Cerebral Vascular Accident (CVA) in Australia Analysis

This essay provides a critical analysis of Cerebral Vascular Accidents (CVA), also known as strokes, in Australia, examining their prevalence, mortality rates, and overall burden on the healthcare system. It explores the characteristics of individuals affected by CVA, including socio-demographic factors and levels of disability, highlighting disparities among different population groups such as Indigenous Australians and those in remote areas. The essay evaluates the impact of CVA on both individuals and the healthcare system, including economic costs and workforce challenges. It outlines the crucial role of nurses in CVA assessment and discusses three health and aged care services available to patients, along with three support services for caregivers. The analysis emphasizes the importance of early intervention, rehabilitation, and access to specialized stroke units to improve outcomes and reduce the long-term burden of CVA in Australia.

Running head: CEREBRAL VASCULAR ACCIDENT
Cerebral vascular accident
Name of the student:
Name of the University:
Author’s note

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A cerebral vascular accident (CVA) is a neurological disorder which is associated with
sudden disruption of blood flow to the brain. The other term for CVA is stroke and the two main
types of CVA include the ischemic stroke during which the supply of blood to the brain is
blocked and the hemorrhagic stroke during which blood vessel supplying blood to the brain
ruptures. The patients suffering from stroke experience symptoms like changes in vision, gait,
speech and hemiparesis. It leads to paralysis of parts of the body for some patients too (Nunes &
Cesar, 2018). CVA has been identified as the leading cause of disability and death in Australia
(Australian Institute of Health and Welfare, 2016). To further understand the extent of impact on
health care system, this essay aims to critically analyse the incidence, mortality and burden of
CVA in Australia and evaluate the characteristics of people who suffer from CVA in Australia.
The essay will discuss about the difference in challenges by varying socio-demographic
characteristics and level of disability in people with CVA. In addition, the paper will evaluate the
role of nurse in CVA assessment. It will give insight into three health and aged care services
available to the people living with CVA. As carers of people with CVA suffer from various
challenges, the paper will also discuss about three support services available for caregivers of the
patients diagnosed with CVA.
The burden of stroke in Australia is increasing every year. In the year 2011, stroke was
responsible for 3% of the total burden of disease in Australia. It comes under third position under
the burden of disease in people who are 85 years old. Compared to 2011, in the year 2015, an
estimated 3, 94, 000 people suffered from strokes at some point in their life. The number of CVA
events was around 100 everyday. CVA increased the overall mortality rate in Australia too. 5.2%
of all deaths in Australia in the year 2016 occurred due to stroke (AIHW, 2016). However, the
positive development is that with improvement in health care standard and treatment for CVA,

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the overall death rate has decreased by 74% between 1980 and 2016. Yearly improvement in
death rate has been found as in the year 2015, 6.8% fatalities occurred due to stroke in Australia
and 5.2% reduction in rate was found in 2016. The analysis of trends related to death in
Australian population indicates that the risk of death due to stroke is higher in older aged groups
and females. The median age at death stroke is 86.6 years (Australian Bureau of Statistics, 2017).
A study investigating about the impact of stroke in Australia reports that the burden of stroke lies
in the high mortality rate. The high morbidity rate is a concern too as it contributes to increase in
number survivors with chronic disability (Donkor, 2018). Thus, the above data shows that CVA
should be considered a disease with public health important and more research must be done to
evaluate and prevent its serious health, economic and social consequences.
People affected by CVA in Australia have different socio-demographic characteristics.
For example, the rate of CVA has been found to be 1.5 times higher in Aboriginal a people
compared to the non-indigenous groups (AIHW, 2016).According to Blacker and Armstrong
(2019), internationally also indigenous people experience stroke at a high rate. The risk of stroke
in this group is higher in men compared to women. However, one gap is that despite having high
incidence of stroke, the relative hospitalization rate in the group is low. Aboriginal stroke
patients are less likely to get admitted in a stroke unit due to several barriers to access of health
services such as poor availability of services in rural and remotes areas and long distance travel.
For this reason, the hospitalization rate is higher for people in remote and very remote areas
compared with major cities (AIHW, 2016). Thus, rate of stroke is higher in indigenous group and
people living remote areas compared to non-indigenous group.
Furthermore, people living in lowest socio-economical areas have highest impact of
stroke compared to those in the lowest socioeconomic areas. This group of people have severe

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deficits and they are less likely to receive evidenced based stroke services. Straney et al. (2016)
explored the impact of socio-demographic characteristics on incidence of CVA and indicated
that population over 65 years, socioeconomic status, smoking prevalence and educational level
were important predictors of incidence in Australia. Thus, the above data shows that care of
elderly group, people living remote areas and low socioeconomic areas and indigenous
Australians must be prioritized to prevent and control stroke in Australia.
The incidence of CVA or stroke is a major health issue in Australia as it is the cause
behind various disabilities in the patients. The problem found in 65% of stroke survivors across
the world is that that they suffer from any one disability that affects their ability to engage in
activities of daily living. A comparative study by Donkor (2018) investigating about stroke
survivors in various countries has revealed that stroke survivors are mostly challenged by
ongoing physical disability. The common complaints among the patients who recovered were
that they lost their usual hand function and ability to take part in daily activities. Such kind of
disability is a concern not only for the affected patient; instead it is a burden for family members
too. A study investigating disability rate five years post stroke has revealed that many patients
suffer from depression due to recurrent and chronic pattern of stroke. Elderly people, individuals
with most severe stroke and those with previous history of stroke and recurrences are at higher
risk of long-term disability. The common issue for the patient having a history of stroke includes
gait impairment and impaired motor functions due to brain lesion. The risk for disability differs
based on education level as educated patients have lesser stigma and they are more likely to
adhere to all the medications compared to the non-educated patients (Yang et al., 2016). This
suggests the need for high quality care and rehabilitation immediately after stroke to reduce the
disability burden. How far Australia has access to ongoing rehabilitation based support can

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determine the quality of life of Australian stroke survivors (Lynch et al., 2019). Thus, from the
above discussion, it can be concluded that there is a need to improve access to stroke units in
Australia, so that rehabilitation needs of all the patients can be identified at an early stage.
To clearly estimate the impact of CVA on Australian health care system, there is a need
to look at the economic impact of the condition in terms of hospitalization, workload and cost
associated with care. According to the Economics (2013), the financial costs of stroke were
estimated to be $5 million in 2012 and the largest component of the cost was productivity cost.
In contrast, in the year 2015-2016, all productivity cost associated with stroke increase by 2.1%
(Fayet-Moore et al., 2019). Furthermore, the high rate of CVA has seriously affected the health
care system of the country as the workload of staffs significantly increased. Purvis et al. (2014)
reported variable interest in Australian doctors who treat stroke patients because of heavy
workload and limited capacity to focus. The study also revealed lack of allied health care
professionals for stroke; thus suggesting the need to upgrade the health workforce and recruit
more number of specialist nurse to coordinate care and discharge plans. However, development
of specialist services is not the only responsibility. Hence, the above gap in stroke services has
made estimating levels of evidence based practice within stroke services in Australia necessary.
In order to take control over the prevalence of stroke in Australia, the Australian nurse
need to take an active role in controlling cases and engaging in proper assessment of the patients.
They are a key player in interdisciplinary stroke team and their role is critical in influencing
stroke rehabilitation. All nursing staffs have the responsibility to engage in proper assessment of
the patient and monitoring of homeostasis and complications. During the acute phase, nursing
assessment is important to identify changes in level of consciousness, measure presence of
absence of movements, stiffness of neck, papillary reactions, colour of the face, speech ability

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and blood pressure. Other neurological assessment that is necessary across the continuum of care
includes loss of consciousness, speech, motor effect, pupils, vital signs and blood glucose. This
is done by validated tools like Glasgow Coma Scale (Baker, 2019). During the post-acute phase,
they have a role to assess mental status, motor control and sensation and perception of the
patient. According to Prendergast and Hinkle (2018), nurse should also perform oral assessment
of the patients after stroke as oral care is compromised in such patients. Their engagement in
evidence-based practices for oral care after stroke is critical too. They also have a critical role in
education of the patient too. This has been revealed by Loft et al. (2019) which showed that
nursing educational intervention has greater role in promoting rehabilitation of the patients. The
above discussion shows how nurse could play a major role in stroke care and rehabilitation in
Australia.
To tackle the patient livings with stroke in Australia, many health services have come up
to address needs and complications of the patient with stroke. Australia has several stroke care
units that aim to provide special care. The national clinical guidelines and policy documents
recommends providing specialized care in these units. Some example of comprehensive stroke
care in Australia is the Royal Melbourne Hospital Comprehensive Stroke Care centre. It is an
example of a tertiary hospital in Victoria that provides pre-hospital, inpatient and outpatient care.
The services in this hospital includes neurosurgical referral service, multimodal CT and MRI
imaging, stroke rehabilitation services, mobile stroke unit and stroke outpatient clinics. Another
example of stroke services includes rehabilitation services. There are also specialized stroke
services for people living in rural areas and aboriginal people. Telestroke services have been
widely implemented in Australia to facilitate acute and rehabilitation stroke care (Department of
Health, 2012). The main challenges in rural and remote areas are to deliver optimal stroke

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service. Dedicated hospital services with access to experienced stroke teams have the capacity to
reduce deaths and disability due to stroke.. In addition to this, six levels of complexity for stroke
service provision are seen in Australia. The level 1 and 2 services can recognize only signs and
symptoms and make referral for transfer of the patients to level 4 services. Level 3 services
provide care to 50 stroke patients per year. However, these services do not have essential
infrastructure. In contrast, a level 4 services are those which admit 50-100 stroke patients every
year and they have access to specialist staffs, CT imaging and other relevant infrastructures.
Level 5 services are primary stroke services which admit more than 300 stroke patients/year and
level 6 is those service which sees high volume of the patients with CVA (Government of South
Australia, 2018). Hence stroke services in Australia distributed by number of beds and volume of
patients.
As elderly people are at high risk of functional impairment and disability due to stroke,
home care services are available in Australia. These services provide home maintenance,
mobility support, self-care support and mobility related support. In addition, primary care and
aged care services and non-governmental organizations in Australia are effective in the delivery
of acute and sub-acute stroke care. The carers of stroke patients also experience emotional and
psychological burden due to behavioural disturbances of their loved one and the change in their
daily life roles. In such case, they are in need of education, medical care, social support as well
as counselling support. Stroke Foundation has dedicated Strokeline helpline to provide support
and assistance to carers in Australia (Stroke Foundation, 2015). This indicates that Australian
government is prepared to meet the needs of elderly people as well carers of people affected with
CVA.

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To conclude, from the analysis of the burden and prevalence of CVA in Australia, it is
clear that the elderly people and those living in remote and low socioeconomic areas are at more
vulnerable compared to other groups. The occurrence of the disease is associated with many
forms of disability and mobility related issues for the patients. Oral hygiene and care of some the
patients are compromised too. Health service is affected as it results in high health care
expenditure, workload for staffs and high cost too. In response to different types of challenges
associated with CVA in Australia, Australia has different types of services to support patients,
carers and elderly patients. Based on the analysis of characteristics of people with stroke in
Australia, many improvement areas have been identified. There is a need to focus on ways to
enhance access to specialist stroke care units so that no patient is deprived of quality stroke
services.

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