Stroke in older adults: FAST signs, emergency care and recovery

The Stroke Association says a stroke happens when the blood supply to part of the brain is cut off, killing brain cells; the effects depend on where in the brain it occurs and how big the damaged area is. An ischaemic stroke is caused by a blockage. A haemorrhagic stroke is caused by bleeding in or around the brain. A TIA is a transient ischaemic attack, or mini-stroke, covered in a separate guide on this site.

Most people who have a stroke are older, although the Stroke Association notes that one in four strokes in the UK happens to people of working age and that younger people, including children, can be affected.

The NHS describes face weakness (one side may droop and it may be hard to smile), arm weakness (unable to lift both arms and keep them there because of weakness or numbness in one arm) and speech problems (slurred or confused speech), with the word FAST standing for face, arms, speech and time to call 999. Other signs listed by the NHS include weakness or numbness down one side of the body, blurred vision or loss of sight in one or both eyes, difficulty speaking or finding words, confusion and memory loss, dizziness or falling over, a severe headache, and nausea or vomiting.

Importantly, the NHS says symptoms can stop after a short time so you may think you are fine, but you should still get medical help straight away. In an older person living alone, a relative may first notice confusion, a fall, slurred speech on the phone or a drooping smile. Do not wait to see if it settles.

The NHS says to call 999 now if you think you are having or have had a stroke, or have had stroke signs in the last 24 hours even if they have stopped. It says not to drive yourself to A&E. Stroke needs urgent hospital care because it can be life-threatening.

Treatment depends on the type of stroke. In the first 24 hours, the NHS says it may include medicine to dissolve blood clots in the brain (thrombolysis), surgery to remove a clot (thrombectomy) or drain fluid from the brain, or a procedure to relieve pressure inside the skull. A team of doctors, specialists and therapists starts recovery in hospital. The Stroke Association says swallowing should be assessed within four hours of arrival and nothing should be eaten, drunk or taken by mouth until checked, since stroke raises the risk of aspiration pneumonia. Longer-term medicines often include anticoagulants to stop clots, blood pressure medicines and statins, per the NHS.

The NHS lists risk increasing if you are over 50, are from a Black or South Asian background, have sickle cell disease, an unhealthy lifestyle, migraines, take the combined contraceptive pill, or are pregnant with pre-eclampsia or have just had a baby. Conditions raising risk include high blood pressure, diabetes, atrial fibrillation, high cholesterol and a previous TIA. The Stroke Association adds family history and lifestyle factors.

After a stroke or TIA you are at higher risk of another, but the NHS says quitting smoking, a balanced diet, exercise and cutting down on alcohol lower it, and it is important not to forget medicines for underlying conditions such as high blood pressure or diabetes; talk to a GP if there are problems with a medicine. For older people on many tablets, a pharmacist or GP medicines review can help keep treatment manageable.

The Stroke Association says all strokes are different: for some the effects are minor and short-lived, others have more serious long-term problems. Effects include physical changes such as swallowing difficulty, pain and altered sensation, problems with speech and understanding (aphasia), emotional and behavioural changes, memory and concentration problems, vision problems (about two thirds of people have them) and brain fog. It links vascular dementia with stroke.

The NHS says recovery can take days or weeks with little impact for some, and months or years for others, possibly with life changes such as adapting the home or stopping work. On discharge the healthcare team creates a home recovery plan that may include physiotherapy, cognitive behavioural therapy for anxiety, depression and tiredness, cognitive rehabilitation for memory and concentration, therapy for speech, swallowing and vision, and help with bowel or bladder problems. Rehabilitation can be done in person or online (telerehabilitation), with equipment and technical support provided. The Stroke Association also mentions neuroplasticity, the brain's ability to re-wire itself to improve skills such as walking, talking and using an affected arm.

The NHS says that if you are caring for someone who has had a stroke you will be a big part of their recovery, and that looking after someone can be difficult, frustrating and lonely, so make sure you get the help you need. It points to the Stroke Association and Different Strokes charity for guides on recovery and caring. For older couples where one carer may themselves be frail, asking for a carer's assessment from social services is worth considering.