Two interventions for improving stroke caregiver knowledge, stabilizing family function, promoting patient adjustment, and enlisting the use of social resources after stroke were compared with routine medical and nursing care of stroke patients (n = 61) at a 440-bed Veterans Administration Medical Center. The education intervention (n = 64) consisted of classroom instruction for caregivers about basic stroke care principles. The counseling condition (n = 63) consisted of education plus seven follow-up problem-solving sessions with a social worker (for the caregiver). Six months and 1 year after the stroke, both interventions significantly improved caregiver knowledge and stabilized some aspects of family function better than routine care. Counseling was consistently more effective than education alone and resulted in better patient adjustment at 1 year. Neither intervention influenced the use of social resources.

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Research studying the clinical effectiveness of stroke rehabilitation has focused on managing acute stages and on evaluating short-term treatment programmes. However, many studies suggest that stroke affects long-term quality of life and the well-being of the family. This article reviews the stroke literature relative to aging, disability, and rehabilitation. The social effects of stroke in terms of clinical problems which make rehabilitation a family dilemma are discussed. Issues identified include the need for family assessment, education, advocacy, and counselling to foster treatment compliance and social support.

In 84 blind clients, incidence of depression was 6% (5 subjects), and symptoms changed markedly as a function of time since determination of legal blindness. Self-reports of feelings of loneliness were evident in 20% (17 subjects). Report of loneliness was correlated with social inactivity. Depression and loneliness were unrelated to gender, marital or cognitive status, diagnostic category, or type of onset (sudden or progressive). Situational reactions were common after determination of blindness, but presence of vegetative signs of depression seemed atypical. Since affective disorders are associated with failure to return to prior social activities and cannot be predicted by commonly used patients' characteristics, the health care team should be prepared to identify, monitor, and manage affective symptoms in patients with significant visual loss.

Physical disability threatens a person's life style and can be detrimental in its effects on mood and activity. We describe a counseling program for severely disabled persons who were involved in telephone support groups in order to solve problems related to feeling discouraged, lonely, or being too inactive to remain healthy. A majority of the participants reported being less anxious and more socially involved as a result of the intervention. Ease with which groups were conducted and positive feedback from participants suggests that research should evaluate the cost effectiveness of phone intervention and explore potential of treating affective problems with scheduled phone contact.