• Stroke survivors are at a significantly increased risk of developing health problems that can impact their daily life even if they have experienced only a single stroke and are still living in the community, according to an analysis of the Health and Retirement Study.
• Physicians, caregivers, and rehabilitation providers need to pay particular attention to these comorbid conditions, particularly in light of the aging population and increased number of stroke survivors, said Dr. Divani, director of stroke research at the University of Minnesota Medical Center in Fairview.
• Dr. Divani and his colleagues used the database to conduct a longitudinal study of health problems in stroke survivors. We collected information on 631 stroke subjects who were noninstitutionalized.
• Diabetes, pain, hypertension, and vision and hearing impairment were all significantly more common among stroke survivors. Significantly more survivors (15% vs. 6%) also needed a proxy respondent to complete the interview. This suggests that stroke survivors were unable to answer questions, hold the phone, or participate in a face-to-face interview.
• Among the four dimensions of sleep quality that the investigators assessed (trouble falling asleep, waking up at night, waking early, and not feeling rested), only one – not feeling rested – was significantly more common among survivors (33% vs. 22%). Falling and fall-related injuries were also significantly more common.
• There also was a significant association between stroke and memory deficit, occurring in 9% of survivors and 3% of nonstroke subjects.
• The investigators then conducted a multivariate analysis to determine which problems were significantly more likely to develop after a stroke. The strongest risk was for memory deficit (odds ratio, 2.4). Survivors also had 64% greater odds of having urinary incontinence and 45% greater odds of having motor impairment than did controls. In the area of sleep quality, survivors had 59% greater odds of not feeling rested, although there were no significant risks associated with the other aspects of sleep.
• All aspects of falls and fall-related injuries became nonsignificant in the multivariate analysis, Dr. Divani noted. “This may be because fear of falling makes them more careful, and having a motor deficit prevents them from doing a complex task like climbing stairs,” so if a fall occurs, it’s more likely to be while walking on a flat surface, and not from an elevated location. “A stair fall has a much higher risk of injury than someone falling while walking.”
• Although the data paint a good initial picture of post stroke health issues, Dr. Divani cautioned that it probably underestimates the true impact. “I need to emphasize that we selected noninstitutionalized subjects who had only one stroke,” he said. “We selected the most healthy stroke survivors, which means we are probably underestimating the true problems among stroke patients.”

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