In addition to Elder Law Month, National Nurses Day, and National Nursing Home Week; May is also designated as Stroke Awareness Month. I worked as a nursing assistant in a nursing home when I was in college, and I distinctly remember one woman who had experienced a stroke. She was paralyzed on one side, and the only word she could say was “go-go.” She was, however, well aware of her surroundings. Communication devices weren’t as common back then, and being young and inexperienced, it was amazing to me how the staff figured out her needs and wants from one-handed gestures and changes in her tone of voice as she repeated that one word. Since stroke is the fourth leading cause of death in the United States, almost 75% of all individuals affected by stroke are over age 65, and it can cause serious long-term disabilities, a basic understanding of stroke is important for all seniors.
The medical term for stroke is CVA, or cerebrovascular accident. A stroke occurs when cells in the brain are damaged or die due to ischemia or hemorrhage. Ischemia is caused by a blood clot blocking a blood vessel, preventing oxygen from reaching the brain cells. The clot could have formed within the brain (thrombosis), or in another part of the body and traveled to the brain (embolism). A blockage can also occur when the walls of a blood vessel in the brain or leading to it become narrowed by the build-up of fatty deposits. Ischemia causes 80% of strokes. The build-up of fatty deposits in artery walls can also cause the vessels to become brittle and prone to cracking, resulting in hemorrhage. A weak spot in the wall of an artery, called an aneurysm, can also break and cause hemorrhage.
Some risk factors for stroke can be controlled and some cannot. Those which cannot be controlled include age, family history, gender (men have a higher risk, but more women die from stroke), and race (African-Americans are twice as likely to have a stroke as Caucasians). Risk factors which individuals can try to do something about include high blood pressure, smoking, heart disease, high cholesterol, and diabetes.
The warning signs of stroke come on suddenly. An individual may experience numbness or weakness in the face, arm, and/or leg, especially on one side of the body. Confusion; difficulty seeing, speaking, understanding or walking; dizziness; loss of balance or coordination; and severe headache may also occur. These symptoms may be brief and resolve without treatment (called a TIA or transient ischemic attack), or they may be prolonged. Regardless of whether only one or several of these symptoms occur, IMMEDIATE medical attention should be obtained. Even if the symptoms resolve, they indicate that a problem exists which should be addressed.
The area of the brain which is damaged will determine the long-term effects of a stroke. Stroke can affect movement, thinking, emotions, speech, and sensation. When movement is affected, an individual may have weakness (hemiparesis) or total paralysis (hemiplegia) on one side of the body. Balance and coordination may be impaired, or difficulty swallowing (dysphagia) may occur.
Areas of thinking which may be affected include attention, learning, judgment, and memory. An awareness of one side of the body or of the field of vision on one side may be absent, which is called “neglect.” Aphasia is the term used to describe the difficulty or inability to form or understand speech. When language ability is present, but speech is slurred, the correct term is dysarthria. Depression, difficulty controlling emotions, or the expression of emotions which are inappropriate for the specific circumstance may result from a stroke.
An uncommon but still possible effect of stroke is the sensation of burning, tingling, sharp stabbing pain or general achiness. These sensations are often felt in the hands and feet, and movement or changes in temperature (especially cold) can increase the intensity of these sensations. This type of discomfort is difficult to treat. Lastly, a stroke in the area of the brain called the brain stem may be fatal or result in a “locked-in” state, in which the individual has no control below the neck. I recall caring for a woman in her fifties who could only blink her eyes, and can’t even describe the emotions of her family and the staff as we cared for her.
All of the above information, as well as information about diagnosis, treatment, and research can be found at www.nihseniorhealth.gov. The most important actions YOU can take are steps to reduce your risk factors and seeking prompt treatment if any symptoms should occur. Improved outcomes are more likely to occur with quicker treatment. Strokes are serious business; don’t treat symptoms lightly.
Karen Kaslow, RN