A Systematic Review of Caregiver Burden following Stroke

Abstract

Caregiver burden following stroke is increasingly recognised as a significant health care concern. A growing number of studies have evaluated the patient, caregiver, and social support factors that contribute to increased caregiver burden. We conducted a systematic review of this literature to guide future research. A search of the MEDLINE, PsycINFO, CINAHL, and EMBASE databases (up to July 2008) and reference sections of published studies using a structured search strategy yielded 24 relevant articles. Studies were included if they evaluated predictors and/or correlates of caregiver burden in the setting of stroke. The prevalence of caregiver burden was 25-54% and remained elevated for an indefinite period following stroke. In studies that evaluated independent baseline predictors of subsequent caregiver burden, none of the factors reported were consistent across studies. In studies that assessed concurrent factors independently contributing to caregiver burden in the poststroke period, patient characteristics and social support factors were inconsistently reported. Several studies identified caregiver mental health and the amount of time and effort required of the caregiver as significant determinants of caregiver burden. Our findings highlight the need for more research to identify caregivers in need of support and guide the development and implementation of appropriate interventions to offset caregiver burden.

Development and evaluation of tools and an intervention to improve patient- and carer-centred outcomes in Longer-Term Stroke care and exploration of adjustment post stroke: the LoTS care research programme

“…Analysis was therefore conducted on an existing data set, 36 with a similar population to that of the stroke system of care trial, to identify criteria to enable us to distinguish between stroke survivors in terms of their social activity level (based on Barthel Index and FAI scores). In this population the median (interquartile range) reduction in Barthel Index score and FAI score from pre stroke to 12 months post stroke was 4 (1-8) and 16 (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26) respectively. Three main categories of stroke survivors were defined: 'doing better than expected', 'failing to thrive' and 'doing as expected (doing well)'.…”

“…[8][9][10] Many stroke survivors require assistance from informal carers, often family members, for activities of daily living, including bathing, dressing and toileting. 11,12 This burden of care has an important effect on carers' physical and psychosocial well-being, 13,14 with up to 48% of carers reporting health problems, two-thirds reporting a decline in their social life and high self-reported levels of strain. 14 In recognition of the pressing need for a 'comprehensive revolution' in stroke care the National Stroke Strategy (NSS) was produced in 2007.…”

“…5,12 Falls and consequent morbidity are also common. 13 Three inter-related themes can be proposed as important stroke challenges: longer-term perspective; greater emphasis on handicap rather than disability; and addressing psychosocial and adjustment needs. 1 Ideally, all require a primary care perspective.…”

Trends in Survival and Recovery From Stroke and Compression of Morbidity

“…Stroke imposes substantial burden, both economic and social, on individuals, their families, and society. 3 As with many other diseases, the incidence of stroke increases dramatically with age. 4 The impact of stroke, and its challenge to health care systems, is expected to increase during the next decade, as the "baby boomers" enter older age.…”

Caring needs in patient-partner dyads affected by heart failure: An evaluation of the long-term effects of a dyadic psycho-educational intervention

“…Taking care of an ill or disabled individual imposes a well-documented burden on the partner, both in terms of mental and physical health and the partner's HRQoL [11][12][13]. There is a relationship between the amount of caregiving and self-rated health;…”