Impact of Living Alone on the Care and Outcomes of Patients With Acute Stroke

Reeves, Mathew J.; Prager, Marla; Fang, Jiming; Stamplecoski, Melissa; Kapral, Moira K.

doi:10.1161/strokeaha.114.006520

Cited by 76 publications

(70 citation statements)

References 9 publications

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“…65 Living alone before stroke is associated with delays in arrival to hospital 66 and lower use of tissue-type plasminogen activator therapy, which likely affects PROMs. 67 Despite this, few of the studies reviewed here included social factors as potential confounders of sex differences with the exception of a small number of studies that adjusted for marital status or living alone. 18,42 A prospective study of ischemic stroke survivors found that social isolation, but not living alone, was associated with a 40% increase in the risk of cardiovascular events or death.…”

Section: Discussionmentioning

confidence: 99%

Focused Update of Sex Differences in Patient Reported Outcome Measures After Stroke

Gall

Phan

Madsen

et al. 2018

Stroke

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W omen experience worse outcomes after stroke than men 1 despite their lower age-adjusted incidence of stroke.2 Previous reviews of sex differences in select stroke outcomes, including activity limitations, 3-5 participation restriction, 4 poststroke depression (PSD), 3 and health-related quality of life (HRQoL), 3,4 demonstrated that women had worse outcomes than men across many of these measures. Women's greater age and stroke severity, as well as poorer prestroke function, seem to contribute to the sex difference in outcomes, but data on other contributing factors are limited.4 Existing reviews included studies published >5 years ago, and given the rapid increase in the number of studies addressing sex differences in stroke outcomes, an updated review is warranted. MethodsFull details of our methods are provided in the online-only Data Supplement. A previous review included studies up to 2007, 3 so we reviewed studies from 2007 onwards that examined sex differences in patient reported outcome measures (PROMs) at ≤12 months after stroke, including activity limitations, HRQoL, participation restriction, impaired cognition, and mood. 6 Full results tables are shown in the online-only Data Supplement. Results Activity LimitationsOf 1875 articles identified, 22 studies (3 population based) that were designed to examine sex differences (Results and Table I in the online-only Data Supplement) met criteria for inclusion. The most common instrument to assess activity limitations was the modified Rankin Scale, followed by the Barthel Index.In 8 studies including ischemic and hemorrhagic strokes, unadjusted estimates showed that women had more activity limitations than men through significantly lower odds of good outcome (odds ratio [OR] range: 0.44-0.61) 7-9 or greater odds of poor outcome (OR range: 1.29-1.62).10-14 In multivariable adjusted analyses, women had worse outcome than men with significantly lower odds of good outcome (OR range: 0.37-0.75) or greater odds of poor outcome (OR range: 1.17-1.74). 7,8,10,12,13 In 2 studies, there was no statistically significant difference between women and men.11,14 Adjustment for covariates, most commonly age, stroke severity, comorbidities, and prestroke function, reduced the associations between 9% and 20%, suggesting these factors partly explain the greater activity limitations for women after stroke.In 11 studies of ischemic stroke ( Table I in the online-only Data Supplement), women generally had worse outcome than men demonstrated by greater odds of poor outcome (mostly modified Rankin Scale ≥3 versus <3; range in ORs: 1.13-2.40) or lower odds of good outcome (eg, modified Rankin Scale ≤1 versus >1 or independent walking).15-25 Among 13 multivariable adjusted comparisons between men and women (some studies had >1 comparison), women's significantly worse outcome compared with men persisted in 7 comparisons with a greater odds of poor outcome (range, 1.30-3.40) or a higher activities of daily living score. [17][18][19][22][23][24] Common covariates included age, stro...

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Section: Discussionmentioning

confidence: 99%

Focused Update of Sex Differences in Patient Reported Outcome Measures After Stroke

Gall

Phan

Madsen

et al. 2018

Stroke

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“…We examined the personal social networks of fast (<6 h) and slow (>6 h) responders, building on prior literature which showed that being unmarried and living alone were risk factors for delay 49,50 . Our preliminary analysis revealed that patients who arrived later had close-knit networks, that is, smaller networks with higher constraint.…”

Section: Applications In Neurologymentioning

confidence: 99%

Social networks and neurological illness

et al. 2016

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Every patient is embedded in a social network of interpersonal connections that influence health outcomes. Neurologists routinely need to engage with a patient’s family and friends due to the nature of the illness and its social sequelae. Social isolation is a potent determinant of poor health and neurobiological changes, and its effects can be comparable to those of traditional risk factors. It would seem reasonable, therefore, to map and follow the personal networks of neurology patients. This approach reveals influential people, their habits, and linkage patterns that could facilitate or limit health behaviours. Personal network information can be particularly valuable to enhance risk factor management, medication adherence, and functional recovery. Here, we propose an agenda for research and clinical practice that includes mapping the networks of patients with diverse neurological disorders, evaluating the impact of the networks on patient outcomes, and testing network interventions.

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“…Stroke survivors living with their family or spouse arrive earlier at the hospital, receive more thrombolytic therapy, are more likely to return home [1], and receive more anticoagulants as secondary prevention [2], compared to stroke survivors living alone. Previous studies showed that stroke survivors’ living alone predicted mortality after stroke [3], which was especially true for male stroke survivors in the long-term perspective [4].…”

Section: Introductionmentioning

confidence: 99%

Stroke survivors’ long-term QALY-weights in relation to their spouses’ QALY-weights and informal support: a cross-sectional study

Persson

Levin

Holmegaard

et al. 2017

Health Qual Life Outcomes

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BackgroundHealthcare interventions that have positive effects on the stroke survivors’ health-related quality of life (HRQoL) and quality-adjusted life-years (QALYs) might also have positive effects for their spouses in terms of improved HRQoL and/or reduced spousal informal support. However, knowledge about stroke survivors’ HRQoL and QALY and the consequences for their spouses’ HRQoL and QALY is limited. Therefore, the aim of this study was to describe the HRQoL and QALY-weights in dyads of stroke survivors in comparison with dyads of healthy controls, and to study the relationship between the stroke survivors’ QALY-weights and consequences for spouses in terms of QALY-weight and annual cost of informal support, using a long-term perspective.MethodsData on stroke survivors, controls, and spouses were collected from the seven-year follow-up of the Sahlgrenska Academy Study on Ischemic Stroke (SAHLSIS). HRQoL was assessed by the SF-36, and the preference-based health state values were assessed with the SF-6D. The magnitude of the support was assessed with a study specific time-diary. An ordinary least squares (OLS) regression was used to estimate the association between stroke survivors’ and spouses’ QALY-weights. A two-part econometric model was used to estimate the association between stroke survivors’ QALY-weights and the time spent and cost of spouses’ informal support.ResultsCohabitant dyads of 248 stroke survivors’ aged <70 at stroke onset and 245 controls were included in the study. Stroke survivors had lower HRQoL in the SF-36 domains physical functioning, physical role, general health, vitality (P < 0.001), and social functioning (P = 0.005) in comparison with their cohabitant spouses. There was no significant difference in HRQoL for the dyads of controls. The results from the regression analyses showed that lower QALY-weights of the stroke survivors were associated with lower QALY-weights of their spouses and increased annual cost of spousal informal support.ConclusionOur results show that the QALY-weights for stroke survivors had consequences for their spouses in terms of annual cost of spousal informal support and QALY-weights. Hence, economic evaluation of interventions that improve the HRQoL of the stroke survivors but ignore the consequences for their spouses may underestimate the value of the intervention.

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Impact of Living Alone on the Care and Outcomes of Patients With Acute Stroke

Cited by 76 publications

References 9 publications

Focused Update of Sex Differences in Patient Reported Outcome Measures After Stroke

Focused Update of Sex Differences in Patient Reported Outcome Measures After Stroke

Social networks and neurological illness

Stroke survivors’ long-term QALY-weights in relation to their spouses’ QALY-weights and informal support: a cross-sectional study

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