Historically, younger stroke victims receive different after-stroke
intervention strategies than those over a certain age. However, Neale
Chumbler, a UGA professor and head of the department of health policy
and management in the College of Public Health, found patients responded
equally to care efforts.
Looking at 127 Veterans Affairs medical centers and a sample of 3,196
patients treated for ischemic strokes, or strokes caused by blood
clots, Chumbler studied patient response to care quality as outpatients
and if the response changed based on age. To determine risk, he looked
at depression symptoms, responses to blood thinning medications and
average blood pressure, blood sugar and cholesterol levels over a period
of six months after patients were released from the hospital following a
He found little difference in health quality across the patients
regardless of age. The results of the study were published in the April
issue of the Journal of Rehabilitation Research and Development.
"Watching these important risk indicators helps prevent future
complications," he said. "We want to ensure patients don't suffer
another stroke or heart attack."
Using the largest integrated medical system in the U.S., electronic
data from the VA medical centers allowed researchers to control for
stroke severity, patient socio-demographics and clinical- and
facility-level characteristics through a hierarchical linear mixed
modeling. Previous studies relied heavily on self-reported information.
"It is an integrated system with electronic medical records, which
makes it a perfect laboratory for quality improvement research," he
According to the National Institutes of Health, two-thirds of all
strokes occur in patients over the age of 65. Blood pressure goals
typically are lower for stroke patients under age 64 when compared to
those 75 to 84. Chumbler's research suggests after-stroke care, like
blood pressure management, be applied across all age groups.
While the study looked primarily at men (97 percent) who had an
average age of 67, Chumbler said the results are widely applicable to
women as well as patients of all ages.
"Anyone who has a stroke should have these risk factors monitored
when they are sent home and when they come back for follow-up
appointments," he said. "Traditionally, preventative care has not been
as aggressive for older patients. This research shows it is just as
important for people in their 80s as it is for those in their 50s."
Treatment for depression, one risk factor associated with stroke, was higher among patients younger than 55.
"Post-stroke depression is very common; 35 to 40 percent of all individuals are at risk for developing severe clinical depression after stroke, so it is very important to monitor prevention strategies for stroke survivors," Chumbler said.
Even though older patients derive as much, if not more, from stroke
prevention treatments, previous research suggests older patients are
less likely to receive interventions than younger patients. Chumbler's
findings suggest they have just as much to gain.
"Stroke management should be guided by the best clinical evidence and
guidelines irrespective of age," he said in the Journal of
Rehabilitation Research and Development article.
The full journal article is available at http://www.rehab.research.va.gov/jour/2013/502/chumbler502.html.
Source: University of Georgia