While medical advances are making strokes less fatal, there are signs that patients are being affected at a younger age due to lifestyle factors

First, the good news. Deaths related to strokes have halved in the past 15 years, aided by improved intervention and advances in treatment, as well as better prevention. According to the Stroke Association’s most recent State of the Nation report, there are more than 1.2 million stroke survivors in the UK – and this is expected to rise by 123 per cent between now and 2035.

Among the clinical advances that are contributing to this are emergency mechanical thrombectomies (the removal of blood clots), which can be used in some cases of acute ischaemic stroke. The treatment has been hailed as radically improving the options available to clinicians, with the NHS expecting that in coming years an estimated 8,000 stroke patients will benefit from this intervention annually.

However, there are new challenges to overcome. Recent Public Health England (PHE) statistics show that strokes are occurring at a younger age than 10 years ago, leaving greater numbers of survivors facing more years of poor health. The PHE figures show that over a third (38 per cent) of first time strokes are occurring in middle-aged adults (between the ages of 40 and 69), with the average age falling from 71 to 68 for men and from 75 to 73 for women.

Lasting damage

While improved survival rates are to be welcomed, it shouldn’t be forgotten that the after-effects of a stroke can be devastating. Almost two-thirds of survivors leave hospital with a disability, ranging from neurological disorders such as speech or memory problems, to limb weakness and loss of bowel control.

That’s not to mention the emotional impact. A third of stroke survivors experience depression, while a fifth are affected by emotionalism – defined as difficulty regulating emotional responses, such as laughing or crying – and many say their relationship with their partner is affected. Pharmacy teams have a vital role to play in helping to reduce the harmful effects of stroke in their communities, but it can be hard to know where to begin. Here is a look at some key considerations.

Brain attack

In order to function, the brain depends on blood circulation for vital oxygen and nutrients. Sometimes described as a ‘brain attack’, a stroke occurs when this blood supply is restricted or stopped, causing brain cells to die. This can result in serious injury or disability, and can in some cases be fatal.

There are two principal types of stroke. Ischaemic strokes, in which a blood clot stops the brain’s blood supply, account for 85 per cent of all cases. Haemorrhagic strokes are due to bleeding in or around the brain, and while they are less common they can be more serious.

A stroke of any kind is classed as a medical emergency. Early intervention is vital, as the sooner a person receives treatment the less damage there is likely to be. Helping the public understand risk factors and warning signs is a crucial area for health professionals such as pharmacy teams to get involved in.

Tony Rudd, national clinical director for stroke at NHS England and stroke physician at Guy’s and St Thomas’ NHS Foundation Trust, says: “Urgent treatment for strokes is essential, so friends and family can play a key part in making sure their loved ones receive care as quickly as possible.

“Every minute counts and knowing when to call 999 – if you see any one of the signs of stroke – will make a significant difference to someone’s recovery and rehabilitation.”

Risk factors

The spike in stroke incidence in middle-aged people has been partly attributed to unhealthy lifestyle habits. The best way for individuals to reduce their risk is to eat healthily, exercise and avoid smoking and excessive alcohol intake. So, an increase in early-age stroke suggests there is more to be done to educate the public on the importance of following this guidance.

PHE’s Professor Julia Verne, a consultant in public health medicine, commented on the shifting incidence pattern: “Many people think that strokes only affect older people, but that’s not the case. We need a better awareness in people aged 40 to 69 of factors that can contribute to stroke such as smoking, being overweight, not getting enough exercise and drinking.”

With more pharmacies rolling out healthy living training to their staff to enable them to stage effective lifestyle interventions, pharmacy teams are ideally placed to initiate conversations with the public around their health. Moreover, the relatively relaxed, informal nature of pharmacy consultations often helps people open up about their health.

Pharmacies in deprived areas have an especially important role to play. For example, charity Sport England’s latest ‘Active Lives’ survey reveals that while the activity gap between higher and lower socioeconomic groups has stabilised, “people on lower incomes and disabled people are still much less likely to be active enough to benefit their health.”

In addition to those with unhealthy lifestyles, people with conditions such as high blood pressure, diabetes, atrial fibrillation and high cholesterol are at increased risk of stroke, as are individuals of South Asian and African or Carribean descent.

Initiatives

Public health campaigns can be a useful way of engaging communities in reducing their stroke risk. This month sees the launch of one such initiative: May Measurement Month, a worldwide campaign encouraging people to get their blood pressure checked.

The National Pharmacy Association (NPA)’s chief pharmacist Leyla Hannbeck encourages community pharmacies to get behind the initiative: “Checking patients’ blood pressure is a relatively simple intervention that can save lives. The NPA believes that community pharmacy should play a far greater role in screening and ultimately managing hypertension.”

Launched in February, PHE’s ActFAST campaign is another high-profile example. This initiative encourages people to watch out for early signs of stroke by remembering the FAST acronym:

Face – the face may have dropped on one side, the person may not be able to smile, or their mouth or eye may have dropped

Arms – they may not be able to lift both arms and keep them there because of weakness or numbness in one arm

Speech – their speech may be slurred or garbled, or the person may not be able to talk at all despite appearing to be awake 

Time – it’s time to dial 999 immediately if you see any of these signs or symptoms.

Pharmacy minister Steve Brine commented that the message behind the campaign is “as relevant as ever”, adding: “The faster you act, the greater the chance of a good recovery. That’s why I’m urging everybody, and we must remember stroke can hit at any age, to familiarise themselves with the signs of a stroke and be ready to act fast.” 

Approaching stroke prevention as a team

Well pharmacies have been working with the Stroke Association to boost awareness of stroke in local communities, as well as raising funds to carry out vital research. TM spoke to Marcia Moss from Well’s Oldham branch. Marcia has been the driving force behind the campaign in Well’s top-performing store, helping raise over £1,300 through sponsored walks, raffles and other activities.

“We started off doing hampers for the Stroke Association. I made them up myself using goods that had been donated to us, then went around the neighbourhood selling tickets. We started off at the beginning of the year with a Mother’s Day hamper, and then after that received a good response we did another for Easter.

“Then we organised a charity walk. We got the local community radio involved, as well as the local church. All in all the walk took us a few hours, it was really a good trek. At the end of it we set off a load of stroke balloons. What was great about this event was how visible it was in the community. All the staff who came were wearing Stroke Association t-shirts and all the participants knew what it was in aid of. Doing it as a walk was also really effective because it tied in with the healthy lifestyle guidance around stroke prevention.

“We also did a blood pressure testing day for walkin patients. We’ve sort of tied everything in with our stroke awareness activities, saying to customers: make sure you get your blood pressure checked, make sure you’re exercising, here’s what you can do to prevent strokes – and if it does happen, here’s the road you go down. Leaflets, banners and Facebook have been great for getting the word out; you name it, we’ve used it.

“We have a few things up our sleeve for the future. We’re hoping to do a skydive, as well as another community walk – a lot of our patients have asked us to do that as the last one was a great day out, which is great for us to hear.

“The response has been absolutely fantastic – to the point where people are coming in just to discuss their stroke risk with us. It’s just having that interaction with customers. Some people have said they never knew much about these things but after a five-minute chat feel confident to get their risk assessed and understand the importance of doing so.

“We approach everything as a team. It doesn’t matter who the customer is or what the condition is, everyone feels empowered to play their part. It’s all about not being afraid to strike up a conversation with patients and offer guidance around things like stroke warning signs.”

“Almost two-thirds of stroke survivors leave hospital with a disability”

Originally Published by Training Matters

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