Although fatigue is a common complaint after stroke, relatively little is known about how poststroke fatigue is experienced and what its related factors are. An in-depth understanding is necessary to develop effective and patient-centered poststroke rehabilitation programs. This review was undertaken to provide a comprehensive synthesis of knowledge from the literature concerning the description, definition, and measurement of fatigue and its relationship to sociodemographic and clinical factors. A search in PubMed, CINAHL, EMBASE, and PsychInfo was performed using "stroke" or "cerebrovascular accident" as medical subject headings in combination with "fatigue" as a key word. Descriptions of fatigue revealed multiple dimensions of the phenomenon. Although no specific theoretical definition of fatigue as a poststroke condition was found, a case definition has recently been published to be used as a tool to determine the presence of fatigue in poststroke patients. Poststroke fatigue is most frequently measured by using the general fatigue scales such as the Fatigue Severity Scale and a Fatigue Visual Analogue Scale, as there is no scale developed to measure poststroke fatigue specifically. Age, sex, living conditions, and personality were associated with poststroke fatigue, albeit with some conflicting findings. Conflicting results also were found in the relationships between fatigue and stroke-related characteristics such as stroke location/type, the number of strokes, and neurological deficits. There is an indication that prestroke and poststroke fatigue are related. Possible antecedent components identified are personal factors, biomarkers, stroke characteristics, prestroke fatigue, and comorbidity. As knowledge regarding poststroke fatigue remains limited, there is a need to continue empirical research with various theoretical orientations.

Depressive symptoms are common in the acute phase after stroke and associated with persistency of depression and mortality after 12 months. A gold standard for the measurement of depressive symptoms in relation to stroke is missing. The knowledge of PSD in the acute phase is still limited, and there is a need for continued empirical research on its profile and patterns.

Background/Aims: The interest in the relation between coping and depression in older persons is growing, but research on the concepts and instruments of coping in relation to depression among older persons is scarce and systematic reviews are lacking. With this background, we wanted to gain a systematic overview of this field by performing a systematic literature search. Methods: A computer-aided search in MEDLINE, CINAHL, PsycINFO, Embase, PubMed and www.salutogenesis.fi was conducted. We systematically searched for studies including coping and depression among persons 60 years of age and above. The included studies were evaluated according to predefined quality criteria. Results: Seventy-five studies, 38 clinical and 37 community settings, were included. Of these, 44 were evaluated to be of higher quality. Studies recruiting samples of older persons with a major depressive disorder, moderate or severe cognitive impairment or those who were dependent on care were scarce, thus the research is not representative of such samples. We found a huge variety of instruments assessing resources and strategies of coping (55 inventories). Although we found the relation between resources and strategies of coping and depression to be strong in the majority of studies, i.e. a higher sense of control and internal locus of control, more active strategies and positive religious coping were significantly associated with fewer symptoms of depression both in longitudinal and cross-sectional studies in clinical and community settings. Conclusion: Resources and strategies of coping are significantly associated with depressive symptoms in late life, but more research to systematize the field of coping and to validate the instruments of resources and strategies of coping in older populations is required, especially among older persons suffering from major depression and cognitive decline.

PurposeThe aim of the study was to describe the lived experience as it develops over time in stroke survivors suffering from early depressive symptoms.MethodThis paper presents a phenomenological hermeneutical interview-study of nine participants at 6, 12, and 18 months after stroke.FindingsThe participants related the depressive symptoms to the consequences of the stroke, and the experience of loss was crucial. Depressive symptoms was not meaningful on its own, but formed the backdrop of the experience of stroke. Our findings revealed three patterns of experience: (1) finding a restored self; (2) trapped in a different life; and (3) fighting to regain self.Two groups of stroke survivors are particularly vulnerable and should receive special attention: (a) old adults living alone; and (b) adults experiencing serious threats to their commitments such as to work, family, and children.ConclusionDepressive symptoms have a severe impact on life after stroke. Life circumstances, degree of residual impairment from a stroke, and social context were found to influence people to move along different paths. Older adults living alone and adults experiencing serious threat to their commitments should receive special attention, in terms of further research and in terms of follow-up in clinical practice.More studies investigating the experience of post-stroke depression (PSD) over time and the association between depressive symptoms and loss/grieving are needed. There is also a need for continued empirical research on the identification of effective interventions aimed at prevention or improved coping with PSD.

The participants confirmed suffering from depressive symptoms, but depression was not seen as meaningful on its own. They related their experiences of post-stroke depression in the acute phase to the losses they experienced. Nurses ought to take into account the depth of the life changes that stroke survivors may experience. There is a need for continued empirical research on how nurses may help and support stroke survivors dealing with depressive symptoms in the acute phase after stroke and how depressive symptoms develop over time.