Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on sleep in brain health

LIVE: Thursday 2nd May 2024, 18:00-19:30 (CEST)

Quality sleep is essential for health. But what happens to our brains when sleep patterns are disturbed? Join our experts to explore the interplay between sleep disruption and neurological diseases, and the questions that you need to be asking your patients to help you prevent the harmful effects of sleep deprivation.
ADVANCED SEARCH
Log in
Top
BMC Health Services Research
Published in: BMC Health Services Research 1/2017

Open Access 01-12-2017 | Research article

Gaps in care for patients with memory deficits after stroke: views of healthcare providers

Authors: Eugene Yee Hing Tang, Christopher Price, Blossom Christa Maree Stephan, Louise Robinson, Catherine Exley

Published in: BMC Health Services Research | Issue 1/2017

Login to get access

Abstract

Background

Stroke is a common cause of physical disability but is also strongly associated with cognitive impairment and a risk for future dementia. Despite national clinical guidelines, the service provided for stroke survivors with cognitive and memory difficulties varies across localities. This study critically evaluated the views of healthcare professionals about barriers and facilitators to their care.

Methods

Seventeen semi-structured individual interviews were conducted by a single interviewer with both primary and secondary care clinicians in regular contact with stroke-survivors. This included stroke medicine specialists, specialist nurses, physiotherapists, occupational therapists, general practitioners and primary care nurses. Topics included individual experiences of the current care offered to patients with cognitive impairment, assessment processes and inter-professional communication. Interviews were audio recorded and transcribed verbatim. Transcripts were thematically analysed and themes grouped into broad categories to facilitate interpretation.

Results

Data analysis identified four key themes as barriers to optimal care for stroke-survivors with memory difficulties: 1) Less focus on memory and cognition in post-stroke care; 2) Difficulties bringing up memory and cognitive problems post-stroke; 3) Lack of clarity in current services; and, 4) Assumptions made by healthcare professionals introducing gaps in care. Facilitators included stronger links between primary and secondary care in addition to information provision at all stages of care.

Conclusions

The care provided by stroke services is dominated by physical impairments. Clinicians are unsure who should take responsibility for follow-up of patients with cognitive problems. This is made even more difficult by the lack of experience in assessment and stigma surrounding potential diagnoses associated with these deficits. Service development should focus on increased cohesiveness between hospital and community care to create a clear care pathway for post-stroke cognitive impairment.
Literature
1.
Feigin VL, Forouzanfar MH, Krishnamurthi R, Mensah GA, Connor M, Bennett DA, Moran AE, Sacco RL, Anderson L, Truelsen T, et al. Global and regional burden of stroke during 1990-2010: findings from the global burden of disease study 2010. Lancet. 2014;383(9913):245–54.CrossRefPubMedPubMedCentral
2.
Savva GM, Stephan BC, Alzheimer's Society Vascular Dementia Systematic Review G. Epidemiological studies of the effect of stroke on incident dementia: a systematic review. Stroke. 2010;41(1):e41–6.CrossRefPubMed
3.
Pendlebury ST, Rothwell PM. Prevalence, incidence, and factors associated with pre-stroke and post-stroke dementia: a systematic review and meta-analysis. Lancet Neurol. 2009;8(11):1006–18.CrossRefPubMed
4.
Douiri A, Rudd AG, Wolfe CD. Prevalence of poststroke cognitive impairment: South London stroke register 1995-2010. Stroke. 2013;44(1):138–45.CrossRefPubMed
5.
Seshadri S, Beiser A, Kelly-Hayes M, Kase CS, Au R, Kannel WB, Wolf PA. The lifetime risk of stroke: estimates from the Framingham study. Stroke. 2006;37(2):345–50.CrossRefPubMed
6.
Seshadri S, Wolf PA. Lifetime risk of stroke and dementia: current concepts, and estimates from the Framingham study. Lancet Neurol. 2007;6(12):1106–14.CrossRefPubMed
7.
Patel M, Coshall C, Rudd AG, Wolfe CD. Natural history of cognitive impairment after stroke and factors associated with its recovery. Clin Rehabil. 2003;17(2):158–66.CrossRefPubMed
8.
Jokinen H, Melkas S, Ylikoski R, Pohjasvaara T, Kaste M, Erkinjuntti T, Hietanen M. Post-stroke cognitive impairment is common even after successful clinical recovery. Eur J Neurol. 2015;22(9):1288–94.CrossRefPubMed
9.
Fens M, van Heugten CM, Beusmans GH, Limburg M, Haeren R, Kaemingk A, Metsemakers JF. Not as transient: patients with transient ischaemic attack or minor stroke experience cognitive and communication problems; an exploratory study. Eur J Gen Pract. 2013;19(1):11–6.CrossRefPubMed
10.
Department of Health: Modern standards and service models: older people - National Service Framework. 2001.
11.
Department of Health: National Stroke Strategy. 2007.
12.
Intercollegiate Stroke Working Party: National Clinical Guideline for stroke. 2016.
13.
Pollock A, St George B, Fenton M, Firkins L. Top ten research priorities relating to life after stroke. Lancet Neurol. 2012;11(3):209.CrossRefPubMed
14.
Pollock A, St George B, Fenton M, Firkins L. Top 10 research priorities relating to life after stroke--consensus from stroke survivors, caregivers, and health professionals. Int J Stroke. 2014;9(3):313–20.CrossRefPubMed
15.
National Audit Office: Progress in improving stroke care. 2010
16.
Care Quality Commission: Supporting life after stroke: a review of services for people who have had a stroke and their carers. 2011.
17.
Royal College of Physicians: First SSNAP annual report: how good is stroke care? 2014.
18.
Stroke Association: A new era for stroke. 2016.
19.
Ritchie J, Spencer L, O'Connor W. Carrying out qualitative analysis in: Ritchie J, Lewis J, editors. Qualitative research practice: a guide for social science students and researchers. London: SAGE; 2003.
20.
Ellis C, Focht KL, Grubaugh AL. Perceptions of stroke recovery: an exclusion of communication and cognition. Neuro Rehabilitation. 2013;33(2):233–9.PubMed
21.
Tatemichi TK, Desmond DW, Stern Y, Paik M, Sano M, Bagiella E. Cognitive impairment after stroke: frequency, patterns, and relationship to functional abilities. J Neurol Neurosurg Psychiatry. 1994;57(2):202–7.CrossRefPubMedPubMedCentral
22.
Royal College of Physicians Clinical Effectiveness and Evaluation Unit on behalf of the Intercollegiate Stroke Working Party: Sentinel stroke National Audit Programme (SSNAP) post-acute Organisational audit public report - phase 2: Organisational audit of post-acute stroke service providers. 2015.
23.
Hoffman T, Mckenna K, Worral L, Read S. Evaluating current practice in the provision of written information to stroke patients and their carers. Int J Ther Rehabil. 2004;11(7):303–10.CrossRef
24.
Hoffmann T, McKenna K, Herd C, Wearing S. Written education materials for stroke patients and their carers: perspectives and practices of health professionals. Top Stroke Rehabil. 2007;14(1):88–97.CrossRefPubMed
25.
Eames S, Hoffmann T, Worrall L, Read S. Stroke patients' and carers' perception of barriers to accessing stroke information. Top Stroke Rehabil. 2010;17(2):69–78.CrossRefPubMed
26.
Wachters-Kaufmann C, Schuling J, The H, Meyboom-de Jong B. Actual and desired information provision after a stroke. Patient Educ Couns. 2005;56(2):211–7.CrossRefPubMed
27.
28.
Kokmen E, Whisnant JP, O'Fallon WM, Chu CP, Beard CM. Dementia after ischemic stroke: a population-based study in Rochester, Minnesota (1960-1984). Neurology. 1996;46(1):154–9.CrossRefPubMed
29.
Allan LM, Rowan EN, Firbank MJ, Thomas AJ, Parry SW, Polvikoski TM, O'Brien JT, Kalaria RN. Long term incidence of dementia, predictors of mortality and pathological diagnosis in older stroke survivors. Brain. 2011;134(Pt 12):3716–27.CrossRefPubMed
30.
Ballard C, Rowan E, Stephens S, Kalaria R, Kenny RA. Prospective follow-up study between 3 and 15 months after stroke: improvements and decline in cognitive function among dementia-free stroke survivors >75 years of age. Stroke. 2003;34(10):2440–4.CrossRefPubMed
31.
Bradford A, Kunik ME, Schulz P, Williams SP, Singh H. Missed and delayed diagnosis of dementia in primary care: prevalence and contributing factors. Alzheimer Dis Assoc Disord. 2009;23(4):306–14.CrossRefPubMedPubMedCentral
32.
Vernooij-Dassen MJ, Moniz-Cook ED, Woods RT, De Lepeleire J, Leuschner A, Zanetti O, de Rotrou J, Kenny G, Franco M, Peters V, et al. Factors affecting timely recognition and diagnosis of dementia across Europe: from awareness to stigma. Int J Geriatr Psychiatry. 2005;20(4):377–86.CrossRefPubMed
33.
Olafsdottir M, Foldevi M, Marcusson J. Dementia in primary care: why the low detection rate? Scand J Prim Health Care. 2001;19(3):194–8.CrossRefPubMed
34.
Connolly A, Gaehl E, Martin H, Morris J, Purandare N. Underdiagnosis of dementia in primary care: variations in the observed prevalence and comparisons to the expected prevalence. Aging Ment Health. 2011;15(8):978–84.CrossRefPubMed
35.
Savva GM, Arthur A. Who has undiagnosed dementia? A cross-sectional analysis of participants of the aging, demographics and memory study. Age Ageing. 2015;44(4):642–7.CrossRefPubMedPubMedCentral
Metadata
Title
Gaps in care for patients with memory deficits after stroke: views of healthcare providers
Authors
Eugene Yee Hing Tang
Christopher Price
Blossom Christa Maree Stephan
Louise Robinson
Catherine Exley
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2017
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-017-2569-5

Other articles of this Issue 1/2017

BMC Health Services Research 1/2017 Go to the issue

Research article

Municipal resources and patient outcomes through the first year after a hip fracture

Research article

Mapping infectious disease hospital surge threats to lessons learnt in Singapore: a systems analysis and development of a framework to inform how to DECIDE on planning and response strategies

Research article

Prevalence and determinants of polypharmacy in Switzerland: data from the CoLaus study

Research article

The modified south African triage scale system for mortality prediction in resource-constrained emergency surgical centers: a retrospective cohort study

Research article

Factors associated with mode of colorectal cancer detection and time to diagnosis: a population level study

Research article

Development and validation of a structured observation scale to measure responsiveness of physicians in rural Bangladesh