Stroke is a disease with an acute beginning and a chronic end. It is a major cause of morbidity and mortality in the elderly. The condition is of equal frequency in the two sexes and increases steeply with age, and approximately 75% of all strokes occur in patients over 65 years of age.
Any obstruction in the flow of blood to the brain may lead to complications in old age. As one grows older; flow of blood to the brain declines gradually. For a child with brain weighing 100grams, there will be a flow of 100 milli-litre blood to the brain per minute. In middle age the flow will settle down to 50 milli-litres and it will come down to 35 milli-litres in the case of an old person with a brain weighing 100 grams. If there is any obstruction in the flow of blood to the brain of an old person it will retard the functioning of the brain and lead to dementia, paralysis or fits. Paralysis or stroke is the most debilitating of the diseases and accounts for the crippling and death of large number of old people. It is the brain which activates all other parts of the body. The power to control and activate parts on the right side of the body lies on the left side of the brain while the right side of the brain activates the parts on the left. If there is obstruction in the flow of blood to the left half of the brain, the right hand, the right leg and the right side of the face will be paralyzed. The speech centre which enables one to speak is on the left and any obstruction in the flow of blood to the left half of the brain will result in the loss of speech with paralysis on the right side of the body. Those who are paralyzed on the left side of the body will be able to speak. If the blood flow to the brain is obstructed, the brain is deprived of oxygen and other essential substances and loses its capacity to function.
- Thrombosis – This is a most common cause of stroke. Arteries become partly closed by the build up of fatty deposits or artherosclerosis. Blood flow is slowed so that clots form in the clogged vessel, blocking the blood supply to a part of the brain.
- Embolism – A wandering clot, originating outside the brain is carried by the bloodstream to the brain. This clot plugs the vessels, blocking the blood flow.
- Hemorrhage – Sometimes, weak points arise in a blood vessel at birth or as result of high blood pressure. A rupture or breakout of a blood vessel in the brain occurs and hemorrhage results. The death rate from this type of stroke is extremely high and the chances of complete recovery are slimmer than with strokes cause by clots.
Not all elderly people suffer from stroke. But chances of paralytic attacks are considerable if the patient has the following disorders.
- The most important of these is hypertension. Many studies have established that, in men and women under the age of 85 years, the blood pressure in excess of 160/90 mHg is associated with increased risk of stroke.
- Patients with diabetes mellitus also are at increased risk.
- Cigarette smoking increases the risk of stroke.
- A moderate consumption of alcohol may have a beneficial effect upon the vascular system, while heavy drinking increases the risk of stroke.
- Hypertension secondary to heart failure, internal bleeding, dehydration and drugs can also predispose the development of stroke.
Symptoms are often vague and confusing, and because they are temporary, people tend to brush them off.
- Sudden blindness or dimming of vision in one or both eyes.
- Weakness or numbness in an arm, leg or facial muscles.
- Difficulty in speaking.
- Mental confusion or epileptic fit.
- Dizziness or fainting.
- Loss of balance.
- The most common complication is aspiration pneumonitis wherein the patient aspirates food into the respiratory tract. This leads to secondary infections in the lungs.
- Due to reduced vascular supply to the brain, the patient may suffer confusion, or speech disturbances.
- Urinary incontinence, urinary infection.
- Residual paralysis, spasticity leading subsequently to contractures and pain.
- Due to restricted mobility, the veins of lower limbs may develop thrombus formation (clots). This obstructs the free flow of blood and produces severe pain. Further the clot may disengage, and reach the lungs via circulation and produce a pulmonary damage which is life threatening.
- Once the patient is bed fast, the risk of developing pressure sores is high. Once the organism enters the blood stream, septicaemia may occur.
- An aphasic (loss of speech) and bedridden stroke patient may not be able to communicate properly and hence if proper care is not taken regarding fluid intake and diet, one may go in for dehydration and nutritional deficiencies.
- Bed fast individual also develops constipation.
- Cramps are commonly seen in stroke patients because of the disability to frequently change positions.
- Stroke patients are more likely to fall than other people. They tend to fall to the affected side because of the weakness of the muscle.
- In patients with long standing stroke, the mineral content of the bone reduces slowly and hence may lead to osteoporosis.
- The ideal treatment for stroke is administration of drugs which will arrest the brain damage, improve the circulation or nutrition of these areas which are affected, and prevent or arrest the process of damage.
- Reduction of the brain oedema by drugs.
- Treatment of the accompanying predisposing factors like hypertension, diabetes mellitus etc.
- The patients should be given nutritious food in required quantities. Adequate fluids should also be given.
- The legs and hands of the paralytic patients tend to be stiff and regular physiotherapy must be given which will help in speedy recovery of the patient.
- Control high blood pressure.
- Avoid smoking.
- Avoid high cholesterol and fatty foods.
- Avoid excess alcohol.
- Reduce salt intake.
- Avoid obesity.
- Exercise regularly.
- Avoid excessive stress.