Stroke Toll is higher for women; Women are more disabled after stroke

Stroke is not viewed as a women’s health issue yet being a women means you are at greater risk of disability and death because of stroke. 1 in 5 women over the age of 45 will have a stroke by age 85 in contrast to the lifetime risk of breast cancer of 1 in 9. Women are much more likely to be disabled by stroke. They are less likely to resume ordinary activities and have difficulty walking. Women are more likely to be admitted to a nursing home rather than return home.

After stroke, women are less likely to go to rehabilitation and those that do not gain as much function as men. It has been suggested that women poorly because they are older but Dr. Stefano Paolucci matched women and men for age and stroke severity and found that women were less independent than men after equal rehabilitation. Women may lack muscle strength of men, may be less fit or may also be depressed post stroke. Dr. Paolucci suggests that treating depression in women may improve rehabilitation outcomes and this would be consistent with research that suggests depression produces worse stroke outcomes. Rehabilitation for women may need to be different. Women may require more strengthening and general fitness training as well as rehabilitation for stroke deficits. Dr. Sandra Olney from Queens University says that research increasingly finds that strengthening is important to reduce stroke disability.

The greatest toll on women may come at discharge. Dr. Robert Teasell, University of Western Ontario and author of the Evidence Based Review of Stroke Rehabilitation says that the most overlooked part of stroke care is community reintegration. People are discharged into the care of families without education or knowledge and there may not be services in the community to support them. Women who do not have a partner or family are much more likely to discharged to a nursing home. At every step of stroke, families and stroke survivors say they need more direct information that will help them recover and cope with stroke.

To address this need the Stroke Survivors Association of Ottawa is having a national conference August 17th and 18th 2007 for stroke survivors, their families and professionals that work with people dealing with stroke. The conference features leading researchers on prevention, treatment and general management of stroke. Early registration deadline is June 30th.

Women who survive stroke are more likely to fare worse than men.
• Analysis by Dr. Moira Kapral of the 2004 statistics (latest available) from the Registry of the Canadian Stroke Network and consistent with other studies, women stay longer in hospital and are more likely to be discharged to a nursing home.
• Women are less often admitted to in patient rehabilitation and do not regain as much function as men. Dr Stefano Paolucci compared age and stroke matched women and men in rehabilitation for differences in functional outcome. Male patients had a higher probability of being more mobile, able to climb stairs and engage in more ordinary daily activities, whereas female patients had a higher probability of walking with a cane and only reaching partial autonomy in daily activities like making meals, taking a shower or getting dressed. .

It is very important that women get early treatment for stroke.
• Dr. Michael Hill’s analysis of results of tPA trials, the Clot Busters, revealed the surprising evidence that women benefit more than men from intravenous thrombolysis. Women had women showing a 20% absolute benefit compared with men who had a 10% absolute benefit with clotbusters. tPa must be used within 3 hours of stroke to be effective. This analysis was consistent with previously cited studies in that nonthrombolysed women fared worse than nonthrombolysed men.
Women do not recognize their risk of stroke.
• Most women identify breast cancer as the leading cause of death for women. One in six women die of stroke; it’s a far more common cause of death than breast cancer, which kills one in 25 women
• Women were 62 percent more likely than men to report nontraditional stroke symptoms
• Women’s stroke symptoms are slightly different than men’s; women were more likely to present with headaches.
• Presenting with headache may be a problem in emergency—women’s stroke symptoms particularly if under 50, it may be assumed that it is migraine rather than stroke. Dr. Kapral suggests that Doctors be aware of the symptoms of and higher risk for women of subarchnoid hemorrhage.
Other facts about Women and stroke
• 5% of strokes occur in women between the ages of 19 and 50 years of age and the consequences of disability are even greater for younger women.
• Female patients have different causes of, or risk factors for, stroke compared with men, including pregnancy, migraine, oral contraceptive use and ruptured aneurysm
• Diagnostic evaluations that should be done on every ischemic stroke patient still aren’t being performed on a third to a half of patients, and they’re less likely to be performed on women
• More women than men die from stroke. The Registry of the Canadian Stroke network shows that in 2004, there were 8,667 female deaths compared to 5959 deaths in men
• women stayed in hospital on average 1 day longer than men and were more likely to be discharged to long-term care. The main determinant of discharge destination is having a caregiver at home.
• 80% of the caregivers to people post stroke are women
• Children have strokes too. The risk between 28 weeks of pregnancy and 1 month of age is 1 in 4000 of full term infants and in children aged 1- 19 the risk of stroke is about 2.3 per 100,000 children.
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If you would like more information on this or would like to schedule an interview please call Janet McTaggart at Telephone: 613-237-0650 Home Phone: 613-692-7875 or ed@strokesurvivors.ca www.strokeconference.ca or www.strokesurvivors.ca
Dr Moira K. Kapral, Toronto General Hospital, 200 Elizabeth St 9 Eaton S, Room 409, Toronto, Ontario, Canada M5G 2C4. E-mail moira.kapral@uhn.on.ca

Michael D. Hill, Associate Professor, Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, Foothills Hospital, Rm 1162, 1403 29th St, NW, Calgary, Alberta, T2N 2T9, Canada. E-mail Michael.hill@calgaryhealthregion.ca

Dr Stefano Paolucci, Fondazione IRCCS Santa Lucia, Via Ardeatina 306, 00179 Rome, Italy. E-mail s.paolucci@hsantalucia.it

Dr. Sandra Olney Queens University : 613-533-6102 olneys@post.queensu.ca

Contact Information

Janet McTaggart

Executive Director

Stroke Survivors Association of Ottawa

Contact via E-mail