- Design
- Subgroup analysis of a single-blinded multicentre randomised trial
- Population
- 268 stroke survivors in Norway, 66 aged 80 or over
- Primary outcome
- Favourable modified Rankin Scale at 18 months
- Effect
- Aged 80 or over: 23.4% vs 57.0% favourable outcome, intervention vs control (p=0.004)
The LAST-long trial randomised 301 stroke survivors at four Norwegian hospitals to 18 months of monthly meetings with a stroke coordinator, using structured risk assessment and individual goals, or to standard care. The main trial found no overall functional benefit. This analysis asked whether age or frailty changed the effect, among 268 with outcome data.
Age did: among those aged 80 or over, a favourable modified Rankin outcome at 18 months was less common with the intervention (23.4% vs 57.0%, p=0.004). In younger participants, the intervention improved a test of executive function (Trail Making B, 32 seconds faster). Frailty did not modify the effect.
The finding is a subgroup result in a trial that was neutral overall, with only 66 participants aged 80 or over, so it may be chance. But it is a reminder that structured goal-driven programmes designed around younger stroke survivors may not suit the oldest, whose priorities and capacity differ. Programmes for this group should be tested in them rather than assumed to work.
- Tailor post-stroke follow-up for people aged 80 or over to their own goals rather than applying a standard programme.
- Ask older stroke survivors what they want from follow-up before setting rehabilitation targets.
- Monitor function in older participants when introducing structured community stroke programmes.
- Treat this subgroup result as a signal for caution, not proof of harm.
Why it matters
Interventions that are harmless or helpful in younger stroke survivors may not transfer to the oldest patients.
Don't overread it
A subgroup finding in a neutral trial does not establish that the programme harms older adults.
The statistics, in plain English
The over-80 difference looks large, but it comes from about 66 people in a trial whose main result was neutral. Subgroup findings like this are easily produced by chance and need confirmation in a trial designed to test them.
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