Understanding Strokes in Young People: Prevention, Signs, and Post-Hospitalisation Rehabilitation with Medwell SA

Strokes are often associated with older adults, but the notion that they only affect the elderly is a myth. Increasingly, younger individuals—those under 65—are experiencing strokes, with significant implications for their health, lifestyle, and recovery. In South Africa, where stroke incidence is rising, understanding the causes, recognising the signs, and implementing effective prevention and rehabilitation strategies are critical. Medwell SA, a leader in home healthcare with over 20 years of experience, provides specialised nursing and rehabilitation services to support stroke survivors in their recovery journey at home. This article explores strokes in young people, the pros and cons of home-based rehabilitation, and how Medwell SA’s services can make a difference, along with practical advice for prevention.

Why Do Strokes Happen in Young People

Strokes occur when blood flow to the brain is interrupted, either by a clot (ischaemic stroke) or a burst blood vessel (haemorrhagic stroke), leading to brain cell damage. While age is a risk factor, strokes in young people are driven by a combination of lifestyle, medical, and genetic factors. Key causes include:

• Hypertension and Cardiovascular Issues: High blood pressure, often undiagnosed in younger individuals, is a leading cause. Heart conditions like atrial fibrillation or congenital heart defects also increase risk.
• Lifestyle Factors: Smoking, excessive alcohol consumption, physical inactivity, and poor diet (high in saturated fats and sugars) contribute significantly. Obesity and diabetes, which are on the rise among younger populations, further elevate the risk.
• Drug Use: Recreational drug use, particularly cocaine and amphetamines, can trigger strokes by causing sudden spikes in blood pressure or vessel constriction.
• Medical Conditions: Conditions like autoimmune diseases, blood clotting disorders (e.g., antiphospholipid syndrome), and migraines with aura are more prevalent in younger stroke patients.
• Stress and Mental Health: Chronic stress and untreated mental health conditions can exacerbate cardiovascular risk factors, indirectly contributing to stroke risk.

The misconception that strokes only affect older people stems from their higher prevalence in those over 65, as nearly 75% of strokes occur in this age group. However, the incidence among younger adults has risen significantly over the past decade, with approximately 150,000 strokes occurring annually in South Africa, many affecting those aged 15–59. This trend underscores the need to dispel the myth and raise awareness among younger populations.

Signs of a Stroke to Watch For

Recognising stroke symptoms early is critical, as timely intervention can prevent severe brain damage. The F.A.S.T. acronym is a widely recommended tool to identify stroke signs:

• Face: Sudden drooping or numbness on one side of the face. Ask the person to smile; if it’s uneven, it’s a red flag.
• Arms: Weakness or numbness in one arm. Ask the person to raise both arms; one may drift downward.
• Speech: Slurred speech or difficulty speaking/understanding. Ask them to repeat a simple phrase.
• Time: If any of these signs are present, call emergency services immediately, noting the time symptoms began, as treatments like thrombolysis (dissolving a blood clot) are time-sensitive (most effective within 4.5 hours).

Other symptoms may include sudden severe headaches, vision problems, dizziness, or loss of balance. In young people, these signs may be dismissed as fatigue or stress, delaying critical care. Only 31% of stroke patients in Australia, for example, reach the hospital within three hours of symptom onset, highlighting the need for awareness.

Preventing Strokes in Young People

Prevention is key to reducing stroke risk, particularly for younger individuals who may not perceive themselves as vulnerable. Here are evidence-based strategies:

• Manage Blood Pressure: Regular monitoring and controlling hypertension through diet, exercise, or medication is critical. The NHS Health Check programme emphasises this for high-risk groups.
• Adopt a Healthy Lifestyle: Limit alcohol, quit smoking, and maintain a balanced diet rich in fruits, vegetables, and whole grains. Regular physical activity (e.g., 150 minutes of moderate exercise weekly) reduces risk.
• Control Chronic Conditions: Manage diabetes, high cholesterol, and heart conditions with regular medical check-ups and adherence to prescribed treatments.
• Avoid Recreational Drugs: Steering clear of substances like cocaine and amphetamines eliminates a significant risk factor.
• Stress Management: Incorporate stress-reduction techniques like yoga, meditation, or counselling to mitigate cardiovascular strain.
• Know Your Family History: Genetic predispositions to clotting disorders or heart conditions should prompt earlier screening and preventive measures.

Public health campaigns, like those from the Stroke Survivors Foundation, emphasise education and awareness to empower young people to take proactive steps.

Post-Hospitalisation Rehabilitation: Home-Based vs. Facility-Based

After a stroke, rehabilitation is essential to regain independence and adapt to physical, cognitive, or emotional changes. Many young stroke survivors prefer recovering at home, but the decision between home-based and facility-based rehabilitation depends on individual needs. Below are the pros and cons of home-based rehabilitation compared to inpatient facilities.

Pros of Home-Based Rehabilitation

• Comfort and Familiarity: Recovering at home provides emotional comfort, reducing stress and isolation, which can exacerbate post-stroke depression. A University of Toronto study found that stroke survivors benefit from having someone to confide in at home.
• Personalised Care: Home care allows tailored therapy plans, focusing on daily activities relevant to the survivor’s lifestyle, such as returning to work or hobbies.
• Cost-Effectiveness: Home care is often more affordable than prolonged stays in skilled nursing facilities or inpatient rehabilitation centres, which can cost significantly more.
• Family Involvement: Care workers can actively participate, fostering motivation and neuroplasticity through consistently practising exercises at home.
• Flexibility: Home-based care, like Medwell SA’s services, offers scheduling flexibility, with therapists and nurses visiting as needed.

Cons of Home-Based Rehabilitation

• Limited Access to Equipment: Homes may lack specialised rehabilitation equipment available in inpatient facilities, such as advanced mobility aids or therapy machines.
• Caregiver Burden: Family caregivers may feel unprepared or overwhelmed, leading to stress or fatigue if not adequately supported. Studies show that unprepared caregivers experience higher rates of depression.
• Inconsistent Services: In resource-constrained settings like rural South Africa, access to trained therapists or follow-up care can be fragmented, delaying recovery.
• Safety Concerns: Without proper home modifications (e.g., grab bars, ramps), survivors with mobility issues face higher risks of falls or complications.
• Less Intensive Therapy: Inpatient facilities often provide at least three hours of therapy daily, which may be challenging to replicate at home without robust support.

Inpatient Rehabilitation: A Comparison

Inpatient facilities, such as acute rehabilitation centres or skilled nursing homes, offer intensive, multidisciplinary care with access to specialised equipment and 24/7 medical supervision. They are ideal for survivors with severe impairments requiring three or more hours of daily therapy. However, they can be costly, less personalised, and may lead to feelings of isolation away from home. Early Supported Discharge (ESD) programmes bridge this gap, allowing medically stable patients with mild to moderate disabilities to transition home with intensive therapy, achieving outcomes comparable to inpatient care.

How Medwell SA Supports Stroke Recovery at Home

Medwell SA is uniquely positioned to address the challenges of home-based rehabilitation, offering comprehensive, expert-led care tailored to stroke survivors’ needs. With a team of experienced nurses, such as Sr. Leni Naude and Sr. Amanda Louw, and a network of rehabilitation professionals, Medwell SA elevates home healthcare across South Africa. Their services include:

• Around-the-Clock Nursing Care: Medwell SA provides 24/7 nursing support to manage medications, monitor vital signs, and prevent complications like pneumonia or deep vein thrombosis, which affect up to 60% of stroke survivors post-discharge.
• Specialised Rehabilitation Visits: Short-term visits by physiotherapists, occupational therapists, and speech therapists focus on restoring movement, daily living skills, and communication. These are tailored for post-stroke recovery, addressing issues like dysphagia (affecting up to 55% of patients) or mobility limitations.
• Holistic Frail Care: For survivors with long-term disabilities, Medwell SA offers comprehensive care within retirement estates, ensuring safety and quality of life through personalised support plans.
• Caregiver Training and Support: Medwell SA educates family caregivers, ensuring they are equipped to support recovery while managing their own well-being.
• Access to Medical Supplies: Medwell SA provides premium medical consumables through our wholesaler Edna, such as mobility aids, to enhance home safety and support rehabilitation goals.

By integrating these services, Medwell SA ensures that stroke survivors receive hospital-level care intensity at home, supporting neuroplasticity through consistent, repetitive practice. Their regional nursing services, led by professionals like Sr. Leni Naude, who brings trauma and ICU expertise, ensure high-quality, compassionate care.

Advice for Stroke Survivors and Caregivers

For young stroke survivors and their families, navigating recovery requires preparation and support:

• Prepare the Home Environment: Install safety features like grab bars, non-slip mats, and adequate lighting. A therapist home visit, as offered by some rehabilitation facilities, can ensure the home is optimised for recovery.
• Follow a Care Plan: Work with clinicians to develop an individualised care plan, including referrals to rehabilitation and community support services. Ensure this plan is shared with your general practitioner.
• Engage in Neuroplasticity: Consistently practise therapy exercises at home to rewire the brain, focusing on affected functions like movement or speech. Medwell SA’s therapists can guide this process.
• Support Caregiver Well-Being: Caregivers should seek respite care and emotional support to avoid burnout. Medwell SA’s holistic approach includes caregiver training to enhance readiness.
• Monitor for Secondary Strokes: Approximately 43% of stroke survivors experience another stroke within 10 years. Regular check-ups and adherence to medications (e.g., antihypertensives, antithrombotics) are essential.

Conclusion

Strokes in young people are a growing concern, driven by lifestyle, medical, and genetic factors, debunking the myth that they only affect older adults. Recognising the F.A.S.T. signs and adopting preventive measures like healthy living and stress management can significantly reduce risk. For those recovering at home, Medwell SA offers a lifeline through expert nursing, tailored rehabilitation, and caregiver support, addressing the pros of comfort and cost-effectiveness while mitigating cons like limited equipment or caregiver burden. By choosing Medwell SA, stroke survivors and their families gain a trusted partner in navigating the challenging yet rewarding journey of recovery, ensuring the best possible outcomes in the comfort of home.