Managing fatigue in stroke survivors could be the key to a healthier life with less risk of secondary stroke

New research on stroke survivors, using data from the 45 and Up Study, has revealed that fatigue is closely tied to depression and a lower quality of life, as well as a person’s chance of another stroke.

The research comes from two studies from the University of Technology (UTS), both of which used data from the 45 and Up Study, including a survey of 576 stroke survivors.

Professor David Sibbritt, Head of the School of Public Health at UTS and lead author of both studies, says that both papers highlight an issue that’s been mostly overlooked by healthcare and research.

“Unless a stroke survivor directly reports fatigue to their GP or specialist, it’s not something that’s commonly asked about,” Professor Sibbritt says.

One study found a significant link between fatigue, disability, depression and quality of life in stroke survivors. The greater the disability in a stroke survivor, the great the level of fatigue reported. For every one unit increase in a person’s depression score, their fatigue score increased by 1.5 points. And for every one unit increase in the quality-of-life score, the fatigue score decreased by 0.7 points.

The second study found that a person’s fatigue and depression scores were both associated with modifiable risk factors for a secondary stroke. High-fatigue scores were linked with diabetes, depression, obesity and low physical activity, while high depression scores were linked with heart disease and anxiety.

These findings are important because there’s a growing number of stroke survivors who have unmet needs, argues Professor Sibbritt.

“The emergency and acute care in Australia is so good that survival rates are increasing,” says Professor Sibbritt. “But that means there are people quite disabled from strokes living for many years.”

In Australia there are approximately 34,000 stroke incidents a year, and around a quarter of those are recurrent strokes which are often more severe. One in five people live at least 15 years after a stroke, but 50% of community-based survivors require daily assistance from a caregiver.

The bi-directional relationship between fatigue and depression in stroke survivors is very important to the findings, as it could help with detection and management of both symptoms, Professor Sibbritt says.

“If someone’s suffering with depression, they don’t want to leave the house, don’t want to exercise, and chances are they don’t have a good diet, so fatigue follows from all that. There’s also the reverse: if you are fatigued in some way and you’re unable to exercise and not leave house and socialise, then it makes sense that it would lead to depression.”

The good news is that once detected, fatigue can be effectively managed.

“Once a health professional is aware of the problem, they can take steps to address it and figure out the cause of it,” explains Professor Sibbritt. “It could be to do with medications, or it could be that lifestyle changes are needed.”

Professor Sibbritt has used 45 and Up Study data for numerous studies over the years on chronic conditions and calls it “a tremendous resource”. He is now in the process of setting up his own cohort of stroke survivors (the Allen Study) for further research into their lifestyle changes, such as diet or exercise. The aim is to find out about the decision-making process behind lifestyle changes and how effective those changes are.

“Working with the 45 and Up Study has provided us with this incredible groundwork, giving us a better understanding of what areas to focus on in our cohort study,” he says.

The 45 and Up Study is the largest ongoing study of healthy ageing in the Southern Hemisphere. It’s made possible thanks to more than 250,000 dedicated participants across NSW, who are kindly sharing their health information with us to help create a healthier Australia.