Stroke

Overview

The average age of stroke onset in Auckland in 2012 in Asian/other ethnic groups was 67.5 years (down from 72.1 years) (Fink, 2016). By comparison, the age of stroke onset is increasing in most ethnic groups in New Zealand (Fink, 2016). The results of a study of 30-day case fatality rates (CFR) of ischaemic stroke in New Zealand from 2000-2004 to 2010-2014 showed that CFR in Asian people rose in Asian people but fell in Europeans (Sandiford, Selak and Ghafel, 2016). This may be due to differences in severity at presentation, or in access and utilisation of the increasingly effective acute and hyper-acute stroke interventions (Sandiford et al., 2016).

The findings of a Rapid Improvement Event (RIE) study conducted to reduce the burden of stroke and to improve services to stroke clients showed that the average age of an Asian client with a stroke at WDHB was almost 10 years less than for European and other ethnic groups (Ratnasabapathy, 2010). Close to half of the Asian stroke clients (44%) were aged less than 65 years of age (compared to European/Other groups –21%). There were proportionately more Asian males with strokes than European and other ethnicities.

Asian groups have higher proportional rates of haemorrhagic strokes than Europeans and other ethnic groups. However, fewer Asian clients have had rehabilitation in AT&R services (over 65 years old) compared to European and other ethnicities. The average length of stay for Asian stroke clients is lower than for European and other ethnic groups. More Asian clients return to their own homes compared to European and other ethnicities. None of the Asian clients received thrombolysis*. Asian communities need information and education on the need to reach hospital as soon as the onset of stroke symptoms occur, to benefit from thrombolytic treatments (Ratnasabapathy, 2010).

Asian patients who present later to hospital after a stroke miss the opportunity for acute stroke treatments, stroke unit care to avoid complications and the provision of early rehabilitation (Fink, 2016).

In a study of Chinese stroke victims in Auckland, traditional Chinese family values, particularly filial piety by the younger generation was emphasised (Wong, 2013). Adult children rather than the spouse were identified as predominantly responsible for the ongoing care of an older person who had suffered a stroke. Chinese families generally preferred sharing care giving among extended family members (Wong, 2013). Although migration to New Zealand reduced the extended family network and limited the support available, Chinese families preferred to to manage care on their own rather than to seek external support. Communication between health providers and the stroke client or the key family member, excluded the extended family, thus undermining their collective model for family decision making. Many Chinese carers did not seek support services although they were needed, because the services did not meet their cultural needs (Wong, 2013).

Migrant families in the study were unaware of the health and social support services available to them and many did not know what financial assistance they were entitled to. Many Chinese families had never received Home Based Support Services (HBSS) and they were less likely to be part of a carer support group (Wong, 2013, p 123):

I don’t know… part of our problem is that we come from a background where there are no social services you know. You make do with whatever you have or how you do it. So I am not very good at trying to access any funding or anything like that (Chinese family carer)

Perhaps they thought we were living with our children so they don’t give us that service. But at the moment, I don’t think we really have the needs. It’s not just the two of us old people you know, there are our children and grandchildren. So whatever I can do I will try to do (Chinese family carer)

*Thrombolysis is recommended as first-line treatment for ischaemic stroke for people who meet specific criteria. Similar to acute MI there is a small window where thrombolysis is of benefit for ischaemic stroke – up to 4.5 hours, but ideally within three hours (Hacke et al., 2004). The sooner the treatment is given, the greater the chance of a successful outcome.