Learning from our Neighbors up North
On three occasions, I have traveled to Canada to participate in Canadian Stroke Conferences as part of my global review of stroke initiatives. This past year I was invited to have a Poster Presentation as part of the Canadian Stroke Congress. I was honored as a survivor since these were scientific meetings and for the most part the posters were scientific.
Since I was also a US Media representative I had a platform to chat with many of the really bright scientists who attended the meeting. At these meeting’s, I have always been impressed with the resources being dedicated to stroke in Canada and when I speak in America always remark about it. Remember, though Canada is a quite large county in terms of square miles, its population is only about 10% of America’s. I have also been quite interested that there were many American presenters.
Having made important connections, I thought it would be interesting to look at some of the highlights of the 2017 Canadian Stroke Report. The following was communicated in an email which I received and thank the Heart and Stroke Foundation in Canada for including me.
I should note that their data is about the Canadian population however there is little reason to think that proportionately it would be much different than the US. Also, they have a completely different healthcare funding scheme – a so called single payor system which is the government. Canadian taxes are higher than in the US however healthcare is paid through taxation.
We would sincerely like to thank the Canadian Heart and Stroke Foundation for their work and for making their Report available.
That said, here are their highlights verbatim:
Highlights from the 2017 Canadian Heart and Stroke Report
Half of stroke survivors require assistance with basic daily activities
OTTAWA, June 7, 2017 /CNW/ – The Heart & Stroke 2017 Stroke Report reveals extensive gaps in recovery support and services for Canadians who experience stroke at any age. Half of stroke survivors need help with daily activities such as eating, bathing, dressing, going to the washroom and getting around. Many deficits are “hidden” such as memory issues, depression or fatigue, or behavior issues in kids. These are not well understood, and overall many needs are not being met.
“We know stroke can happen at any age,” says Yves Savoie, CEO, Heart & Stroke. “We need to ensure all Canadians who experience stroke and their families receive support and that they are at the center of care, their personal goals are understood, and they are involved every step of the way as recovery progresses and their needs change.”
Age is the strongest risk factor for stroke and the population is aging; at the same time stroke in younger people is on the rise – at a rate faster than older adults. There are more than 400,000 Canadians living with long-term disability from stroke and this will almost double in the next 20 years.
Lasting – and misunderstood – effects
The effects of stroke range from mild to severe, and can be obvious physical limitations or more subtle. One in three stroke survivors is diagnosed with aphasia, a language problem that affects the ability to talk with and understand others. Between one-third and one-half develop depression; and between one-third and three-quarters have post-stroke fatigue. However, according to a poll commissioned by Heart & Stroke fewer than 3% of Canadians identified fatigue or depression as lasting effects associated with stroke.
“I am still affected by it. My hand will never be the same; my arm will never be the same. I have good days and bad days. I will never be the guy I was pre-stroke. He’s gone. I can only be this guy. But I am still singing at the top of my game,” says Alan Frew, lead singer of Glass Tiger, who had a stroke in 2015 at age 58, worked hard to recover and is back performing and touring.
Challenges for everybody
Stroke affects quality of life and influences family relationships. While some excellent resources are available in communities, they are too few and mostly in major centers. Barriers exist around awareness, access, and cost. Recovery needs can change over time and some challenges are specific to ages but others are consistent across life stages.
“One thing I have learned over the years is in the Indigenous community, there is a significant lack of proper resources at the community level,” says Senator Murray Sinclair who had a minor stroke in 2007 at age 56. “I feel lucky that when I had a stroke I was living in an urban area because if it had happened to me in some of the communities where I have traveled over the years I would have suffered significantly from the lack of appropriate medical care, particularly urgent medical treatment.”
A family affair
Two-thirds of stroke survivors return home and family caregivers play an essential role in their recovery.
The stroke caregiver role starts abruptly and they rarely receive the preparation they need. They must adapt quickly and learn to be experts and advocates, attend appointments, and update various health professionals. Caregivers can experience negative impacts on their mental and physical health and on their work/career and finances, and have less time for other family obligations.
According to our poll of Canadians, 31% of respondents said they would not feel capable of personally caring for a family member who experienced stroke. Their top three concerns are: lack of skills and ability to provide care, finances and not having free time or help from others.
Stroke across the ages
For babies and kids recovering from stroke, it is about habilitation not rehabilitation; their brains are growing and recovering at the same time. Some of the biggest challenges facing kids with stroke are cognitive and behavioral issues such as attention deficit disorder, poor decision making, and social isolation. There is a lack of awareness of stroke in the very young, gaps in treatment and care, and little disability support.
“The earlier in life you have a stroke, the longer you deal with its effects,” says Dr. Adam Kirton, Director, Calgary Paediatric Stroke Program. “If you have a stroke as a baby you will be living with stroke your entire life.”
Stroke in younger adults (20 – 59 years) is on the rise, at a rate faster than older adults. This “sandwich generation” faces unique recovery challenges around being able to drive again, returning to work or school, and raising young families while looking after older parents. Funding for recovery support services is limited; in general services exist for those under 18 and over 65 but not for those in between. This lack of benefits can be financially devastating.
The average older stroke patient has five other chronic conditions (co-morbidities), adding complexity to their recovery. Often the primary caregiver is elderly and also has chronic conditions. Many older stroke patients and their caregivers face issues around isolation and depression.
Stats
§ There are 62,000 strokes in Canada each year.
§ 80% of people survive stroke.
§ Only about 16% of stroke patients who leave inpatient acute hospital care get into inpatient rehabilitation right away, and only 19% within the first month after leaving hospital (Canadian Stroke Best Practice Recommendations target is greater than 30%.)
§ One in 6,300 babies is born with stroke; this is one each week and about double previous estimates.
§ In Canada, there are more than 10,000 children (0 – 18 years) living with stroke.
§ It is estimated that more than 60% of children with stroke will have some long-term disability.
§ 19% of hospital admissions for stroke and TIA are for younger adult patients between the ages of 20 and 59.
§ A new stroke happens in about one in 10,000 young adults under the age of 64.
§ Age is a strong risk factor for stroke; 80% of all strokes happen to those over 60.
§ There are eight million caregivers across Canada, providing at least $25 billion of unpaid care every year.
Read the report at heartandstroke.ca/strokereport.
About Heart & Stroke
Life. We don’t want you to miss it. That’s why Heart & Stroke leads the fight against heart disease and stroke. We must generate the next medical breakthroughs, so Canadians don’t miss out on precious moments. Together, we are working to prevent disease, save lives, and promote recovery through research, health promotion and public policy.
SOURCE Heart and Stroke Foundation
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