Consequences of severity at stroke onset for health-related quality of life (HRQL) and informal care: A 1-year follow-up in elderly stroke survivors
Introduction
Severity of stroke influences the possibility of discharge and living at homes after acute stroke. Severity at stroke onset has been discussed as one possible prognostic factor for functional outcome and future residence (Jörgensen et al., 1999, Meijer et al., 2003). However, definitions of severity of stroke differ between studies (Jörgensen et al., 1999, Haacke et al., 2006) and this makes the comparisons between studies difficult.
Disability after stroke is common (Stephens et al., 2005) and it has been shown that cognitive impairments were frequent in 72% of an elderly population 20 months after a stroke, compared to 36% of a control group (Lindén et al., 2004). Another study showed that female stroke survivors did not recover as well as male did, however this might be explained by facts like the females were older and had poorer physical function prior to stroke onset (Lai et al., 2005). Remaining disability after stroke affects the HRQL and it has been reported that elderly persons that were dependent in personal assistance in ADL rated their HRQL lower than the others (Gosman-Hedström and Blomstrand, 2004). There has been a growing interest in reporting post-stroke HRQL as a key outcome measure and as an indicator of therapeutic efficacy (Saladin, 2000).
The policy in Europe differs somewhat from country to country. However, studies from Spain (Otero et al., 2002), Sweden (Johansson et al., 2003), Great Britain (Smith et al., 2004), the Netherlands (Koopmanschap et al., 2004, Visser-Meilly et al., 2005) and have emphasized that the number of informal caregivers is increasing, and that the burden on the caregivers, who are mostly women is often heavy. Although the severity of stroke and its consequences must greatly affect elderly caregivers’ life situation, to the best of our knowledge, this issue has not been studied systematically in stroke studies focusing on elderly stroke survivors.
The aim of the study was to explore how severity at stroke onset is related to HRQL and informal care among 147 stroke survivors living in their own homes 1 year after acute stroke.
Section snippets
Sample
This prospective cohort study is part of “The Göteborg 70+ Stroke Study” that included 249 elderly persons after acute stroke. The recruitment, study design and inclusion and exclusion criteria for that study have been described in detail previously (Fagerberg et al., 2000). One year after stroke 11% lived in some kind of assisted living, 25% had died, and 5% had withdrawn. At the 1-year follow-up, 59% (n = 147) of the 249 persons lived in their own homes. Of these 147 persons, 39% were married
Results
The main part of these elderly persons was classified as mild stroke at onset (n = 86). The remaining 61 persons were classified as having a moderate/severe stroke. There were no gender differences in severity of stroke at onset. At the 1-year follow-up all persons, except eight subjects were classified as mild stroke. Five of those that had moderate stroke still had moderate stroke. Two of the severe stroke at start had moderate stroke and one person still had severe stroke.
After 1 year the
Discussion
In the present study we found that the informal caregivers assisted their spouses to a large extent, regardless of severity of stroke at onset. Spouses gave most support, but also many children were involved, but not on a daily basis as were most of the spouses. The clinical implications would be that different kinds of support should be developed on group level but also on an individual basis to elderly stroke survivors and their families.
Although as expected, mild strokes need less support
Conclusion
Data from this study suggest that elderly persons assessed, as having moderate/severe stroke at onset should be considered to have need of rehabilitation resources. The stroke severity as assessed by senior OTs at stroke onset, seems to be a proper indicator of the need for informal and formal support after 1 year for stroke survivors at old age. However, even if these elderly persons recovered well in terms of motor capacity, they still needed a great deal of care and rehabilitation resources
Acknowledgements
The study was supported by grants from the Vårdal Institute, the Swedish Institute for Health Sciences, the John and Brit Wennerströms Foundation for Neurological Research, the Rune and Ulla Amlöv Foundation for Neurological Research, the Foundation in Memory of Sigurd and Elsa Goljes, Per-Olof Ahl's Foundation for Cerebrovascular Diseases and the Swedish Stroke Association.
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