Stroke recurrence remains a major challenge in older adults, despite well-established secondary prevention guidelines. Sustaining long-term adherence is particularly complex in aging populations, where multimorbidity, polypharmacy, cognitive decline, and functional limitations often interfere with consistent prevention practices. This international systematic review synthesized randomized controlled trials evaluating secondary stroke prevention interventions in adults aged 60 years and older, with a focus on real-world barriers and facilitators influencing long-term engagement. Following PRISMA 2020 guidelines and PROSPERO registration (CRD420251177501), PubMed and Scopus were searched through April 2025. Seventeen trials involving approximately 17,000 participants were included, and risk of bias was assessed using the Cochrane RoB 2 tool. Across diverse healthcare settings, multicomponent interventions combining medication management with structured education, behavioral support, and ongoing follow-up, often delivered through home-based or digital approaches, were most consistently associated with improved adherence, vascular risk-factor control, and quality of life. In contrast, pharmacological strategies alone showed limited or short-lived benefits. Common barriers included low motivation, cognitive challenges, technological difficulties, and fragmented continuity of care, whereas facilitators centered on personalized education, multidisciplinary coordination, and sustained monitoring. These findings suggest that effective secondary prevention in older stroke survivors requires integrated, person-centered models that embed education and follow-up as essential components of care, supporting healthier aging and addressing the persistent gap between guideline recommendations and real-world implementation.

Funding: This project has received funding from Boehringer Ingelheim (Grant number 695751, 2023).

Authors:
Myrto Pyrrou, University of Macedonia, Greece
Anna Tsiakiri, Democritus University of Thrace, Greece
Konstantinos Vadikolias, Democritus University of Thrace, Greece
Hariklia Proios, University of Macedonia, Greece

About the Presenter(s)
Myrto Pyrrou is a Special Educator and Sociologist and MSc candidate in Stroke Studies focusing on ageing, vascular health, and stroke prevention. Her current research explores secondary prevention and health behaviour adherence in older adults.

See this presentation on the full schedule – Thursday Schedule

Bookmark