Stroke risk factors, outcomes and models of stroke care in a culturally and linguistically Diverse (CALD) elderly population.
Stroke is one of the leading causes of mortality and disability worldwide. The majority of stroke patients are elderly. Advanced age, hypertension, diabetes mellitus, atrial fibrillation, smoking and heavy alcohol drinking are the major risk factors. Treatment of modifiable risk factors is an important strategy for primary and secondary stroke prevention. The primary aim of this thesis was to examine stroke risk factor profile, risk factor management and clinical outcomes, as well as their association with ethnicity (defined as English-speaking background ? ESB, and non-English-speaking background - NESB) in a group of elderly patients from a multiethnic background. Stroke risk factor profile and outcomes of stroke were similar between English and non-English-speaking background patients. However, a higher prevalence of diabetes mellitus in the NESB patient group was observed in the study (41% vs. 10% in the ESB patient group) (Chapter 2). In addition, predictive factors and predictive models for stroke outcomes were developed. Advanced age, visual field loss and stroke type were the main predictors for mortality and functional dependency at 12 months post-stroke (Chapter 3). Delirium occurred in one quarter of the elderly patient post-stroke and was also associated with a worse clinical outcome (Chapter 4). Risk factor management may be suboptimal in elderly patients. For example, anticoagulant therapy for stroke prevention in patients with atrial fibrillation was underused, particularly in NESB patients (Chapter 2). The reasons for under-usage of anticoagulant therapy were investigated in a general practitioner survey (Chapter 6). Results showed that NESB, older age, cognitive impairment (especially living alone) were significant potential barriers for anticoagulant prescription by general practitioners. Stroke units have been proven to be a better care model for stroke patients, with shortened hospital length of stay and improved clinical outcomes. Clinical audits from Bankstown Combined (Co-located) Acute and Rehabilitation Stroke Unit and later the newly established Blacktown Combined Co-located Stroke Unit have demonstrated these benefits (Chapter 5). However, further studies need to be performed in order to determine whether a combined co-located stroke unit care model is superior to other stroke unit care models, and if so, the reasons behind this.
Cerebrovascular disease., Cerebrovascular disease -- Patients -- Rehabilitation., Cerebrovascular disease -- Patients -- Care.
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