NASHVILLE, Feb. 4 -- As more people continue to work after the age of 65 and the older population in the U.S. -- those most susceptible to strokes -- also grows, a new economic dilemma is created: Can people work after having a stroke and what factors limit a stroke survivors ability to return to work? In a new study, researchers found that just over half of those who survive the most common type of stroke were able to return to work within six months.
"The study, reported here today at the 24th American Heart Association International Conference on Stroke and Cerebral Circulation, represents an investigation into a subject about which little is known," says lead author Marcella A. Wozniak, M.D., Ph.D., assistant professor of neurology at the University of Maryland School of Medicine.
"Although stroke is extremely common in this country, the relationship of stroke and the ability to go back to work after stroke has received very little study," Wozniak says. "As the U.S. population gets older and the minimum age for full Social Security retirement benefits increases, significantly more people are going to be working at the time they have a stroke. This is going to be an important economic problem and it is important to develop predictors for who will return to work."
The degree of disability suffered by the stroke survivor is the best predictor of whether he or she will be able to return to work, say researchers. A person's gender, ethnic background or level of depression do not appear to play a role in whether or not the individual goes back to work.
The study enrolled 200 men and women from the Baltimore-Washington, D.C., area who suffered ischemic strokes, caused by the blockage of vessels that carry blood to the brain.
The initial analysis involved research data gathered about 104 stroke survivors at six weeks and six months following their stroke. Thirty-eight percent of them were women and 39 percent were black. Their ages at the time of their strokes ranged from 27 to 64, and they held jobs in a wide variety of occupations.
Of the 104 patients, 56 percent returned to work six months after their stroke, 91 percent of those who returned to work were able to work at the same job they held before their stroke, and 88 percent worked 40 hours or more a week.
"We are interested in understanding why it is that some patients are not able to return to work after stroke, and why other patients are able to overcome their disability and get back to work," Wozniak says. "We hope this preliminary study will give us data to suggest ways to help patients return to work after stroke."
Six weeks after the stroke, the researchers assessed the patients' ability to do such daily activities as feeding and dressing themselves, using the toilet, and walking up and down stairs.
At 6 months and 12 months after the stroke, the scientists checked each patients medical outcome -- whether they had required rehospitalization because of the effects of their stroke, suffered a second stroke, or suffered a heart attack. They also assessed the patients degree of disability, whether the person was working; and his or her quality of life as the stroke had affected it. Depression and social interactions with other people were evaluated.
The researchers expect to complete the full analysis of study participants by the end of 1999.
"Obviously, we are in the preliminary phase of the data analysis," Wozniak says. "We hope this study will reveal some potentially interesting trends in the relationship between job characteristics and return to work, which could allow us to make modifications that would make it easier for people to return to their jobs."
Physical disability six weeks after a stroke is the major predictor of whether someone will return to work, the researchers report.
Congress has mandated a gradual increase in the age when people can obtain full retirement benefits under Social Security. For people born in 1937 or before, the age for retirement remains 65. People born in 1938 must wait until they reach age 65 and two months to claim full benefits. The full retirement age continues to increase until it reaches age 67 for those born in 1960 or later.
Co-authors of the study are Steven J. Kittner, M.D.; Thomas R. Price, M.D.; Jeffrey V. Johnson, Ph.D.; Lynn M. Grattan, Ph.D.; Nancy K. Zappala, R.N.; Douglas D. Bradham, D.P.H.; and Michael A. Sloan, M.D.
Media advisory: Dr. Wozniak can be reached by phone at 410-328-0736, by fax at 410-328-1409 or by e-mail at mwozniak@umaryland.edu. (Please do not publish numbers.)