Why Women Experience Worse Outcomes After a Stroke

It’s no secret that stroke is a major health problem, with close to 800,000 Americans having a stroke each year, but what you might not know is that it affects women at a higher rate and wreaks more havoc on their lives. Around 55,000 more women have strokes annually than men. Stroke is also the third leading cause of death for women but only the fifth for men.

Unfortunately, the news goes from bad to worse for females. If women survive a stroke, their quality of life and health are worse than their male counterparts.

Researchers recently published an article in the American Heart Association’s scientific journal, Stroke, reviewing the differences between men’s and women’s outcome measures after a stroke. The authors looked at 22 studies from 2007 to the present to review patients’ reported activity limitations, health-related quality of life, participation restriction, impaired cognition and mood.

Based on the authors’ examination, the studies showed that women were more likely to have a worse outcome and a higher prevalence of depression, as well as experiencing a decrease in quality of life after a stroke, than men. The evidence was not as strong for higher rate of cognitive impairment or participation restriction, but women were less likely to return to work after a stroke.

Deborah Stabell Tran, M.S., R.N., neuroscience program manager at Texas Health Presbyterian Hospital Dallas, says when women recognize a change in their feelings after having a stroke, being honest with their health care provider is paramount.

“Feelings of depression can occur after a stroke and the chances of this are higher in women than in men,” Tran says. “Do not be ashamed of these feelings, which are a natural part of some strokes. Research is looking for locations in the brain that are affected by stroke and their likeliness to cause depression. While depression after a stroke is more common in women, light activity (as prescribed by your doctor), keeping contact with loved ones for support and meditation can help lift mood. However, keep in mind that sometimes talking to a therapist or medications may be necessary.”

Researchers concluded that patients’ level of health before their stroke significantly impacts their recovery, which is meaningful because women are more likely to have a stroke at a later age than men, usually because they already have other health problems. Post-stroke depression is also highlighted as a major concern, as it negatively affects recovery and quality of life.

The likelihood of having a stroke doubles every 10 years after the age of 55, and since women have a longer life expectancy than men, researchers in the Stroke study found that elderly women shoulder a heavier burden when it comes to stroke. They are twice as likely to live alone, which can lead to delays in receiving emergency care, and may struggle more financially. It is also more common for women to be more affected by loneliness, social isolation and limited social support after a stroke.

The National Stroke Association (NSA) explains that recovery after a stroke can take anywhere from months to several years, and should focus on physical, emotional and social health. A patient will not only need to work to prevent more strokes in the future, but also address the effects of his or her recent stroke, which could include relearning skills or adapting to limitations by learning new skills. Support from family members and friends is crucial to a person’s recovery, as they can offer emotional, social and practical care, such as driving to appointments and therapy.

Tran points to the importance of focusing on a patient’s emotional and physical needs to ensure an optimal recovery.

“Emotional well-being affects the patient’s ability to participate in functional or physical recovery,” she explains. “Think of the positive outlook and the willingness to fight through issues versus a feeling of helplessness that prevents full recovery. One is not more important than the other, but both are needed for full recovery.”

Recovery can be complicated, and while some people recover with little to no lasting effects, others may struggle to regain independence. The NSA provides the following statistics on recovery for stroke survivors:

  • 10 percent recover almost completely
  • 25 percent recover with minor impairments
  • 40 percent experience moderate to severe impairments, which require special care
  • 10 percent require full-time care at a nursing home or long-term care facility
  • 15 percent die shortly after the stroke

Rehabilitation begins as soon as possible after the stroke and continues in whatever setting is best for the patient’s individual needs, ranging from rehab hospital care or in-home therapy to outpatient therapy or long-term care in a facility. The goal is for the patient to regain as much independence as possible through speech, physical and occupational therapy, and may require him to relearn basic life skills such as talking, walking eating, bathing and dressing.

Preventing additional strokes is also a high priority, as one in four strokes is recurrent. The chance of another stroke within 90 days of the first is around 17 percent, with the first week post-stroke holding the highest risk. This is one of the many reasons why receiving treatment quickly is so important, so a patient’s care team can help manage his or her other risk factors, prescribe necessary medication, and recommend lifestyle changes and even surgery, when necessary.

Physicians may be more likely to primarily focus on the physical recovery of patients, but it is clear that care teams should also find ways to address the emotional, mental and social needs of stroke patients, with this being especially crucial for women and their overall health.

“Because women are more likely than men to undergo post-stroke depression, we need to be watchful for the signs of depression and not write it off as just being a little down due to the diagnosis,” Tran explains. “These signs include a lack of interest in activities you once enjoyed, a sad mood, feeling helpless/hopeless in your current condition, or a desire to end one’s life. Ask those around you to mention it if they notice you are not yourself, so it can be discussed with your doctor.

“Also, changes in mood can be a chemical/mechanical problem from the stroke, so the person doesn’t necessarily need to have a history of depression for this to occur. Since women are often the caretakers in the home, it can be hard to ask for help but they need to know that emotional changes after a stroke are treatable.”

Unfortunately, not all strokes can be prevented because certain risk factors, like age, family history, ethnicity and gender, can’t be controlled. Knowing the symptoms of stroke can help keep you safe. If you experience sudden one-sided numbness, difficulty seeing or speaking, dizziness, trouble walking, or an intense headache, call 911 immediately.

To learn more about stroke and to find the accredited stroke center nearest you, visit TexasHealth.org/Stroke.

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