Stroke with a focus in the elderly : from a gender and socioeconomic perspective

Abstract: Stroke is one of the leading causes of death and disability in Sweden and in the Western world. Despite this, stroke with focus on elderly is a field where few studies have been conducted from a gender and socioeconomic perspective. The objectives in this thesis were to analyse from a gender, age and socioeconomic perspective how women were affected by stroke compared with men. The focus was on what it meant for elderly women and men to live with stroke and to explore various gender constructions among men and women. The study also included aspects such as incidence, medical treatment and case fatality after stroke. Both quantitative and qualitative methods were used. During a two-year period (15 October 2000–14 October 2002), uniform information was collected for all cases of first-ever and recurrent (>28 days) stroke occurring in people of all ages living the region of Umeå, admitted to the University Hospital. Five different registers were used to achieve maximum coverage; the Riks-Stroke (RS) register, the Hospital Discharge Register (HDR), the Cause of Death Register, the northern Sweden WHO MONICA study, and one case-finding study in nursing homes and homes for elderly performed for this thesis. For the qualitative study a maximum variation sampling procedure was used to retrieve participants for in-depth interviews in a follow-up study. Nine women and seven men were interviewed about their experiences of treatment and care after suffering a stroke, as well as about their perceptions and experiences of help from others (health care personnel, relatives and home help personnel). The first-ever incidence of stroke was higher among low-educated than high educated men and women. Our study showed that there was an education-related age-dependent difference in stroke incidence, where elderly women had the highest incidence of stroke. The 28-day case fatality was shown to be associated with low educational level in patients above 75 years, after controlling for sex, risk factors and acute care variables. The elderly stroke patients experienced subordination in their contacts with health care personnel and the medical context. The participants used different ways to negotiate in the subordinate position, and some of these negotiations were interpreted as being gendered. We have also shown how the elderly stroke patients minimized their own needs of help, strove for independence and accepted help. The men and the women differed in their perceptions and experiences of help from others. Also, the participants expressed multiple types of needs. The elderly stroke patients’ perceptions and experiences of help from others must be studied in relation to their life circumstances and expectations from society. Further analyses of the patients’ perceptions and experiences of help from others were interpreted as being different examples of constructions of masculinities and femininities. Stroke with a focus on the elderly is a field where few studies have been conducted from a gender and socioeconomic perspective. With further community-based stroke incidence studies including elderly men and women and with the development of appropriately targeted interventions, the burden of stroke in the population could be reduced. More research is needed where both qualitative and quantitative methods are used, as this can provide a richer and perhaps more authentic description of the issue under investigation.