Preventing a second stroke, and what help at home can do

The NHS page on preventing a stroke lists the medical conditions that raise the risk: high blood pressure, diabetes, atrial fibrillation (an irregular and fast heartbeat), high cholesterol, and a previous TIA. It then lists what lowers it: stopping smoking, a balanced diet, exercise, cutting down on alcohol, and remembering to take the medicines for those conditions. The Stroke Association, the UK charity for people affected by stroke, adds staying a healthy weight, and says plainly that although the risk is higher after a stroke or TIA, it can be reduced.

Your relative will not have all of these. The discharge letter or the GP will say which apply, so ask if nobody has told you.

NICE describes the medical side of prevention as "best medical treatment": control of blood pressure, antiplatelet medicines, cholesterol lowering through diet and drugs, and lifestyle advice (NICE guideline NG128, recommendation 1.2.4). The GP can prescribe and review, but what happens with the tablets and the meals from one day to the next is up to the household.

For the wider picture, stroke recovery care gives the wider picture of the months after a stroke, and the first weeks home after a stroke covers the period straight after discharge, when the new medicines usually start.

The NHS page on TIA treatment says most people who have had a TIA will need to take one or more medicines every day, long term, to reduce the chance of a stroke or another TIA, and the NHS stroke treatment page lists anticoagulants, blood pressure medicines and statins among the long-term treatments after a stroke.

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None of these medicines is there to make your relative feel better, and that is what makes them easy to let slip. The Stroke Association's article on taking medication to reduce your risk of stroke says that blood thinners typically will not make somebody feel different, because they are prescribed to reduce the risk of future strokes. It asks people to keep taking them for as long as they are prescribed, and, if there are side effects, not to stop but to contact the GP, a pharmacist or 111. The NHS says the same of statins: talk to a doctor or pharmacist before stopping.

A missed tablet now and then is a question for the pharmacist, who can tell you what to do about that particular medicine. A pattern of missed tablets, or a relative who has decided to stop one, is a question for the GP. If swallowing tablets has become hard since the stroke, say so: NICE guideline NG236 asks for the medicine to be reviewed and, if it is still needed, for its form to be changed. The dysphagia diets page explains the swallowing side.

If your relative also has another heart condition, such as heart failure, the list gets long. Ask the pharmacy for a printed list of everything prescribed and keep it where anybody helping can see it.

That is the NHS wording from the stroke symptoms page, which also lists other signs: weakness or numbness down one side of the body, blurred vision or loss of sight, finding it hard to speak or think of words, confusion and memory loss, dizziness or falling over, a severe headache, and feeling or being sick. The NHS says to call 999 if you think somebody is having a stroke or has had one, and if there have been signs of a stroke in the last 24 hours even if they have now stopped.

After a first stroke it can be hard to tell a new sign from the weakness that was already there, so watch for change. A face that droops more than it did this morning, or speech that is suddenly worse, is a 999 call rather than a call to the GP.

Put a note by the phone with your relative's name, date of birth, address, GP surgery and the list of medicines, including any blood thinner. A carer or visitor who has to ring 999 in a hurry can then read it out. The blood thinner matters: NICE lists anticoagulant treatment among the reasons for an immediate brain scan when a stroke is suspected (NG128, recommendation 1.3.2).

For food, the NHS Eatwell Guide shows a balanced plate, and our guide to elderly nutrition covers appetite, weight and cooking for an older person. If your relative's swallowing has been affected, the speech and language therapist's advice on food and drink comes first, even where it seems to sit awkwardly with the advice above.

For activity, the NHS physical activity guidelines for older adults are the starting point, but after a stroke the physiotherapist decides what is safe. Rehab at home after a stroke explains how the exercise sheet works between therapy visits, and how far an 80-year-old should walk each day is a gentle place to begin once walking is allowed.

The NHS explains what 14 units of alcohol looks like and how to get free help to stop smoking.

Changing habits is hard at a time when your relative may be low or frightened, and the Stroke Association notes that for many survivors another stroke is their greatest fear. If mood is getting in the way of any of this, emotional changes after a stroke is the page to read next, and the GP should hear about it.

The six-month and annual reviews come from NICE guideline NG236 (recommendation 1.17.5), which also asks for the needs of family carers to be reviewed at the same time. The NHS page on stroke recovery says you should get a review after about six months, and to speak to your team if you do not.

Before each appointment, write down any missed tablets, any side effects, the home blood pressure readings if you have them, and anything that has changed, such as falls or low mood. The Stroke Association also encourages going back to the GP to ask about your relative's own risk of another stroke if it has not been explained.

Prompting and helping with tablets is ordinary work for a carer. Taking the dose out of the pack and giving it is a different job, which needs clear written directions and a carer trained to do it. Can a private carer give medication? explains where the line sits and what to agree before the first visit. Write what the carer will do with medicines into the care plan, which writing a care plan together covers, and brief them on FAST and the note by the phone on their first day.

Seeing the same carer every time is what makes the noticing possible, and the same carer every visit explains how to arrange it. If your relative would like someone to help with tablets, meals and walks, you can search for carers near you and compare their rates. Hourly visits on PrimeCarers run from £18 to £25 an hour with our fee included, against £28 to £35 an hour at an agency. If the help needed is closer to round the clock, live-in care after a stroke explains that option, and a council care needs assessment is free to ask for.