View article

Background

Stroke is a difficult disease to audit, but not necessarily any more difficult than many of the other areas included in the National Service Framework for older people. Studying disease in older people is an intrinsically complex process, which is why it needs to be done by some of the best physicians in the country. Stroke is not a single disease, but rather a clinical syndrome caused by a range of pathologies. It has an unpredictable natural history, even if variable pathology is taken into account. It is largely a disease of older people (but not exclusively, as it also occurs in children and young adults), with half the strokes in the UK occurring in people over the age of 75 years. When considering this age group, normal ageing processes have to be considered as these will affect the natural history of the disease. The patients suffering from stroke come from a wide range of social backgrounds and circumstances which will also affect the outcome. This will be particularly relevant if the outcome used is the proportion of people discharged to their own homes or if measures of quality of life are used. Finally, measurement of outcome after stroke is hindered by the lack of evidence linking process with outcome. Table 1 shows some of the areas where the lack of evidence is a particular problem.