Stroke in Australia: long term survivors have fallen into a black hole

• DOI: 10.5694/mja2.51691
• Publication Date: 2022-08-28T18:02:03Z
• Authors: Katharine Scrivener; Catherine Dean; Ian D Cameron; Louise Ada
• Keywords: Stroke

People with long term disability after stroke should have access to the services they need, when require them Over recent years, management of has undergone major changes in Australia, including introduction stroke-equipped ambulances, improved delivery thrombolysis, and formation acute units.1 However, despite more people surviving, many are left lifelong disability.2 Furthermore, ongoing support perceived be inadequate by stroke.3 This means that living may not opportunity achieve their preferred life goals. It is time focus on individual burden disease how we can best term. Stroke a chronic, health condition, but it managed like an condition Australia. Typically, person admitted hospital for early management; then receive inpatient rehabilitation if meet selection criteria, followed outpatient rehabilitation.4 In reality, amount provided sector limited. Recent moves towards discharge home been shown less effective maximising function than rehabilitation,5 whereas functional gain possible investment subacute community (eg, Council Australian Governments national partnership agreements).6 After hospitalisation, 64% referred rehabilitation; however, actual occurs profoundly low.7, 8 caught between health, ageing sectors. sector, resources prioritised phase care, once community, funding via general practitioner Chronic Disease Management Plan limited five annual subsidised allied sessions (https://www1.health.gov.au/internet/main/publishing.nsf/Content/mbsprimarycare-chronicdiseasemanagement). hard from sector. report feeling forgotten neglected allotted quota finished.9 cost sectors estimated $1.3 billion 2020.1 Having disjointed inequitable system cannot ensure value money. One costs National Disability Insurance Scheme (NDIS), Australia's model. 2020, NDIS supported 5160 who nominated as primary — approximately 1% Australia at time.1 The does readily accept two reasons. First, you must aged 65 years or younger acquire your disability. 61% had 2020 were over years.1 Second, permanent significant impact participation roles (https://www.ndis.gov.au/applying-access-ndis/am-i-eligible). incorrectly assumed recover therefore will disability, especially initial mild moderate symptoms. While typically some recovery stroke, usually partial plateaus first 6 months.10 A proportion also deteriorate time, creating greater levels disability.10 If eligible NDIS, need wait until care services, which currently only do optimise quality life.11 Other chronic conditions such heart aimed preventing recurrence.12 exercise promotion physical activity secondary prevention strategies important rarely accessible. Further, programs complexity severity post-stroke impairments, muscle weakness cognitive/language deficits.1 them. We suggest new model experience cornerstone deliberate move article call able regardless age current multiple sources, leading inequality receives when. ability regular check-ups implemented where required, lifestyle text reminders, person-centred tools self-management, habit-forming exercise, gym memberships, meaningful social interactions.13, 14 These issues applicable others urgency strategy community.15 Open publishing facilitated Macquarie University, part Wiley - University agreement Librarians. Katharine Scrivener consulting role private provider delivering under NDIS. Not commissioned; externally peer reviewed.