Original article
Factors Affecting the Burden on Caregivers of Stroke Survivors in South Korea

https://doi.org/10.1016/j.apmr.2004.09.013Get rights and content

Abstract

Choi-Kwon S, Kim HS, Kwon SU, Kim JS. Factors affecting the burden on caregivers of stroke survivors in South Korea.

Objective

To elucidate the factors related to the caregiver burden in stroke survivors in Seoul, Korea.

Design

Cross-sectional study.

Setting

Outpatient clinic of a university hospital in Korea.

Participants

We randomly selected 340 stroke patients and evaluated them for 3 years poststroke. Among them, 147 caregivers and patients were finally interviewed.

Interventions

Patients’ demographic data, neurologic symptoms, depression, emotional incontinence, and Modified Rankin Scale (MRS) score were assessed. In addition, primary caregivers’ demographic data, hours of care per day, relationship with the patients, health status, anxiety and depression, and the presence of alternative caregivers were assessed.

Main outcome measures

Caregiver burden was evaluated with the Sense of Competence Questionnaire, which has 3 subdomains with a total of 27 items.

Results

Caregiver burden score was high as compared with reports from Western society. Patient factors related to the burden scores were being unemployed (P<.05), the presence of diabetes mellitus (P<.05), aphasia (P<.01), dysarthria (P<.05), dysphagia (P<.01), cognitive dysfunction (P<.01), severe MRS score (P<.01), emotional incontinence (P<.05), and depression (P<.01). Caregiver factors related to high burden scores were being female (P<.05), unemployment (P<.01), being daughters-in-law (P<.01), anxiety (P<.01), depression (P<.01), and long caregiving hours (P<.05). On multivariate analysis, the most significant predictor for overall caregiver burden was caregiver anxiety followed by patient MRS score and caregivers being daughters-in-law. Caregiver depression, current employment status, and patient depression were also factors related to their burden.

Conclusions

Caregiver anxiety, patient physical deficits, and caregivers being daughter-in-law are important factors related to the caregiver burden in our population. Strategies to reduce caregiver burden should be developed based on understanding of these factors.

Section snippets

Methods

From the stroke registry of Asan Medical Center, we randomly chose 340 stroke patients admitted between January 1994 and December 1998. All the patients underwent computed tomography and magnetic resonance imaging to confirm the presence of stroke. We excluded stroke patients who had transient ischemic attack without progression to stroke; those who had severe heart, liver, or renal diseases that may exert additional burden on caregivers; and those with a history of depression before their

Characteristics of patients and caregivers

Among 340 patients, 117 (34.4%) could not be reached by telephone. Among the remaining 223 patients, 45 (20.2%) had died, 18 (8.1%) did not give consent, and 6 (2.7%) had had a subsequent stroke, yielding 154 patients. An interview with the caregiver was performed in 147 cases (45 at the patient’s house, 102 in our outpatient clinic). The MRS score at the time of discharge differed between the patients who were reached via phone and included in the interview (mild in 81%) and those who were not

Discussion

For assessment of caregiver strain, previous studies have used either depression and anxiety scales or the Bakas Caregiving Outcomes Scale.3, 13, 19, 20 The Caregiver Strain Index and a self-rated burden questionnaire have also been reported as concise and simple.5 However, we chose the SCQ because it covers depression and anxiety as well as other aspects of burden.5 Moreover, it enabled us to assess caregiving-related problems in different subdomains.18 Although the SCQ has a floor effect,18

Conclusions

The present study showed that the caregiver’s anxiety, patient’s MRS score, caregiver being a daughter-in-law of the patient, and depression of caregivers and patients are important factors influencing the level of burden experienced by stroke caregivers in Korea. Strategies to reduce caregiver burden should be developed and these strategies should be based on understanding these differences. For instance, we may have to develop strategies to reduce caregivers’ depression and anxiety. It would

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    Supported by the Korean Ministry of Health and Welfare (grant no. 03-PJ1-PG1-CH06-0001).

    No party having a direct interest in the results of the research supporting this article has or will confer a benefit on the author(s) or on any organization with which the author(s) is/are associated.

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