Long Term Prognosis After a Stroke

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It’s important for a caregiver to understand what to expect in the long term after a loved one has survived a stroke. Because every brain is a unique and complex organ, the longer-term impact of the stroke will depend on many individual factors, such as the type of stroke that occurred, the length and severity of the stroke, and which part of the brain was affected.

“Impairments can range from vision loss to cognitive issues to language problems to paralysis,” says Harold Adams, MD, Professor of Neurology at the University of Iowa Healthcare and Director of the Division of Cerebrovascular Disease, Neurology and Comprehensive Stroke Center.

The long-term prognosis for stroke survivors will depend on a long list of factors including their overall health and the severity of the stroke they experienced. Being prepared for what to expect during recovery will help you provide the best care for your loved one.

Life and health after stroke

Each stroke is different, and stroke survivors are affected in different ways. The general statistics for stroke recovery and severity are as follows:

  • 10% of stroke survivors recover completely or almost completely
  • 25% recover with minor impairments
  • 40% have moderate to severe impairments that require special care
  • 10% will need care in a nursing home or other long-term care facility
  • 15% die shortly after the stroke

Usually, those with complete or near recovery will be able to return to their lives with only a few changes. They may suffer from feelings of anxiety or uncertainty, and might worry a stroke will happen again, particularly if the stroke happened without any warning. Physicians will likely recommend these survivors make some lifestyle changes, but they will not need long-term intensive care.

Survivors with moderate to severe impairments may need prolonged rehabilitation and therapies, and may have permanent disabilities. They are more likely to have trouble standing or moving, and might be more at risk for falls. It is also common to experience difficulty speaking or swallowing. Mobility aids like walkers or use of thickening agents with beverages can assist with these problems. These survivors may be able to remain in their own homes (typically with some adjustments for increased comfort or safety), but it may also be helpful to explore assisted living options. Setting goals, diligent rehabilitation and celebrating progress are helpful for continued recovery.

A survivor of a severe stroke will have serious care considerations; he or she will have severe disabilities and may be partly or fully paralyzed. A stroke survivor with profound paralysis or severe complications like vascular dementia will require hands-on care for the rest of his or her life.This will mean major lifestyle changes for the primary caregiver, and may involve a move into a long-term care facility. Depending on the health of the survivor, it may be appropriate to begin thinking about end-of-life care.

Recovery will look different for each survivor, even if they are in the same category of stroke severity. Much of what to expect during recovery will depend on which part of the brain was affected. This means that one stroke survivor with minor impairments may some difficulties speaking, while another survivor with minor impairments has a weakened left arm but can speak normally.

No matter the severity, a stroke is a serious health event even after the initial emergency treatment is over and recovery and rehabilitation has begun. A 2014 Canadian study found that stroke survivors are at a higher risk of a second stroke or other serious health complications for up to five years after their first stroke. And in one Danish study, stroke survivors were twice as likely to die as the general population a year after the event—causes of death included other cardiovascular diseases but also cancer, complications like pneumonia, accidents, and suicide. The health risks depend on the overall well-being of the stroke survivor—an older survivor with a previous heart complications will have a different prognosis than a younger survivor who is well enough to exercise regularly or make other lifestyle changes, for example.

End-of-life decisions

Although many stroke survivors will regain some health and abilities, some will have their quality of life severely impacted.  Dr. Adams recommends taking a holistic approach to health or end-of-life decisions after a serious stroke, putting it in the context of your loved one’s overall health and other medical problems. The treating physician will be able to give the most accurate prognosis for your loved one.

Ideally, you’ll have discussions about end-of-life considerations well before it becomes necessary. The topic can be difficult, but it’s important to speak with a loved one who has survived a stroke about their wishes regarding future medical care. A 2014 study found that there was a lack of open communication and engagement between stroke survivors and health care providers on the subject of advance-care planning. Speaking with your loved one now, and urging them to make an advance care plan, may help you feel more comfortable making decisions about their care if it ever becomes necessary. (Related: The Hardest Conversation: Your Loved One’s End-of-Life Wishes)

Many families of survivors find themselves having these intense discussions only after a severe stroke, or after their loved one’s condition has deteriorated. If you find yourself contemplating end-of-life care without any advance care directives from your loved one, Dr. Adams suggests considering your answers to the following questions:

  • Do you want your loved one resuscitated after a cardiac or respiratory arrest?
  • Do you want further treatments administered to your loved one to treat or prevent complications? (For example, would you like health care workers to give antibiotics to your loved one if he or she contracts pneumonia?)
  • Do you want to have tube feeding done on a long-term basis?

These are difficult questions, but making a decision beforehand will make the process easier if you are ever faced with these situations down the road.

After a stroke, the long-term prognosis of a survivor will depend on many different factors. Speaking with your loved one’s physician in the days and months after a stroke will help you gain a better idea of what to expect from the recovery process, what kind of progress your loved one could make, and how you can best care for them.

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