Old stroke survivor
a life of low quality
yet high quantity.
A stroke, otherwise known as a cerebrovascular accident, is a serious health problem whereby blood flow to the brain is interrupted by a blocked or ruptured blood vessel. A stroke is life threatening and requires emergency medical attention. If an individual survives a stroke, then he or she may live with one or more long-term effects, such as memory loss, hemiplegia (i.e. paralysis on one side of the body), visual impairment, or speech problems. Such long-term effects can negatively impact on a stroke survivor’s quality of life across multiple domains: independent living, social relationships, illness, physical senses, and psychological wellbeing. While quality of life has been well studied in the short term after stroke, few studies have investigated quality of life among long-term stroke survivors.
In original research conducted as part of my Master of Biostatistics degree, I assessed quality of life at seven years post-stroke among people residing in the north-eastern suburbs of Melbourne. The validated Assessment of Quality of Life (AQoL) instrument was used to measure quality of life. In the AQoL instrument, scores range from -0.04 (worse than death) to 0.00 (death equivalent) to 1.00 (optimal). Among 1321 stroke cases with a mean age of 68 years, 413 (31% of stroke cases) were still alive at seven years post-stroke and 328 (79% of survivors) were assessed in my study. Of the 328 long-term stroke survivors assessed, 76 (23%) had very poor quality of life ranging from -0.038 to 0.100. Furthermore, 6% of patients had quality of life that healthy individuals deem worse than death (i.e. ranging from -0.038 to 0.00). The mean quality of life score at seven years post-stroke was 0.51. This score means that, if faced with the prospect of being an average seven-year stroke survivor, a given person in the general population would rather live in full health for half of his or her expected life span.
This research is important in that it highlights the dire need for interventions to improve quality of life in the long-term after stroke. Potentially modifiable factors associated with better quality of life in the long-term after stroke could be targeted to improve the quality of stroke survivors’ lives. In my original research, the potentially modifiable factors associated with better quality of life included lesser handicap and independence in activities of daily living (e.g. indoor mobility, dressing, and shopping). An example of a promising targeted intervention to improve post-stroke quality of life is cognitive training aimed at improving brain function. As cognitive training has been shown to make people more independent in activities of daily living over a five-year period, it is a promising intervention to improve quality of life in the long-term after stroke.
Original research:
Leach MJ, Gall SL, Dewey HM, Macdonell RAL, Thrift AG. Factors associated with quality of life in 7-year survivors of stroke. Journal of Neurology, Neurosurgery & Psychiatry. 2011; 82(12):1365-1371. http://dx.doi.org/10.1136/jnnp.2010.234765
Dr Michael J. Leach is an Australian health researcher, biostatistician, and poet with a PhD in Pharmaco-epidemiology and a passion for health humanities. Examples of his science poems are available online: https://imagesofhealth.wordpress.com/.
If you enjoyed this sciku, check out Michael’s other sciku ‘Drug-Induced Hip Fractures‘, ‘The Psychopharmacological Revolution‘, ‘The Core Correlate of Covid-19 Vaccine Acceptance’, ‘The Early Impacts of COVID-19 on Australian General Practice‘, ‘The Burden of Bushfire Smoke‘, and ‘Australian Science Poetry‘ with science communicator Rachel Rayner.