In this cohort of elderly patients with aSAH, an exploratory, cohort-derived threshold of approximately 80 years identified patients with markedly lower survival and functional recovery, with post-discharge improvement common in patients aged <80 years but rare in those aged ≥80 years.
Among 110 elderly patients with aneurysmal subarachnoid hemorrhage, in-hospital mortality was 18.2% and all-cause mortality during follow-up was 48.2%.
Age independently predicted both in-hospital death and long-term mortality.
An exploratory, cohort-derived age cut point of 79.5 years separated patients with markedly different mortality and survival.
Among patients discharged alive, discharge mRS independently predicted post-discharge survival, including in patients aged ≥80 years.
Functional trajectories after discharge differed by age group: recovery was frequent in patients aged <80 years but uncommon in those aged ≥80 years, who frequently progressed to death.
This study looked back at 110 people aged 65 or older treated at a London neurosciences hospital for a ruptured brain aneurysm causing bleeding around the brain (aneurysmal subarachnoid hemorrhage) between 2013 and 2022. About 18% died in hospital, and nearly half (48%) had died by the end of follow-up, which had a median of 24 months. Each additional year of age was linked to a higher risk of dying, both in hospital and over the longer term. The researchers searched for an age at which outlook changed sharply and found a cut point of about 80 years in this group. Mortality was 10.4% in those under 80 and 36.4% in those 80 or older, and median survival was about 95 months versus 3 months. Among people who left hospital alive, those under 80 often continued to improve in daily function, whereas improvement was uncommon in those 80 or older, who more often went on to die. How disabled a person was at discharge also predicted later survival in both age groups. This research suggests that age around 80 may mark a shift in prognosis after this type of bleed, and that function at discharge carries useful information even in the oldest patients. The 80-year threshold came from this one small, single-centre, retrospective cohort and is described as exploratory, so it should not be treated as a fixed rule for individual decisions, and the findings need confirmation in other groups of patients.
Fiore G, Reischer G, Kovacs B, Murphy M, Miserocchi A, Castanho P. (2026). When age matters: mortality and disability after aneurysmal subarachnoid hemorrhage in a cohort of elderly patients.. Neurosurgical review. https://doi.org/10.1007/s10143-026-04546-w