Caregiver strain in spouses of stroke patients

Abstract

Objective: To test the ability of a previously generated logistic regression model to predict caregiver strain from carer mood, negative affectivity and perceived patient functional ability. Design: Postal prospective survey. Setting: Spouses of community-residing patients identified from hospital stroke registers. Method: Spouses were assessed at three and six months after stroke. A previously derived equation was used to make predictions at three months of their level of strain at six months, which were compared with observed outcomes. Measures: Spouses were asked to complete the Caregiver Strain Index (CSI), the General Health Questionnaire (GHQ-12), the Positive and Negative Affectivity Schedule (PANAS) and to assess patients' independence in activities of daily living on the Extended Activities of Daily Living Scale (EADL). Results: Of 409 stroke patients, 276 had an identifiable co-resident spouse and 116 (42%) completed the measures. At three months after stroke, 39 carers (34%) were under significant strain with 40 (35%) under strain at six months. The predictive model using the GHQ-12, PANAS and EADL at three months was 78% accurate in predicting levels of caregiver strain at six months. Conclusion: Carers at risk of later strain could be identified for further followup. Services to provide emotional support to carers might be effective in the reduction of carer strain.

Determinants of Caregiving Burden and Quality of Life in Caregivers of Stroke Patients

“…Selection criteria would have excluded patients with severe disability or cognitive impairments; most patients made Relationship with patient significant physical recovery, and all caregivers were in good health. This may explain why variables such as patient disability, cognitive impairments, and patients' or caregivers' health, found to be significant in studies on caregivers of severely disabled patients, 4,9,13,25 were not independent predictors of caregiver burden in this study. These factors make substantial difference in the level of caregiving burden and need to be considered in caregiver risk assessment.…”

“…1,2 Recent years have seen increasing awareness of the role of caregivers in the long-term management of stroke patients, and there is growing literature on the caregiving burden, poor caregiver outcomes, lack of caregiver support, and equivocal success, with interventions aimed at alleviating the caregiving burden. [2][3][4][5] It is also becoming clear that the emphasis in stroke rehabilitation needs to shift from a patient-focused approach to a combined patient-and caregiver-focused approach because these individuals are central in preserving rehabilitation gains and the long-term well-being of stroke survivors. 4,5 However, the success of early attempts to support caregivers has been limited, largely because the determinants of caregiving burden and the needs of caregivers remain poorly understood.…”

“…[2][3][4][5] It is also becoming clear that the emphasis in stroke rehabilitation needs to shift from a patient-focused approach to a combined patient-and caregiver-focused approach because these individuals are central in preserving rehabilitation gains and the long-term well-being of stroke survivors. 4,5 However, the success of early attempts to support caregivers has been limited, largely because the determinants of caregiving burden and the needs of caregivers remain poorly understood. 6 Little research has been devoted toward understanding the complex and multilayered phenomenon of caregiving, beyond patient dependence and the emotional or psychological aspects of caregiving after stroke.…”

Functioning at 6 months post stroke following discharge from inpatient rehabilitation

“…Fifty-six per cent of caregivers had CSI scores ≥7, reflecting high levels of strain. 18 Financial strain (65.9%) and work adjustments (53.6%) featured prominently.…”

Evidence-Based Educational Guidelines for Stroke Survivors After Discharge Home

“…Numerous studies show caregivers sustain negative psychological effects during the first year after a stroke survivor is discharged home (Blake, Lincoln, & Clarke, 2003;Burton, 2000;Clark & Smith, 1998;Coombs, 2007;Grant et al, 2004;Ski & O'Connell, 2007). Recent research finds stroke survivors often do not reach their rehabilitation goals and lack of information is a major barrier to continued recovery (Jones, 2006).…”