. Morris, Honorary Professor/Consultant Clinical Psychologist, Cardiff University/Cardiff and Vale UHB, Cardiff, UK.

Sunil k. Munshi, Consultant Physician and Geriatrician, Nottingham University Hospitals, Nottingham, UK

Sushma Dhar Munshi Consultant Ophthalmologist Sherwood Forest Hospitals NHS Foundation Trust Mansfield Road Sutton in Ashfield Nottinghamshire, UK

Ossie Newell, MBE, Founder & Trustee of the Ossie Newell Foundation Trust Ambassador for Stroke & Patient Representative University of Nottingham, Nottingham UK

Declan O'Kane, Consultant Physician, Brighton and Sussex University Hospitals, Brighton, UK

Rowena Padamsey, Advanced Occupational Therapy Practitioner, Nottingham University Hospitals NHS Trust, Nottingham, UK

Deborah Plunkett, Head Orthoptist Orthoptic Department King's Mill Hospital Mansfield Road Sutton In Ashfield Nottinghamshire, UK

Senthil Raghunathan, Consultant Stroke Physician, Nottingham City Hospital, Nottingham, UK

Thompson G. Robinson, Head of Department and Professor of Stroke Medicine, University of Leicester, Leicester, UK

Jagdish Sharma, Lincoln County Hospital, University of Lincoln, Lincoln, UK

Ashit K.Shetty, Consultant stroke Physician & HOS for stroke, Hon.[Clinical] Assistant .Professor University of Nottingham, Nottingham University Hospital Nottingham UK

Michela Simoni, Neurology Registrar in the West Midlands Deanery, working at Queen Elizabeth Hospital, Birmingham, UK

Nikola Sprigg, Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, City Hospital, Nottingham, UK

Christopher D. Stephen, Instructor in Neurology, Massachusetts General Hospital, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA

Ganesh Subramanian, Consultant Stroke Physician, Nottingham University Hospitals NHS Trust Honorary Clinical Associate Professor, University of Nottingham, Nottingham, UK

Wayne Sunman, Consultant Stroke Physician, Nottingham University Hospitals NHS Trust, Nottingham, UK

Joanna M. Wardlaw, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK

Dee Webster, Highly Specialist Speech & Language Therapist / University Teacher, Nottinghamshire Healthcare NHS Foundation Trust / University of Sheffield, Sheffield, UK