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Stroke patients in tight-knit families can take longer getting to the hospital.
Reuters//Yves Herman
Herd mentality.
TIES THAT BIND

Your family may be keeping you from getting to the hospital in time

By Oliver Staley

Isolation is bad for your health. Men and women who live alone are at higher risk for heart attacks, and loneliness is linked to a range of illnesses, from depression to diabetes to Alzheimer’s disease.

Intuitively, this makes sense. When we live with those who care about us, they can help encourage us to eat right and exercise, and notice health problems we may miss or ignore. It would follow that the closer our network of friends and family, the better off we’d be.

But paradoxically, the opposite is true when it comes to stroke. A recent study in Nature Communications shows that when stroke patients are surrounded by close connections like their immediate family, they are less likely to get to the hospital in time for treatment, compared to patients with looser social connections.

Amar Dhand is a neurologist at Harvard Medical School with a PhD in sociology from Oxford who studies the relationship between social connections and health. His team surveyed 175 stroke patients in Boston and St. Louis, and mapped their social networks against the time it took them to arrive at the hospital. The 67 patients who took more than six hours to arrive had both smaller and tighter-knit social networks than the 108 who arrived in under six hours.

In stroke, the world’s second-leading killer, timing is everything. Strokes are caused by either blockages or ruptures in the blood vessels in the brain, which deprive brain cells of essential glucose and oxygen. Without blood, brain cells die in huge numbers and for every hour blood isn’t flowing to the brain, a stroke victim loses as many brain cells as in 3.6 years of normal aging.

The most effective treatment option for the most common form of stroke is a drug called tPA. To be effective, it must be administered within 4.5 hours of a stroke.

“This is the biggest problem in stroke therapy today,” Dhand says. “The delay that is caused by patients and the caregivers. The social context is the largest part of the delay, hands down, in stroke patients arriving in hospital in time.” There’s a predictable sequence of events for stroke patients in close networks, he notes. Initially, a patient may delay telling their family about their symptoms, not wanting them to worry.  “Secondly, they [the family] over-negotiate the symptoms, and perhaps even argue about them,” Dhand says. “Then they all validate each others opinion to watch and wait.”

He calls it an”echo chamber,” where family members, hoping for the best, minimize the gravity of the situation and conflate it with previous, less severe illnesses.

In contrast, when patients with only loose social networks have a stroke, there isn’t as much dithering. Patients who suffer strokes in a public place may be sent to the emergency room out of an abundance of caution by employees of the mall, store, or restaurant where they are afflicted. In some cases, an ambulance may be called by someone who doesn’t want the responsibility of caring for the sick person.

While the results of the study are perhaps counter-intuitive, Dhand finds them encouraging. Much of what occurs during a stroke is still largely out of the control of patients and doctors: They strike without warning, and to patients of all ages and races. But social networks can be shaped, and outside voices can be introduced to people who are otherwise surrounded by family. When potential stroke victims—who are often elderly—expand their circle by joining clubs or taking part in group activities, they add acquaintances who could be a valuable resource in an emergency, Dhand says.

“In some of these situations, the outside voice—if introduced—can tend take on a sort of objective authority,” Dhand says. “They tend to trust an objective voice of reason that can give a rational perspective of the situation, more than a loved one blinded by love.”