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Published on: May 22, 2019
Characterisation of young stroke presentations, pathways of care, and support for 'invisible' difficulties: a
Michaela Grech1, Toni Withiel2, Marlena Klaic3
1School of Psychology and Public Health, La Trobe University, Melbourne, Vic, Australia.
Insights
Young stroke survivors often leave hospital without rehabilitation, unlike older patients. This study highlights unmet cognitive and psychological needs in young stroke survivors, suggesting current services require adaptation.
Area of Science:
- Neurology
- Rehabilitation Medicine
- Health Services Research
Background:
- Young stroke survivors face unique challenges in acute care compared to older individuals.
- Existing research lacks detailed insights into the real-world care pathways for young stroke survivors.
- There is a need to understand the specific rehabilitation and support needs of this demographic.
Purpose of the Study:
- To compare the characteristics and care pathways of young (≤45 years) and older stroke survivors.
- To describe stroke presentations and predictors of care in young survivors.
- To investigate the provision of care for cognitive and psychological difficulties in young stroke survivors.
Main Methods:
- Retrospective audit of 847 medical records from an Australian tertiary hospital.
- Included 67 young stroke survivors (mean age 36) and 780 older survivors (mean age 70).
- Analyzed stroke characteristics, cognitive difficulties, length of stay, and discharge destination.
Main Results:
- No difference in length of stay between young and older survivors.
- Young survivors were more likely to be discharged home without rehabilitation.
- Cognitive difficulties predicted longer hospital stays for young survivors, while stroke severity and age predicted discharge destination.
Conclusions:
- Young stroke survivors' cognitive and psychological needs may be inadequately addressed by services designed for older populations.
- Current service models may not fully meet the complex needs of young stroke survivors.
- Findings support the development of specialized services, like the Australian Young Stroke Service, to better cater to young survivors.
Abstract:
Background Young stroke survivors are likely to be discharged home from acute hospital care without rehabilitation more quickly than older survivors, but it is not clear why. File-audit studies capturing real-world clinical practice are lacking for this cohort. We aimed to compare characteristics and care pathways of young and older survivors and describe stroke presentations and predictors of pathways of care in young survivors (≤45years), including a focus on care received for 'invisible' (cognitive, psychological) difficulties. Methods A retrospective audit of 847 medical records (67 young stroke survivors, mean age=36years; 780 older patients, mean age=70years) was completed for stroke survivors admitted to an Australian tertiary hospital. Stroke characteristics and presence of cognitive difficulties (identified through clinician opinion or cognitive screening) were used to predict length of stay and discharge destination in young stroke survivors. Results There were no differences in length of stay between young and older survivors, however, young stroke survivors were more likely to be discharged home without rehabilitation (though this may be due to milder strokes observed in young stroke survivors). For young stroke survivors, stroke severity and age predicted discharge destination, while cognitive difficulties predicted longer length of stay. While almost all young survivors were offered occupational therapy and physiotherapy, none received psychological input (clinical, health or neuropsychology). Conclusions Cognitive and psychological needs of young stroke survivors may remain largely unmet by a service model designed for older people. Findings can inform service development or models of care, such as the new Australian Young Stroke Service designed to better meet the needs of young survivors.
