Treatment and Outcomes of Working Aged Adults with Stroke: Results from a National Prospective Registry

Abstract

Background: Given the potential differences in etiology and impact, the treatment and outcome of younger patients (aged 18–64 years) require examination separately to older adults (aged ≥65 years) who experience acute stroke. Methods: Data from the Australian Stroke Clinical Registry (2010–2015) including demographic and clinical characteristics, provision of evidence-based therapies and health-related quality of life (HRQoL) post-stroke was used. Descriptive statistics and multilevel regression models were used for group comparisons. Results: Compared to older patients (age ≥65 years) among 26,220 registrants, 6,526 (25%) younger patients (age 18–64 years) were more often male (63 vs. 51%; p < 0.001), born in Australia (70 vs. 63%; p < 0.001), more often discharged home from acute care (56 vs. 38%; p < 0.001), and less likely to receive antihypertensive medication (61 vs. 73%; p < 0.001). Younger patients had a 74% greater odds of having lower HRQoL compared to an equivalent aged-matched general population (adjusted OR 1.74, 95% CI 1.56–1.93, p < 0.001). Conclusions: Younger stroke patients exhibited distinct differences from their older counterparts with respect to demographic and clinical characteristics, prescription of antihypertensive medications and residual health status.

Investigating the transition to home experience for people with mild stroke: the mild stroke transitional experience in Australia

“…The findings from this project cannot be undervalued, with recent Australian reports identifying that mild stroke not only contributes substantially to the overall stroke population in Australia, but more and more individuals between the ages of 18 and 64 are contributing to this population (Lannin et al, 2017). Whilst this population reports higher health related quality of life scores than their older counterparts, their scores are lower than the aged matched general population (Lannin et al, 2017). This reflects findings of the current program of research and brings into question the difference between surviving and living after stroke.…”

“…Turner and colleagues (2018) from the United Kingdom also emphasised the need for this research, particularly in understanding experiences of current care in different locations. Other researchers in the general stroke field have also enforced this, paying particular attention to outcomes for younger people with stroke (Lannin et al, 2017). Exploring these outcomes from a longitudinal perspective, including the economic implications for future generations would also be helpful to direct services accordingly.…”

“…Support for research in this area has been indicated by a number of authors, who have stated that optimal management in the delivery of healthcare for people with mild stroke still requires further research (Finch et al, 2017;Lannin et al, 2012;Turner et al, 2018). Specific service areas to be addressed include those that cater for people of working age (Lannin et al, 2017), return to work (Sinclair et al, 2014), follow up care and the best setting for it (Turner et al, 2018). Consideration of the impact of the medical model and an impairment-centred approach is needed and the development of future services should incorporate a strengths-based approach for this population.…”

“…Whilst a mild stroke results in less 'observable' symptoms than its more severe counterparts, it has been indicated that contextual factors in the person's life contribute to the severity of its implications (White, Attia, Sturm, Carter, & Magin, 2014;Wolf et al, 2009). For instance, people under the age of 65 make up a large proportion of the mild stroke population and are often working full-time and raising a family at the time of the stroke (Lannin et al, 2017;Wolf et al, 2009). This can result in productivity and economic implications, especially when services to assist in community reintegration and return to work are not provided (Burns et al, 2018;Wolf et al, 2009).…”

“…Currently there is a dearth of mild stroke specific services, with ongoing implications for health services and society in general (Wolf et al, 2009) and potential increased likelihood of subsequent strokes for the person (White et al, 2014). As a result of limited mild stroke specific services there is also minimal understanding of this population's experiences of health services (Burns et al, 2018;Lannin et al, 2017) restricting advancement in the field.…”