Life after stroke

Abstract

Stroke is a common, disabling, and expensive condition. In the Unites States alone, stroke prevalence exceeds 3.2%, with an annual cost approaching $40 billion, including the cost of health care services, medications, and lost productivity. 1 Stroke is not restricted to old age. Nearly 1 of every 5 strokes occurs in young adults; strokes can also occur in adolescents and children. 2 Several lines of evidence have raised public health concerns about the rising prevalence of traditional vascular risk factors in young individuals, and their potential role in increasing the risk for ischemic stroke, recurrent stroke, and poststroke mortality. 3,4 These data have started drawing attention to the problem of stroke in the young, 2 and have already stimulated research in the field.Compared to stroke in the aged population, stroke at young age incurs a disproportionately large economic cost by leaving victims disabled in, or prior to, their most productive years. A sizeable proportion (up to 53%) of young stroke patients do not return to the workforce, and an additional 23% require occupational adjustment in order to resume work. 5,6 Factors such as poststroke functional independence, positive attitude, and type of work are independent predictors of resuming work. 7 In this issue of Neurology ® , an esteemed group of researchers in the field of young adult stroke report on the prevalence, excess risk, and risk factors of unemployment after a stroke or TIA in young individuals in the Netherlands. 8 Over a span of 3 decades , the investigators prospectively accrued and followed a relatively large number of young stroke patients. By obtaining de-identified data from the Dutch Central Bureau of Statistics, a national registry of citizens who receive disability payments, these authors, in contrast to previous studies, could compare disability payments (a marker for unemployment) in stroke patients vs the working population. Nearly 30% of this stroke cohort received disability payments after a mean follow-up of 8.1 years, with 84.2% on full disability and the rest on partial disability. The higher risk for unemployment in stroke cases was evident for both sexes and across most age groups. Those in the 35-44 years age group endured the highest risk for unemployment, at a time when individuals are typically the most productive. As expected, patients with brain hemorrhage had the highest rates of unemployment. Baseline stroke severity and the duration of follow-up were associated with a higher risk for unemployment. Interestingly, excluding TIA patients from the analysis did not substantially change the risk for unemployment. These results suggest an enduring effect of stroke-related neurologic deficits, and possibly other intangible effects of stroke regardless of deficits, which prevent survivors from returning to the workforce.Stroke survivors need more than just medications or limb or language rehabilitative services to resume life after stroke. A greater understanding of stroke-induced cognitive, psychosocial, and personality...

Sickness absence and return to work among Japanese stroke survivors: a 365-day cohort study

“…This type of study may help companies establish and improve their RTW support system for stroke survivors, and improvements in healthcare policies may provide greater support and satisfaction for stroke survivors’ and their families. 13 Organisational RTW support is very important for facilitating RTW for workers with long-term sickness leave. 40 Future studies should investigate, in more detail, predictors of recurrent sickness absence after RTW to mediate drafting of a strategy for RTW support for employees who have had a stroke.…”

“… 1 4 9–11 Stroke at a younger age causes a disproportionate burden due to direct costs of providing medical care to the patient as well as indirect costs associated with lost productivity. 4 12 13 This is not only an individual loss, but an economic burden to society, as the expected duration of sickness absence is high in these younger patients. 14 15 Return to work (RTW) after stroke has become increasingly important as a stroke-related outcome in occupational health services as well as in community-based rehabilitation, 3 16–18 and promoting early RTW after stroke may help reduce indirect costs that, for example, are associated with lost productivity for companies.…”

“…Furthermore, this study may help companies establish or improve their RTW support systems for stroke survivors, and these improved healthcare policies may provide greater support and satisfaction to stroke survivors and their families. 13 …”

Pulse on Stroke in Pulseless Disease (Takayasu Arteritis)

“…8,9 After all, although uncommon, Takayasu arteritis affects young patients where the occurrence of stroke and even TIA carries a disproportionately high socioeconomic and psychological impact. [10][11][12]…”