Depression Screening Essential For Caregivers, People Living With Stroke, New National Guidelines Say
March 26, 2013
For immediate release: March 19, 2013, 12:01 a.m. ET
Too many people failing to get mental health services they need: experts
OTTAWA – New guidelines released today for physicians, nurses and allied health professionals recommend depression screening for all individuals living with stroke and their caregivers. The incidence of depression in both groups exceeds 30 per cent – and too many people fail to receive proper care, according to experts.
“The occurrence of post-stroke depression and changes to cognition affect a large proportion of patients who have experienced stroke,” says Dalhousie University professor Dr. Gail Eskes, who chaired an expert national panel on Mood and Cognition in Patients Following Stroke. “Of equal concern is the large number of spouses and informal caregivers who experience depressive symptoms in the post-stroke recovery phase.”
New recommendations, posted at www.strokebestpractices.ca, will be widely disseminated in the Canadian health-care community. Recent reports on the quality of stroke services in Canada show inconsistent screening and monitoring of stroke patients for depression and cognitive changes, even in large urban centres. Treatment delays may lead to poor outcomes, prolonged recovery and desperation on the part of patients and families.
This update to the Canadian Best Practice Recommendations for Stroke Care marks a new emphasis on psychological care of family and caregivers in addition to stroke patients. Depression can happen at different points in the recovery process – from months to years after the stroke. Annual assessment is recommended for patients and caregivers, who should have access to specially trained providers with expertise in mental health, neuropsychology, psychiatry and occupational therapy.
“Stroke impacts on the whole family, not just the person who has suffered a stroke,” says neuropsychologist Dr. Elizabeth Gilchrist of Glenrose Hospital in Edmonton, who helped develop the new recommendations. “Just like the patient, families and caregivers are at heightened risk of depression after a loved-one has had such a health crisis. With these new guidelines, there is not only recognition of the value of regularly monitoring the mood of patients but of the importance of doing so for the patient’s family and caregivers.”
Neurologist Dr. Eric Smith of the Calgary Stroke Program, a member of the expert panel says: “Depressive symptoms are very common and may inhibit full recovery from stroke, including return to work. Depression is not seen only in severe strokes. Many patients with milder strokes, even strokes that appear to have resolved completely, may be still affected by depression or cognitive problems that decrease quality of life.
Recommendations also highlight the need to screen stroke patients for cognitive decline and dementia. Research shows that two-thirds of patients experience cognitive impairment (changes to the way they think) and as many as a third of patients develop dementia. Mortality rates among stroke patients with cognitive impairment are double those of other patients.
The Canadian Best Practice Recommendations for Stroke Care is a joint initiative of the Canadian Stroke Network and the Heart and Stroke Foundation.
There are about 50,000 strokes in Canada every year and 300,000 people living with the after-effects of stroke. Stroke is a leading cause of adult disability and a leading cause of death. Learn more by visiting www.strokebestpractices.ca.
Major National Study finds there is significant work to be done to improve the quality of stroke care in Canada
July 4, 2011
OTTAWA – A major Canadian Study on the quality of stroke care released today by the Canadian Stroke Network (CSN), one of Canada’s Networks of Centres of Excellence, finds that there is significant work to be done to improve prevention, treatment and recovery from stroke.
The study’s key findings include:
- Two thirds of stroke patients admitted to hospital do not arrive in time to receive the best possible stroke care.
- Stroke patients need greater access to stroke units – 77% of stroke patients do not receive treatment in a stroke unit.
- When patients arrive at hospital, they are not treated fast enough – Only 40% of patients who arrived within 3.5 hours of symptom onset received a CT (computed tomography) or MRI (Magnetic resonance imaging) scan within an hour of arrival.
- Patients receive good care in hospital but several aspects of stroke care need to be significantly improved – Only 12% of ischemic stroke patients admitted to a hospital with the capability to administer the important clot dissolving drug tPA were treated with the drug. Based on tPA rates at some of Canada’s top stroke centres, the target number could be triple the current rate for those ischemic strokes that arrive within the 3.5-hour window.
Only 22% of the hospitals studied were affiliated with a secondary stroke prevention clinic.
- Access to rehabilitation is vital – Only 37% of moderate to severe strokes cases are discharged to a rehabilitation facility.
“The Quality of Stroke Care in Canada could not be timelier,” says Dr. Robert Côté, Chair of the study’s National Steering Committee and a Professor at McGill University. “The results of this study should be used to prioritize investments in stroke care and improve and monitor the quality of stroke care for all Canadians. Stroke is one of the leading causes of death and the main cause of neurological disability in Canada. The study will be of great value to our health system.”
“The study’s findings and recommendations are a ‘call to action’ to the Canadian stroke care community,” says Dr. Moira Kapral, a national steering committee member and Associate Professor, Faculty of Medicine and Department of Health, Policy Management and Evaluation at the University of Toronto. “There needs to be a greater emphasis on improving the public’s awareness about the early signs and symptoms of stroke and the importance of calling 9-1-1 and having an ambulance bring them to hospital immediately.”
The study looked at the quality of stroke care provided in emergency response, in-hospital care and in rehabilitation and recovery. Anonymous information from patients’ records was used and included: time of stroke symptom onset, timeliness of emergency medical system access, treatment received in the emergency department, acute inpatient care and information related to patient discharge from the acute care hospital.
“We are extremely pleased with the results of the study because it illustrates what can be achieved in stroke care in Canada. If Canada invests now in innovative and sustainable stroke care systems and programs-we will achieve real benefits such as saving more lives and reducing the impact of stroke,” says Dr. Antoine Hakim, CEO and Scientific Director of the Canadian Stroke Network.
The study included data from all health jurisdictions in Canada including government and health systems.
To view the The Quality of Stroke Care in Canada and Backgrounder please go to:
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Janet Weichel McKenzie
The Canadian Stroke Network includes more than 100 of Canada’s leading scientists and clinicians from 24 universities who work collaboratively on various aspects of stroke. The Network, which is headquartered at the University of Ottawa, also includes partners from industry, the non-profit sector, provincial and federal governments. The Canadian Stroke Network, one of Canada’s Networks of Centres of Excellence, is committed to reducing the physical, social and economic impact of stroke on the lives of individual Canadians and on society as a whole.
Comprehensive new report examines how obesity varies across Canada, who’s most at risk and possible actions to address it
Eliminating all physical inactivity among Canadian adults (defined as less than 15 minutes of low-impact activity a day) could avert the equivalent of 646,000 cases of obesity in women and 405,000 cases in men, according to an analysis included in a comprehensive joint report released today by the Canadian Institute for Health Information (CIHI) and the Public Health Agency of Canada (PHAC). Similarly, improving poor-quality diets—as measured by the frequency of fruit and vegetable consumption—could result in the equivalent of 265,000 fewer cases of obesity among men and 97,000 fewer cases of obesity among women. However, people’s ability to achieve higher physical activity levels and healthier eating habits is influenced by many interconnected factors.