Burden of Chinese stroke family caregivers: the Hong Kong experience

Stroke caregivers' perception on instant messaging application use for psychological intervention: a qualitative study

In caring for patients with stroke, the leading cause of death and disability affecting over 80 million people worldwide, caregivers experience substantial psychological and physical burdens and difficulties in help-seeking owing to physical and time-constraints. Social distancing measures imposed during the coronavirus disease 2019 (COVID-19) pandemic further restricted them from using caregiver support services. While the use of telehealth emerged as a global prevailing trend during the COVID-19 pandemic, evidence for utilising instant messaging (IM) applications for psychological intervention is scanty. This study aimed to explore stroke caregivers' perceived potential utility of IM-delivered psychological intervention. Between January and August 2020, 36 adult family stroke caregivers in Hong Kong were recruited to individual telephone semi-structured interviews using purposive sampling. The interviews were audio-recorded, transcribed verbatim and analysed using an interpretive description approach. Three themes of caregivers' perceptions towards IM-delivered psychological intervention emerged: perceived high convenience and ease of use, perceived advantages that overcome existing barriers to services and message delivery tailored to individual needs. Our findings suggested that there is an imminent need among stroke caregivers for personalised psychological interventions and that IM is a potential modality for overcoming existing barriers in delivering accessible support to caregivers in real-time, real-world settings. Our study highlighted caregivers' acceptance and perceived benefits of IM-delivered psychological intervention and provided practical insights into the design of IM-delivered psychological interventions.

Caregiver Employees' Mental Well-Being in Hong Kong

BACKGROUND

The rapidly aging global population has increased the demand for caregivers. Many caregivers simultaneously engage in paid employment, and the dual role makes the needs of caregiver employees conceivably more remarkable. However, there is a gap in the literature about the specific needs of caregiver employees.

METHOD

Caregiver employees (n = 1205) across Hong Kong caring for those ≥65 years were recruited for a cross-sectional face-to-face survey from December 2021 to January 2022, to evaluate mental well-being measured by the Short Warwick -Edinburgh Mental Well-being Scale. Univariate and multivariate analyses were conducted; significant variables (p < 0.05) were included in multiple linear regression, along with caregiver-friendly workplace policies' availability, to understand their association with their mental well-being.

FINDINGS

The mean score of the Short Warwick-Edinburgh Mental Well-being Scale among caregiver employees in this study was 24.9, with 7.2% indicative of probable clinical depression and 10.0% possible mild depression. In addition, the current study showed that 30.2% of the caregiver employees felt distressed about the caregiving role. Among external factors, family support (measured by the Lubben Social Network Scale) and workplace culture (measured by the Marshall Supervision Subscale) positively correlated with mental well-being with regression coefficients of 0.252 (p < 0.001) and 0.482 (p < 0.001), respectively. In the fully adjusted model, a negative regression coefficient was observed for overall spillover (-0.050, p < 0.001) and Short Warwick-Edinburgh Mental Well-being Scale scores, while positive regression coefficients were observed for overall self-rate (0.041, p < 0.001), Lubben (0.124, p < 0.001), and corporate culture (0.365, p < 0.001). Better Short Warwick-Edinburgh Mental Well-being Scale scores were observed when caregiver-friendly workplace policies were clearly stated than when they were made on a case-by-case discretionary basis.

CONCLUSIONS

Caregiver-friendly workplace policies may be critical to Hong Kong's sustainable future, both economically and socially, as they ensure a healthy and productive workforce to support an aging population.

The caregiver burden of informal caregivers for stroke patients with and without dysphagia: A multi-center, cross-sectional study in Türkiye

Objectives

The aim of this study was to investigate the caregiver burden (CB) of informal caregivers for stroke survivors with and without dysphagia and to assess the relationship between the CB levels of informal caregivers for stroke survivors with dysphagia, patients' swallowing-related quality of life (QoL), and patients' stroke-specific QoL.

Patients and methods

This multi-center, prospective, cross-sectional study included a total of 120 stroke patients (76 males, 44 females; mean age: 61.1±12.3 years; range, 19 to 86 years) between October 2019 and 2020. Of the patients, 57 had dysphagia and 63 had no dysphagia. The Functional Oral Intake Scale (FOIS) was used to classify the degree of functional dietary limitation caused by each patient's swallowing impairment. Patients and caregivers completed the Eating Assessment Tool (EAT-10), Swallowing Quality of Life (SWQoL) questionnaire, Stroke Impact Scale (SIS), and the Zarit Caregiver Burden Interview (ZBI).

Results

The CB levels were higher in those caring for stroke patients with dysphagia than in those caring for stroke patients without dysphagia. Caregiver burden was found to be associated with patients' swallowing-related QoL and stroke-related QoL. Significant predictors of high CB scores (F=2.55, R2=0.59; p=0.007) were being an employed caregiver (B=17.48, p=0.003), being a caregiver with high school (B=-19.6, p=0.03), and secondary school (B=-16.28, p=0.02) educational status, being son, daughter (B=30.63, p=0.007) or other relative of the patient (B=20.06, p=0.01), lower FOIS stage (B=-3.14, p=0.011), lower SWQoL (B=0.52, p=0.009) and lower SIS (B=-0.37, p=0.04) scores.

Conclusion

Caregivers of stroke patients with dysphagia suffer from a higher CB than those without dysphagia. In stroke patients with dysphagia, swallowing-related QoL is associated with the QoL levels of stroke patients and the CB levels of their caregivers. Employment status, educational status of caregiver, caregiver's relativity to the patient, FOIS stage, swallowing and stroke related QoL of the patients are factors related to burden levels of caregivers of stroke patients with dysphagia. These results may help health professionals to understand dysphagia as an essential source of CB and consider it, while planning treatments.

The Effects of Patients' and Caregivers' Characteristics on the Burden of Families Caring for Stroke Survivors

Background: Vascular strokes are the leading cause of long-term disability for adults. They impose high levels of burden on the patient, the family, and national healthcare systems worldwide. This study aimed to assess the effects of patients’ and caregivers’ characteristics on the perceptions of burden in families caring for a loved one living with stroke in Greece. Methods: Using purposive sampling, 109 dyads of patients and their respective caregivers were recruited from the Attica region. Patients completed a questionnaire that included personal characteristics and the Barthel Index, while caregivers completed a set of questionnaires—personal characteristics, revised Bakas Caregiving Outcomes Scale (BCOS), Personal Resource Questionnaire (PRQ 2000), and Center for Epidemiological Studies-Depression (CES-D). Results: Caregiving burden was linked to both patients’ and caregivers’ characteristics. A patient’s educational level, the number of family members living in the same house, the existence of equipment and facilities in the house, and the duration of provided care were associated with perception of greater burden. Regarding caregivers’ characteristics, those in good health had a significantly lower perception of burden. Higher PRQ 2000 scores were significantly associated with higher BCOS scores (less burden), and higher CES-D scores were significantly associated with lower BCOS scores (more burden). Conclusion: Caring for a loved one affected by stroke places a considerable burden on the caregiver. Systematic assessment and intervention strategies can help to identify caregivers at risk so that suitably targeted assistance may be provided.

Subjective caregiver burden and anxiety in informal caregivers: A systematic review and meta-analysis

There is increasing evidence that subjective caregiver burden is an important determinant of clinically significant anxiety in family carers. This meta-analysis aims to synthesise this evidence and investigate the relationship between subjective caregiver burden and anxiety symptoms in informal caregivers. We searched PubMed, CINAHL and PsycINFO up to January 2020. Combined estimates were obtained using a random-effects model. After screening of 4,312 articles, 74 studies (with 75 independent samples) were included. There was a large, positive association between subjective caregiver burden and anxiety symptoms (r = 0.51; 95% CI = 0.47, 0.54; I2 = 0.0%). No differences were found in subgroup analyses by type of study design (cross-sectional vs. longitudinal), sampling, control of confounders or care-recipient characteristics. Subjective caregiver burden is an important risk factor for anxiety in informal caregivers. Targeting subjective caregiver burden could be beneficial in preventing clinically significant anxiety for the increasing number of family carers worldwide.

Qualitative Study of Chinese Stroke Caregivers' Caregiving Experience During the COVID-19 Pandemic

BACKGROUND AND PURPOSE

The coronavirus disease 2019 (COVID-19) outbreak has led to disruptions in health care service delivery worldwide, inevitably affecting stroke survivors requiring ongoing rehabilitation and chronic illness management. To date, no published research has been found on stroke caregiving during the COVID-19 pandemic. This study aimed to explore Hong Kong stroke caregivers' caregiving experiences in the midst of this difficult time.

METHODS

Individual semistructured interviews were conducted with 25 Chinese adult primary stroke caregivers from May to June 2020 via telephone. Interviews were transcribed verbatim and analyzed using an interpretive description approach and constant comparison strategy.

RESULTS

Five themes of the stroke caregiving experience during the COVID-19 pandemic emerged: care service adversities, additional caregiving workload and strain, threatened relationship between caregiver and stroke survivors, threats to caregivers' physical and psychological well-being, and needs for continuing caregiving roles. Our findings suggested that caregivers have worsened physical and psychological well-being because of increases in care burden with simultaneously reduced formal and informal support. The relationship between caregiver and stroke survivor was subsequently affected, placing some survivors at heightened risk of abuse.

CONCLUSIONS

Our study provides valuable findings about stroke caregiving experiences and needs during the pandemic. Delivery of psychological support, telemedicine, and household hygiene resources would be useful to mitigate caregivers' psychological distress during the COVID-19 pandemic.

Who is taking care of the Chinese functionally impaired older people? The characteristics of family caregivers from China Health and Retirement Longitudinal Study

OBJECTIVE

To investigate caregiving in terms of personal, family and living arrangement among Chinese functionally impaired older people.

METHODS

A secondary cross-sectional analysis of data obtained from China Health and Retirement Longitudinal Study (CHARLS) was performed. Among 6,252 participants aged 65 years or older, people with at least one indicator of Activities of Daily Living Scales (ADLs) of disabilities were included in this research. Statistical analyses included chi-square tests and multiple logistic regression modelling.

RESULTS

Data of 973 functionally impaired people aged 65 and over, and 2772 adult offspring were extracted and analysed. The level of impairment, age, gender, marital status of the functionally impaired older people, adult offspring's income and living status were significantly associated with caregiving types.

CONCLUSION

This research describes the characteristics of functionally impaired older people and their caregivers, which may help improve the efficiency, quality and equity within the Chinese social care system.

Review of nursing diagnosis validation studies: caregiver role strain

OBJECTIVE

To analyze the nursing diagnosis NANDA-I - Caregiver Role Strain validation studies.

METHODS

Integrative literature review. Research of studies carried out between 2000 and 2018 with the descriptors: caregivers, nursing diagnosis and validation study in the following databases: Web of Science, EBESCOhost, Scielo Brasil and Portugal, LILACS, RCAAP, CAPES, NANDA-I website, and in the bibliographic references of the articles. Articles in Portuguese, English or Spanish were included.

RESULTS

The sample consisted of seven validation studies, with heterogeneity in the methodologies used. The populations where the diagnosis was clinically validated focused on caregivers for the elderly and people with chronic illness. The most prevalent defining characteristics were Stress and Apprehension related to the future.

CONCLUSIONS

This diagnosis requires further validation studies among different populations in search of greater accuracy and a reduction in the number of defining characteristics, facilitating the use of taxonomy.

Upper limb surgery for severe spasticity after acquired brain injury improves ease of care

For individuals with acquired brain injury and severe upper limb spasticity, personal care is often difficult, time-consuming and painful. Previous studies on outcomes after surgery for upper limb spasticity have focused on functional gain, pain, hygiene and appearance. We operated on 38 non-communicative patients (45 limbs, 535 procedures) with severe spasticity and a non-functional upper limb(s). The surgical goals were to provide opening of the fingers and thumb, wrist stability and, if required, to release muscles around the elbow and shoulder. We used the Carer Burden Score as a relevant outcome measure. Preoperatively and 3 months postoperatively, the carer rated the degree of difficulty in cleaning the palm, cutting the fingernails, cleaning the axilla and dressing the upper body on a 5-point Likert scale. Surgery significantly improved the ease of care, which has implications not only for the patient but also for carers and associated health costs. Level of evidence: IV.

Measures used to assess impact of providing care among informal caregivers of persons with stroke, spinal cord injury, or amputation: a systematic review

PURPOSE

(1) To identify measures used to evaluate the impact of caregiving among caregivers of persons with stroke, spinal cord injury, and amputation; and (2) to systematically evaluate their clinimetric properties reported in validation studies.

MATERIALS AND METHODS

Two separate systematic reviews (Embase, PsycINFO, CINAHL, Pubmed/Medline) were conducted. COSMIN guidelines were used to assess clinimetric properties and methodological quality of studies.

RESULTS

(1) 154 studies published between 2008 and May 2019 were included, in which 48 measures were used, mostly describing negative impact. Thirty measures were used only once and not further described. (2) In general, structural validity, internal consistency, and hypothesis testing were often investigated. Reliability, cross-cultural and criterion validity to a lesser extent, and scale development and content validity were rarely described. Tests of measurement error and responsiveness were exceptional. Most supporting evidence was found for the Zarit Burden Interview Short Form, Caregiver Burden Scale and Positive Aspects of Caregiving Questionnaire.

CONCLUSIONS

There is a wide variety of impact of caregiving measures. The present study provided a detailed overview of what is known about clinimetric characteristics of 18 different measures repeatedly used in research. The overview provides clinicians a guidance of appropriate measure selection.

PROSPERO REGISTRATION

CRD42018094796IMPLICATIONS FOR REHABILITATIONClinicians should be aware that information about measure development and clinimetric properties for most measures used to assess impact of informal caregiving is incomplete.Most supporting evidence was found for the Zarit Burden Interview Short Form, Caregiver Burden Scale and Positive Aspects of Caregiving Questionnaire.This overview of clinimetric properties provides clinicians guidance for selection of an appropriate measure.

Determinants of caregiver burden of patients with haemorrhagic stroke in China

AIM

The aim of this study was to assess the caregiver burden over time of patients with haemorrhagic stroke and the determinants of this.

BACKGROUND

Identification of the predictors for caregiver burden can be used to improve the outcomes of stroke survivors and caregivers. Few studies focus on the caregiver burden of patients with haemorrhagic stroke and how this changes over time.

DESIGN

This was a prospective longitudinal study.

METHODS

A convenience sample of 202 stroke survivor/caregiver pairs were recruited in the neurosurgery unit from March 2015 to March 2016. The participants were assessed at three different times by face to face or telephone interview. Caregiver burden was assessed using the Bakas Caregiver Outcomes Scale. Sociodemographic data and other characteristics of the pairs were also collected. Multiple linear regression was performed to identify the determinants.

RESULTS

Caregiver burden decreased from T1 to T3 significantly. The physical function, depression of stroke survivors, and self-rated burden of caregivers were the most important determinants for overall caregiver burden. The factors identified explained 41.6% to 67.4% of overall burden.

CONCLUSION

Caregiver burden decreased over time, affected by factors from patients and caregivers. More professional caregivers are needed to support informal carers.

Relationship between the anxiety/depression and care burden of the major caregiver of stroke patients

To investigate the anxiety/depression of caregivers of stroke patients.This study used a cross-sectional survey design and convenience sampling.Totally, 117 caregivers of stroke patients were enrolled. Data were collected from questionnaires. Hamilton anxiety scale, Hamilton depression scale, and Zarit caregiver burden interview were performed. Multiple linear regression and correlation analysis were used.The anxiety score, depression score and total burden score of 117 stroke caregivers were 16.56 ± 8.02, 18.63 ± 9.39, and 25.88 ± 10.35, respectively. Anxiety symptoms, mild to moderate depressive symptoms, and severe depressive symptoms were found in 43.9%, 26.5%, and 27.4% of the caregivers, respectively. Daily care time and medical payment method were influencing factors for anxiety and depression (P < .05). Both anxiety and depression were positively correlated with total care burden score (P < .01).Anxiety and depression are common in the caregivers of stroke patients and are closely related to care burdens. In this regard, appropriate home care guidance, psychological counseling and social support should be provided to the caregivers to reduce their physical and mental burden.

A Meta-analytic Study of Predictors for Informal Caregiver Burden in Patients With Stroke

BACKGROUND

Several studies have reported on predictors for caregiver burden in patients with stroke, but the magnitude of the impact of these variables remains unclear. The aim of the study was to determine the magnitude of relationship between each predictor and caregiver burden.

METHODS

Articles related to this filed were search in PUBMED, MEDLINE and Cochrane Library electronic database from the upset to May 2018. Of the 812 articles identified, 22 were included in the final analysis (3025 patients and 2887 caregivers). Weighted correlation coefficient (r-index) was computed as effect size for each predictor.

RESULTS

Of predictor variables of patients, the activity of daily living and anxiety had moderate to large effect sizes; gender, neurological function and depression had the small to moderate effect sizes. Of caregivers' predictors, depression, anxiety, and sense of coherence had large effect sizes; gender, daughter in law, physical health and employment status had small to moderate effect sizes.

CONCLUSIONS

The most powerful predictors of caregiver burden using meta-analysis were identified to direct future research and evidence-based practice.

Mediating effects of burden on quality of life for caregivers of first-time stroke patients discharged from the hospital within one year

Background

Caregiver burden may be either a predictor or an outcome of caregiver quality of life (QoL). Patient or caregiver factors that directly affect caregiver QoL, predictors that are simultaneously shared with caregiver burden and QoL, and factors that affect caregiver QoL through caregiver burden are not well understood. This study explored predictors of caregiver QoL and identified whether caregiver burden is a mediator for caregivers of first-time stroke patients.

Methods

This is a cross-sectional study. We recruited first-time stroke patients who had been discharged from the hospital within 1 year. We screened caregivers with two major inclusion criteria: age > 20 years old and being the family member who provides the most patient-care hours out of all family caregivers. Caregiver burden (Caregiver Strain Index, CSI), QoL (Caregiver Quality of Life Index, CQLI), and patient and caregiver characteristics were assessed with structured questionnaires. Multiple-regression and bootstrap analysis were conducted for data analysis.

Results

A total of 126 caregivers completed the questionnaires. Higher caregiver burdens, lower caregiver education level, lower self-rated health, lower monthly family income, and spouses who were responsible for medical fees were significant predictors of lower caregiver QoL. Poor self-rated health and monthly family income of $ 666 USD or below were the strongest predictors of caregiver QoL. Spouses who were responsible for medical fees and lower monthly family income had direct negative effects on caregiver QoL, but these factors exhibited no indirect mediating effect between caregiver characteristics and QoL through caregiver burden as a mediator. Caregiver education level at or below elementary school and poor or fair self-rated-health had direct negative effects on caregiver QoL, which were mediated by caregiver burden.

Conclusions

Our study indicated predictors of caregiver QoL and the relationships with caregiver burden among first-time stroke survivors in the early stage. Caregivers’ financial factors affected caregiver QoL directly. Caregivers’ poor self-rated health and lower education level negatively affected caregiver QoL indirectly through caregiver burden as a mediator. Interventions to make appropriate policies for financial subsidies, to enhance caregivers’ health and to provide tailored stroke-related education through multidisciplinary cooperation may effectively promote caregiver QoL.

Human Hand Motion Analysis during Different Eating Activities

The focus of this research is to analyse both human hand motion and force, during eating, with respect to differing food characteristics and cutlery (including a fork and a spoon). A glove consisting of bend and force sensors has been used to capture the motion and contact force exerted by fingers during different eating activities. The Pearson correlation coefficient has been used to show that a significant linear relationship exists between the bending motion of the fingers and the forces exerted during eating. Analysis of variance (ANOVA) and independent samples t-tests are performed to establish whether the motion and force exerted by the fingers while eating is influenced by the different food characteristics and cutlery. The middle finger motion showed the least positive correlation with index fingertip and thumb-tip force, irrespective of the food characteristics and cutlery used. The ANOVA and t-test results revealed that bending motion of the index finger and thumb varies with respect to differing food characteristics and the type of cutlery used (fork/spoon), whereas the bending motion of the middle finger remains unaffected. Additionally, the contact forces exerted by the thumb tip and index fingertip remain unaffected with respect to differing food types and cutlery used.

Informal caregivers' burden and stress in caring for stroke survivors with spatial neglect: an exploratory mixed-method study

BACKGROUND

Spatial neglect prolongs stroke survivors' recovery to independence. However, little is known about the impact of spatial neglect on caregivers of stroke survivors.

OBJECTIVE

To explore the factors associated with burden and stress among informal caregivers of stroke survivors with spatial neglect.

METHODS

Following the previous study of 108 stroke survivors, we reached 24 stroke survivors' caregivers, and 20 caregivers (age: M±SD=56.9±12.7 years; 12 females) completed the study. 10 survivors had symptoms of spatial neglect, and 10 did not (i.e., SN+ or SN-, respectively) at the time when discharged from inpatient rehabilitation, which was 9.3±6.2 months before the present study. Via a semi-structured telephone interview, we assessed caregivers' burden and stress qualitatively and quantitatively.

RESULTS

No difference was observed across caregiver groups in cognitive function, depressive mood, or community mobility. In comparison, caregivers of the SN+ group allocated more time to care, controlling for survivors' disability (adjusted effective size d = 1.80). Their self-perceived burden and stress were more severe than the other group (adjusted d = .99). Qualitative analysis indicated caregivers of the SN+ group were more likely to describe economic stressors and undesirable changes in career and vacation planning. While 80% of participants preferred their care recipients to receive additional motor or mobility therapy, caregivers of the SN+ group were more likely to suggest additional therapy for cognitive impairment.

CONCLUSIONS

This exploratory study suggests that spatial neglect may heighten caregivers' burden and stress levels. Future studies with a large sample size are required.

Family caregivers and outcome of people with schizophrenia in rural China: 14-year follow-up study

OBJECTIVE

This study examined the differences in 14-year outcomes of persons with schizophrenia with and without family caregiver(s) in a rural community in China.

METHODS

All participants with schizophrenia (n = 510) aged 15 years and older were identified in a 1994 epidemiological investigation of 123,572 people and followed up in 2004 and 2008 in Xinjin County, Chengdu, China.

RESULTS

Individuals without family caregiver in 1994 had significantly higher rate of homelessness (23.8 %) and lower rate of survival (47.5 %) in 2008 than those with family caregivers (5.1 and 70.9 %). Compared with individuals with family caregivers, those without family caregivers were more likely to be male, live alone, have fewer family members, lower family economic status, lower rates of marriage and complete remission, higher mean scores on PANSS and lower mean score on GAF in 2008. The predictors of participants without family caregiver in 2008 included having a small number of family members at baseline and being male.

CONCLUSIONS

The absence of a family caregiver is a predictive factor of poorer long-term outcome of persons with schizophrenia in the rural community. The critical role of family caregiving should be incorporated in the planning and delivering of mental health policies and community-based mental health services.

The mediating effect of caregiver burden on the caregivers' quality of life

[Purpose] Quality of life (QoL) can be closely related to caregiver burden, which may be a potential mediating effect on the relationships among stroke patient caregivers. This study investigated the predictors of caregiver’s QoL based on patient and caregiver characteristics, with caregiver burden as a mediator. [Methods] This study was conducted using surveys, a literature review, and interviews. Survey data were collected from 238 subjects, who were diagnosed with stroke, and their family caregivers from October 2013 to April 2014. [Results] Caregiver health status, income, spouses caring for patients, and duration of hospitalization were identified as significant predictors of caregivers’ QoL with a mediating effect of caregiver burden. The time spent on caregiving per day and patient education level were the only direct predictors of caregivers’ QoL. [Conclusion] The responsibility of caring for patients with stroke, in particular for a spouse, must be administered by means of a holistic family-centered rehabilitation program. In addition, financial support and availability of various health and social service programs must be comprehensively provided in order to maintain caregivers’ well-being.

The effect of post-stroke depression on rehabilitation outcome and the impact of caregiver type as a factor of post-stroke depression

OBJECTIVE

To evaluate the effect of post-stroke depression (PSD) on rehabilitation outcome and to investigate the risk factors of PSD, especially, the role of caregivers type (family or professional) in subacute stroke patients.

METHODS

Two hundred twenty-six stroke patients were enrolled retrospectively. All the subjects' basic characteristics, Korean version of the Beck Depression Inventory (K-BDI), Korean version of the Modified Barthel Index (K-MBI), and the modified Rankin Scale (mRS) were recorded when the patient was transferred into the Department of Rehabilitation Medicine and at the time of discharge. The results were statistically analyzed by using SPSS ver. 20.0.

RESULTS

The patients' K-BDI score showed a significantly negative association with K-MBI at discharge (β=-0.473, p<0.001) and a significantly positive association with the mRS score at discharge (β=0.316, p<0.001). Patients with lesions on the left hemisphere (odds ratio [OR], 3.882; 95% confidence interval [CI], 1.726-8.733) and professional caregiver support (OR, 0.028; 95% CI, 0.012-0.065) had a higher rate of depression.

CONCLUSION

Depression was prevalent in stroke patients, and it had a negative effect on patients' functional outcome. Patients who had a lesion on the right hemisphere had less depression. The type of caregiver was related to the incidence of subacute PSD, and family caregivers were found to lower the frequency of stroke patients' depression.

Spouses of stroke survivors may be at risk for poor cognitive functioning: a cross-sectional population-based study

BACKGROUND

Stroke often results in chronic disability and the need for long-term assistance, which is provided in large part by spouses. Stroke caregivers experience poorer health and well-being compared with non-caregivers, but less is known about the specific toll that caregiving may exact on cognitive functioning.

OBJECTIVE

To investigate whether persons caring for a spouse who experienced a recent stroke may be at risk for poor cognitive functioning compared with non-caregivers.

METHODS

Existing data from the United States' Health and Retirement Study (HRS) were used to identify 146 caregivers from among couples in which 1 individual reported surviving a recent stroke and experiencing functional limitations. This cross-sectional population-based analysis compared the stroke caregivers with 3,416 non-caregivers in time orientation, working memory, semantic memory, learning, and episodic memory.

RESULTS

Overall, the caregiver group was considerably more disadvantaged than the non-caregiver group in terms of background characteristics, socioeconomic status, health, and well-being. Results of weighted Poisson regression models indicated that stroke caregivers were at risk for poorer performance than non-caregivers in working memory, semantic memory, learning, and episodic memory. The gap between stroke caregivers and non-caregivers in episodic memory remained after adjusting for systematic differences between the 2 groups across an array of risk factors.

CONCLUSIONS

Spousal caregivers of stroke survivors may be at risk for poor cognitive functioning. More work is needed to identify the processes that may contribute to the diminished cognitive capacity among these adults so that interventions may be developed to reduce caregiver burden and promote cognitive health.