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Jammal M, Kolt GS, Liu KPY, Dennaoui N, George ES. The impact of caregiving on the roles and valued activities of stroke carers: A systematic review of qualitative studies. PLoS One 2024; 19:e0304501. [PMID: 38820455 PMCID: PMC11142509 DOI: 10.1371/journal.pone.0304501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 05/14/2024] [Indexed: 06/02/2024] Open
Abstract
OBJECTIVE To understand the experiences of informal carers and the impact of role and activity changes on their health and wellbeing. METHODS A systematic search of CINHAL, MEDLINE, Embase, APA PsycInfo, and Web of Science was conducted. Studies were eligible if they included informal stroke carers (≥18 years), used a qualitative methodology, explored the roles and valued activities of stroke carers, and were published in English. The 10-item Critical Appraisal Skills Programme checklist for qualitative studies was used to assess methodological quality. The results of the included studies were thematically synthesised. RESULTS A total of 36 qualitative studies were included and four overarching themes were identified: (1) Life adjustment; (2) Changing role and identity; (3) Changing activities: From meaningful to purposeful; and (4) Understanding and supporting carers. CONCLUSION The sudden nature of stroke requires major readjustment in the carers life that has implications on their relationships, roles, and activities, subsequently impacting on their health and wellbeing. Health professionals and researchers should collaborate with stroke carers to identify their valued activities and implement realistic strategies to maintain these activities. Future interventions designed for carers should implement education about the importance of participating in valued activities and strategies to maintain these activities.
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Affiliation(s)
- Melissa Jammal
- School of Health Sciences, Western Sydney University, Sydney, NSW, Australia
| | - Gregory S. Kolt
- School of Health Sciences, Western Sydney University, Sydney, NSW, Australia
| | - Karen P. Y. Liu
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, Hong Kong
| | - Nariman Dennaoui
- School of Health Sciences, Western Sydney University, Sydney, NSW, Australia
| | - Emma S. George
- School of Health Sciences, Western Sydney University, Sydney, NSW, Australia
- Translational Health Research Institute, Western Sydney University, Sydney, NSW, Australia
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Alselami S, Butcher HK, Longo J. The Uncertainty in Family Caregivers of Hospitalized Persons With a Stroke in Saudi Arabia: Unitary Caring Perspective. ANS Adv Nurs Sci 2024; 47:104-120. [PMID: 38132430 DOI: 10.1097/ans.0000000000000519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
Uncertainty is a universal experience of family caregivers caring for persons with a stroke and affects caregivers' readiness to care for their family members with a stroke. Guided by the unitary caring theory and unitary-caring hermeneutic-phenomenological research method, this study was conducted among 15 family caregivers of persons in the hospital who have survived strokes through in-depth semi-structured interviews. Five essences emerged from the analysis: living in a dark reality; yearning for professional support; enduring a life full of tribulations; attempting resolution; and creating new patterns of living. Each of the 5 essences was interpreted from Smith's unitary caring theory perspective.
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Affiliation(s)
- Seham Alselami
- Nursing, King Saud bin Abdul-Aziz University for Health Sciences, Jeddah, Saudi Arabia (Dr Alselami); and Nursing, Florida Atlantic University, Boca Raton (Drs Butcher and Longo)
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Nuccio E, Petrosino F, Simeone S, Alvaro R, Vellone E, Pucciarelli G. The needs and difficulties during the return to work after a stroke: a systematic review and meta-synthesis of qualitative studies. Disabil Rehabil 2023:1-14. [PMID: 38018092 DOI: 10.1080/09638288.2023.2287016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 11/09/2023] [Indexed: 11/30/2023]
Abstract
PURPOSE To describe which needs and difficulties are experienced by stroke patients and caregivers regarding their return to work and to synthesise the lived experiences of stroke patients and caregivers. MATERIALS AND METHODS A systematic review and metasynthesis was conducted on PubMed, CINAHL, Scopus, Web of Sciences and PsycInfo, in according to the Enhancing Transparency in Reporting the Synthesis of Qualitative Research. Studies eligible for the review had to fulfil the following inclusion criteria: qualitative studies, stroke patients and their caregivers in a working age (approximately from 18 to 65 years old), discharged from the hospital. RESULTS Thirty-eight studies involving stroke patients and caregivers were included in this review. For the stroke patients' group, three main themes were identified: (a) Towards the future; (b) Professional support in return to work; and (c) return to work and employment perspective, while for caregivers two main themes were: (a) daily life challenges and role overload; and (b) employment challenges. CONCLUSIONS Integrating public employment, social and health services, support for job placement, return to work, and social participation of stroke patients should be more supported in individual rehabilitation programs to help stroke survivors and caregivers in their return-to-work process.
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Affiliation(s)
- Emanuela Nuccio
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Francesco Petrosino
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Silvio Simeone
- Department of Experimental and Clinical Medicine, University of Catanzaro "Magna Graecia", Viale Europa, Italy
| | - Rosaria Alvaro
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Gianluca Pucciarelli
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
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Bhattacharjya S, Linares I, Langan J, Xu W, Subryan H, Cavuoto LA. Engaging in a home-based exercise program: a mixed-methods approach to identify motivators and barriers for individuals with stroke. Assist Technol 2023; 35:487-496. [PMID: 36441082 PMCID: PMC10460826 DOI: 10.1080/10400435.2022.2151663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2022] [Indexed: 11/30/2022] Open
Abstract
Community-dwelling individuals with chronic stroke used a novel, portable rehabilitation system, mRehab, that uses a smartphone app coupled with 3D printed objects resembling daily use items. The objectives of this study include evaluating participant's approach and nature of engagement with mRehab and identifying factors that influenced the users' engagement with mRehab. An explanatory mixed-method approach was used. In the first phase, 16 participants used mRehab at home for six weeks; six participants were recruited from the first phase for in-depth interviews. Participants were categorized into High, Moderate, and Low Frequency groups based on their frequency of mRehab use. High frequency of use was not related to improved performance on clinical assessments; instead, High Frequency users more commonly initiated performance of new activities after the mRehab program compared to participants with lower frequency of use. Useful activities that are challenging and meaningful to the participants, and availability of objective feedback for self-monitoring were some of the motivators for mRehab use. Difficulty with time management, lack of caregiver availability, and difficulties with the design of the system posed as barriers to mRehab use. Tailoring home programs to the recipients' needs including perceived meaningfulness of the activities is key for long-term rehabilitation.
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Affiliation(s)
| | - Isabelle Linares
- Biomedical Engineering, University at Buffalo, Buffalo, New York, USA
| | - Jeanne Langan
- Rehabilitation Science, University at Buffalo, Buffalo, New York, USA
| | - Wenyao Xu
- Computer Science and Engineering, University at Buffalo, Buffalo, New York, USA
| | - Heamchand Subryan
- Center for Inclusive Design and Environmental Access, University at Buffalo, Buffalo, New York, USA
| | - Lora Anne Cavuoto
- Industrial and Systems Engineering, University at Buffalo, Buffalo, New York, USA
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Qureshi A, Swain N, Aldabe D, Hale L. Exploring challenges affecting resilience in carers of stroke survivors: a qualitative descriptive study. Disabil Rehabil 2023; 45:3696-3704. [PMID: 36269117 DOI: 10.1080/09638288.2022.2135774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 08/31/2022] [Accepted: 10/08/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE To develop an intervention to build resilience in carers of stroke survivors this study aimed to understand these carers' (1) Challenges that adversely affect their resilience, and (2) suggestions for a relevant intervention to build resilience. METHODS Individual semi-structured interviews were used. Participants included carers of stroke survivors (stroke duration > six months). Transcripts were analysed using the General Inductive Approach. This study followed guidelines of Consolidated criteria for Reporting Qualitative research (COREQ). RESULTS Four themes were identified that affected resilience: (1) carer psychosocial outcomes, (2) stroke's sudden and unexpected impact, (3) financial stressors, and (4) carer exclusion in care planning. Carers suggested an intervention comprising information sharing and training in coping skills, positive communication, problem-solving, and connection with "people who have gone through this" to improve resilience. Most supported a group, monthly delivery of the intervention. CONCLUSION These findings provide direction for a suitable intervention. Further, they suggest that stroke rehabilitation could be improved by adopting a family-centered model of care so that carers can be included as active partners in care process. Protecting carers from the negative impact of caring role on their resilience may sustain their ability to provide long-term care for the stroke survivor.IMPLICATIONS FOR REHABILITATIONThe provision of informal care to stroke survivors can be associated with significant emotional consequences, withdrawal from social activities, and poor quality of life for the carers.The abruptness of stroke presentation along with its long-term nature can negatively affect the resilience of informal carers.Exploration of challenges affecting carer resilience is important to develop interventions to build resilience in carers of stroke survivors.Integrating interventions focusing on carers' resilience as part of the stroke rehabilitation process is imperative to ensure well-being of carers and sustainability of the care provided to the stroke survivor.
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Affiliation(s)
- Ayesha Qureshi
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Nicola Swain
- School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Daniela Aldabe
- School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Leigh Hale
- School of Physiotherapy, University of Otago, Dunedin, New Zealand
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Ponzini GT, Kirk B, Segear SE, Claydon EA, Engler-Chiurazzi EB, Steinman SA. Addressing Uncertainty in Informal Familial Caregivers of Stroke Survivors: A Systematic Meta-Ethnography. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11116. [PMID: 36078846 PMCID: PMC9518135 DOI: 10.3390/ijerph191711116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/01/2022] [Accepted: 09/02/2022] [Indexed: 06/15/2023]
Abstract
Background: Informal familial caregivers of stroke survivors experience uncertainty that begins at the time of the stroke event and continues into home-based care. The uncertainty faced by caregivers contributes to poor mental and physical health outcomes. Objective: This review details the factors associated with, impacts of, and coping skills used to manage uncertainty across the caregiving trajectory. By defining uncertainty reduction and tolerance recommendations, this review also builds upon the Stroke Caregiver Readiness Model to improve preparedness following the stroke event. Methods: A meta-ethnographic review was systematically conducted on thirteen qualitative studies with 218 participants from four countries. The Critical Appraisal Skills Programme (CASP) was used to assess study quality. Results: Following the stroke event, caregivers reported a lack of knowing (e.g., about the cause of the stroke event and survivor prognoses) as contributing to post-stroke uncertainty. As a result of this uncertainty, caregivers expressed concerns about their abilities to navigate caregiving responsibilities and how to plan for the future. Longer-term concerns (e.g., managing finances) and feelings of hopelessness occurred after discharge. Still, caregivers identified strategies to manage uncertainty. Caregiver coping skills included present-focused thinking, gratitude, faith, humor, and social support. Conclusions: The uncertainty faced by informal familial caregivers of stroke survivors is pervasive and changes across time. Uncertainty reduction and tolerance interventions can be used to build upon caregiver strengths and promote preparedness across the caregiving trajectory.
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Affiliation(s)
| | - Brenna Kirk
- School of Public Health, West Virginia University, Morgantown, WV 26506, USA
| | - Sarah E. Segear
- Department of Psychology, West Virginia University, Morgantown, WV 26506, USA
| | | | | | - Shari A. Steinman
- Department of Psychology, West Virginia University, Morgantown, WV 26506, USA
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Semonella M, Andersson G, Dekel R, Pietrabissa G, Vilchinsky N. Making a Virtue Out of Necessity: COVID-19 as a Catalyst for Applying Internet-Based Psychological Interventions for Informal Caregivers. Front Psychol 2022; 13:856016. [PMID: 35465576 PMCID: PMC9022647 DOI: 10.3389/fpsyg.2022.856016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 02/22/2022] [Indexed: 12/17/2022] Open
Affiliation(s)
| | - Gerhard Andersson
- Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden.,Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.,Division of Psychiatry, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Rachel Dekel
- School of Social Work, Bar-Ilan University, Ramat Gan, Israel
| | - Giada Pietrabissa
- Department of Psychology, Catholic University of Milan, Milan, Italy.,Psychology Research Laboratory, Istituto Auxologico Italiano - Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Noa Vilchinsky
- Department of Psychology, Bar-Ilan University, Ramat Gan, Israel
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WANG C, LIN S, WANG Q, Xie S, Tu Q, ZHANG H, PENG M, ZHOU J, REDFERN J. The experience of stroke survivors and caregivers during hospital-to-home transitional care: A qualitative longitudinal study. Int J Nurs Stud 2022; 130:104213. [DOI: 10.1016/j.ijnurstu.2022.104213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 02/21/2022] [Accepted: 02/22/2022] [Indexed: 11/16/2022]
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Haji Mukhti MI, Ibrahim MI, Tengku Ismail TA, Nadal IP, Kamalakannan S, Kinra S, Musa KI. Family Caregivers' Experiences and Coping Strategies in Managing Stroke Patients during the COVID-19 Pandemic: A Qualitative Exploration Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19020942. [PMID: 35055764 PMCID: PMC8775342 DOI: 10.3390/ijerph19020942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 12/29/2021] [Accepted: 01/13/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND Stroke is a chronic disease that requires stroke survivors to be supported long-term by their families. This is especially because of the inaccessibility to post-stroke rehabilitation outside hospitals. The Corona Virus Disease 2019 (COVID-19) crisis and the pandemic restrictions in Malaysia are expected to exponentially increase the demand from family caregivers in supporting stroke survivors. Thus, this study aims to explore the burden, experience, and coping mechanism of the family caregivers supporting stroke survivors during the COVID-19 pandemic. METHODOLOGY A phenomenological qualitative study was conducted from November 2020 to June 2021 in Malaysia. A total of 13 respondents were recruited from two public rehabilitation centers in Kota Bharu, Kelantan. In-depth interviews were conducted with the participants. Comprehensive representation of perspectives from the respondents was achieved through purposive sampling. The interviews were conducted in the Kelantanese dialect, recorded, transcribed, and analyzed using thematic analysis. RESULTS Three themes on burdens and experiences were identified. They were worsening pre-existing issues, emerging new issues, and fewer burdens and challenges. Two themes on coping strategies were also identified. They were problem-focused engagement and emotion-focused engagement. CONCLUSIONS The COVID-19 pandemic has changed the entire system of stroke management. While family caregivers mostly faced the extra burden through different experiences, they also encountered some positive impacts from the pandemic. The integrated healthcare system, especially in the era of digitalization, is an important element to establish the collaborative commitment of multiple stakeholders to compensate burden and sustain the healthcare of stroke survivors during the pandemic.
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Affiliation(s)
- Muhammad Iqbal Haji Mukhti
- Department of Community Medicine, Health Campus, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Malaysia; (M.I.H.M.); (T.A.T.I.); (K.I.M.)
| | - Mohd Ismail Ibrahim
- Department of Community Medicine, Health Campus, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Malaysia; (M.I.H.M.); (T.A.T.I.); (K.I.M.)
- Correspondence: ; Tel.: +60-97-676-621
| | - Tengku Alina Tengku Ismail
- Department of Community Medicine, Health Campus, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Malaysia; (M.I.H.M.); (T.A.T.I.); (K.I.M.)
| | - Iliatha Papachristou Nadal
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK; (I.P.N.); (S.K.); (S.K.)
| | - Sureshkumar Kamalakannan
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK; (I.P.N.); (S.K.); (S.K.)
- Department of Social Work, Education and Wellbeing, Faculty of Health and Life Sciences, Northumbria University, New Castle NE7 7XA, UK
| | - Sanjay Kinra
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK; (I.P.N.); (S.K.); (S.K.)
| | - Kamarul Imran Musa
- Department of Community Medicine, Health Campus, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Malaysia; (M.I.H.M.); (T.A.T.I.); (K.I.M.)
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Petrovic M, Bonanno S, Landoni M, Ionio C, Hagedoorn M, Gaggioli A. Healing with Stories: using the Transformative Storytelling technique to generate empowering narratives for informal caregivers. A Method Demonstration (Preprint). JMIR Form Res 2022; 6:e36405. [PMID: 35802492 PMCID: PMC9382549 DOI: 10.2196/36405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 05/11/2022] [Accepted: 06/01/2022] [Indexed: 01/19/2023] Open
Abstract
Background Objective Methods Results Conclusions
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Affiliation(s)
- Milica Petrovic
- ExperienceLab, Università Cattolica del Sacro Cuore, Milan, Italy
| | | | - Marta Landoni
- Department of Psychology, Centro di Ricerca sulle Dinamiche Evolutive ed Educative, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Chiara Ionio
- Department of Psychology, Centro di Ricerca sulle Dinamiche Evolutive ed Educative, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Mariët Hagedoorn
- Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Andrea Gaggioli
- Research Center in Communication Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
- IRCCS, Istituto Auxologico Italiano, Milan, Italy
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Garcia‐Rudolph A, Sauri J, Garcia‐Molina A, Cegarra B, Opisso E, Tormos JM, Frey D, Madai VI, Bernabeu M. The impact of coronavirus disease 2019 on emotional and behavioral stress of informal family caregivers of individuals with stroke or traumatic brain injury at chronic phase living in a Mediterranean setting. Brain Behav 2022; 12:e2440. [PMID: 34910375 PMCID: PMC8785633 DOI: 10.1002/brb3.2440] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 10/30/2021] [Accepted: 11/03/2021] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Even in nonpandemic times, persons with disabilities experience emotional and behavioral disturbances which are distressing for them and for their close persons. We aimed at comparing the levels of stress in emotional and behavioral aspects, before and during coronavirus disease 2019 (COVID-19), as reported by informal family caregivers of individuals with chronic traumatic brain injury (TBI) or stroke living in the community, considering two different stratifications of the recipients of care (cause and injury severity). METHODS We conducted a STROBE-compliant prospective observational study analyzing informal caregivers of individuals with stroke (IC-STROKE) or traumatic brain injury (IC-TBI). IC-STROKE and IC-TBI were assessed in-person before and during COVID-19 online, using the Head Injury Behavior Scale (HIBS). The HIBS comprises behavioral and emotional subtotals (10 items each) and a total-HIBS. Comparisons were performed using the McNemar's test, Wilcoxon signed-rank test or t-test. Recipients of care were stratified according to their injury severity using the National Institutes of Health Stroke Scale (NIHSS) and the Glasgow Coma Scale (GCS). RESULTS One hundred twenty-two informal caregivers (62.3% IC-STROKE and 37.7% IC-TBI) were assessed online between June 2020 and April 2021 and compared to their own assessments performed in-person 1.74 ± 0.88 years before the COVID-19 lockdown. IC-STROKE significantly increased their level of stress during COVID-19 in five emotional items (impatience, frequent complaining, often disputes topics, mood change and overly sensitive) and in one behavioral item (overly dependent). IC-TBI stress level only increased in one behavioral item (impulsivity). By injury severity, (i) mild (14.7%) showed no significant differences in emotional and behavioral either total-HIBS (ii) moderate (28.7%) showed significant emotional differences in two items (frequent complaining and mood change) and (iii) severe (56.6%) showed significant differences in emotional (often disputes topics) and behavioral (impulsivity) items. CONCLUSIONS Our results suggest specific items in which informal caregivers could be supported considering cause or severity of the recipients of care.
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Affiliation(s)
- Alejandro Garcia‐Rudolph
- Universitat Autònoma de BarcelonaBellaterraCerdanyola del VallèsSpain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i PujolBadalonaSpain
- Institut Guttmann Hospital de NeurorehabilitacioBadalonaSpain
| | - Joan Sauri
- Universitat Autònoma de BarcelonaBellaterraCerdanyola del VallèsSpain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i PujolBadalonaSpain
- Institut Guttmann Hospital de NeurorehabilitacioBadalonaSpain
| | - Alberto Garcia‐Molina
- Universitat Autònoma de BarcelonaBellaterraCerdanyola del VallèsSpain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i PujolBadalonaSpain
- Institut Guttmann Hospital de NeurorehabilitacioBadalonaSpain
| | - Blanca Cegarra
- Universitat Autònoma de BarcelonaBellaterraCerdanyola del VallèsSpain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i PujolBadalonaSpain
- Institut Guttmann Hospital de NeurorehabilitacioBadalonaSpain
| | - Eloy Opisso
- Universitat Autònoma de BarcelonaBellaterraCerdanyola del VallèsSpain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i PujolBadalonaSpain
- Institut Guttmann Hospital de NeurorehabilitacioBadalonaSpain
| | - Josep Maria Tormos
- Universitat Autònoma de BarcelonaBellaterraCerdanyola del VallèsSpain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i PujolBadalonaSpain
- Institut Guttmann Hospital de NeurorehabilitacioBadalonaSpain
| | - Dietmar Frey
- CLAIM Charité Lab for AI in MedicineCharité Universitätsmedizin BerlinBerlinGermany
| | - Vince Istvan Madai
- CLAIM Charité Lab for AI in MedicineCharité Universitätsmedizin BerlinBerlinGermany
- QUEST Center for Transforming Biomedical ResearchBerlin Institute of Health (BIH), Berlin, Germany, Charité – Universitätsmedizin BerlinBerlinGermany
- School of Computing and Digital TechnologyFaculty of Computing, Engineering and the Built Environment, Birmingham City UniversityUnited Kingdom
| | - Montserrat Bernabeu
- Universitat Autònoma de BarcelonaBellaterraCerdanyola del VallèsSpain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i PujolBadalonaSpain
- Institut Guttmann Hospital de NeurorehabilitacioBadalonaSpain
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Tyagi S, Luo N, Tan CS, Tan KB, Tan BY, Menon E, Venketasubramanian N, Loh WC, Fan SH, Yang KLT, Chan ASL, Farwin A, Lukman ZB, Koh GCH. Support system diversity among family caregivers of stroke survivors: a qualitative study exploring Asian perspectives. BMC Geriatr 2021; 21:594. [PMID: 34696724 PMCID: PMC8543837 DOI: 10.1186/s12877-021-02557-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 10/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Caregiving is a global phenomenon which is bound to increase in tandem with the aging population worldwide. Stroke is a condition common in older people that requires complex caregiving necessitating provision of adequate support to the caregivers. Past literature consists of limited accounts of types and organization of support arrangements needed by different caregivers. We aimed to describe the support system of caregivers of stroke survivors in Singapore, highlighting differences across the different caregiver identities (i.e. spouse, adult-child, etc.). METHODS We conducted a qualitative descriptive study in the community setting involving 61 purposively sampled and recruited stroke survivors and caregivers. Semi-structured interviews were conducted, and transcripts were analysed using thematic analysis. RESULTS Our findings were summarized across the following 4 themes: 1) cultural influence and caregiving; 2) caregiver support system with the following sub-themes: 2.1) dyadic caregiver support type, 2.2) extended caregiver support type, 2.3.) distributed caregiver support type and 2.4) empowering caregiver support type; 3) breaks in care of stroke survivor and 4) complex relationship dynamics. We operationalized the caregiver support system as comprising of type, people and activities that enable the caregiver to participate in caregiving activities sustainably. While spouse caregivers preferred dyadic and extended support systems positioning themselves in a more central caregiving role, adult-child caregivers preferred distributed support system involving family members with paid caregivers playing a more central role. CONCLUSIONS Our findings highlight caregiver identity as a surrogate for the differences in the caregiver support systems. Practical implications include imparting relationship-building skills to the stroke survivor-caregiver dyads to sustain dyadic support system and educating clinicians to include differences in caregiving arrangements of stroke survivors in practising family-centred care.
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Affiliation(s)
- Shilpa Tyagi
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore
| | - Nan Luo
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore
| | - Chuen Seng Tan
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore
| | - Kelvin Bryan Tan
- Policy Research & Economics Office, Ministry of Health, Singapore, Singapore
| | | | - Edward Menon
- St. Andrew's Community Hospital, Singapore, Singapore
| | - N Venketasubramanian
- Raffles Neuroscience Centre, Raffles Hospital, Singapore, Singapore.,Singapore National Stroke Association, Singapore, Singapore
| | - Wei Chin Loh
- St. Andrew's Community Hospital, Singapore, Singapore
| | - Shu Hui Fan
- St. Andrew's Community Hospital, Singapore, Singapore
| | | | - Audrey Swee Ling Chan
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore
| | - Aysha Farwin
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore
| | - Zunairah Binti Lukman
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore
| | - Gerald Choon-Huat Koh
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore.
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Pucciarelli G, Lyons KS, Petrizzo A, Ambrosca R, Simeone S, Alvaro R, Lee CS, Vellone E. Protective Role of Caregiver Preparedness on the Relationship Between Depression and Quality of Life in Stroke Dyads. Stroke 2021; 53:145-153. [PMID: 34496626 DOI: 10.1161/strokeaha.120.034029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Depression and quality of life (QOL) have an interdependent and transactional nature in stroke survivor-caregiver dyads. While the strong relationship between depression and physical and emotional QOL in stroke survivor-caregiver dyads is well known, it is less clear if this relationship is moderated by caregiver preparedness, which could easily be targeted with interventions. In this study, we examined the moderating role of caregiver preparedness on the association between depression and QOL in stroke survivor-caregiver dyads. METHODS We used a longitudinal design with follow-ups every 3 months over a 1-year period. Considering the nonindependent nature of the data (survivors and their caregivers), we used multilevel modeling to analyze data at the dyad level. We implemented 4 longitudinal dyadic moderation models (one for each QOL domain: physical, psychological, social, and environmental) using hierarchical linear modeling. RESULTS A sample of 222 stroke survivor-caregiver dyads was analyzed. Stroke survivors were older (M=70.8, SD=11.9) than their caregivers (M=52.4, SD=13.1). Stroke survivors predominantly had an ischemic stroke, equally distributed by site. Caregivers were primarily female (66%), with a medium to high educational level (57%). Caregiver preparedness significantly moderated the association between survivor depression and survivor psychological (B=0.56, P<0.01) and environmental (B=0.58, P<0.01) QOL at baseline and social QOL over time (B=0.24, P<0.05). Similarly, caregiver preparedness significantly moderated the association between caregiver depression and caregiver physical (B=0.25, P<0.01) and environmental (B=0.18, P<0.05) QOL over time. CONCLUSIONS Caregiver preparedness has a positive influence on both members of the dyad. Assessment of stroke-caregiver preparedness could be helpful to motivate clinicians to develop and implement interventions for stroke survivor-caregiver dyads.
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Affiliation(s)
- Gianluca Pucciarelli
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy. (G.P.)
| | - Karen S Lyons
- Boston College, William F. Connell School of Nursing (K.S.L., C.S.L.)
| | - Antonello Petrizzo
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy. (A.P.)
| | - Rossella Ambrosca
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy. (R. Ambrosca)
| | - Silvio Simeone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy. (S.S.)
| | - Rosaria Alvaro
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy. (R. Alvaro)
| | - Christopher S Lee
- Boston College, William F. Connell School of Nursing (K.S.L., C.S.L.)
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy. (E.V.)
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14
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Ho LY, Lai CK, Ng SS. Testing the psychometric properties of the Chinese version of the Neurological Fatigue Index-Stroke. Clin Rehabil 2021; 35:1329-1340. [PMID: 33722084 DOI: 10.1177/02692155211001684] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To test the psychometric properties of a Chinese version of the Neurological Fatigue Index-Stroke (C-NFI-Stroke) in stroke survivors. DESIGN This was a validation study. Cross-cultural adaptation of the scale was conducted according to standard guidelines. Reliability, validity, responsiveness, and interpretability were measured. SETTING Self-help groups and a community center. SUBJECTS One hundred and twelve Chinese stroke survivors and 65 healthy Chinese older people living in the community. INTERVENTIONS Not applicable. MAIN MEASURES The C-NFI-Stroke, Fatigue Severity Scale, Mental Fatigue Scale, General Self-Efficacy Scale, and Geriatric Depression Scale were used. RESULTS Cronbach's α coefficients were 0.69-0.88; the item-level agreement was 70.4%-88.9%; the weighted Kappa value was 0.47-0.79; and the intra-class correlation coefficients were 0.88-0.93. The C-NFI-Stroke had no ceiling and floor effects. It had good content validity and had two factors, "lack of energy" and "tiredness/weakness." The confirmatory factor analysis showed a good fit to the model. The C-NFI-Stroke significantly correlated with existing fatigue scales (rs = 0.55-0.63), self-efficacy (rs = -0.31 to -0.37), and depressive symptoms (rs = 0.53-0.60). The C-NFI-Stroke could discern differences between stroke survivors and healthy older people. CONCLUSIONS The C-NFI-Stroke is a reliable and valid tool for clinical and research use on people who have been diagnosed with stroke for a year or more, although its factor structure differs from that of the original English version.
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Affiliation(s)
- Lily Yw Ho
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR
| | - Claudia Ky Lai
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR
| | - Shamay Sm Ng
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR
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15
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Scheffler E, Mash R. Figuring it out by yourself: Perceptions of home-based care of stroke survivors, family caregivers and community health workers in a low-resourced setting, South Africa. Afr J Prim Health Care Fam Med 2020; 12:e1-e12. [PMID: 33054273 PMCID: PMC7565662 DOI: 10.4102/phcfm.v12i1.2629] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 07/22/2020] [Accepted: 07/23/2020] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND In less resourced settings, formal rehabilitation services for stroke survivors were often absent. Stroke survivors were referred to community health workers (CHWs) who were untrained in rehabilitation. AIM To describe the experience and perceived needs of stroke survivors, their caregivers and CHWs in a context with limited access to and support from formal rehabilitation services. SETTING The Breede Valley subdistrict, Western Cape, South Africa, a rural, less resourced setting. METHODS A descriptive exploratory qualitative study. Four focus group interviews were held with purposively selected stroke survivors and caregivers and four with CHWs. A thematic approach and the framework method were used to analyse the transcripts. FINDINGS A total of 41 CHWs, 21 caregivers and 26 stroke survivors participated. Four main themes and 11 sub-themes were identified. Because of the lack of knowledge, training and rehabilitation services, the main theme for all groups was having to 'figure things out' independently, with incontinence management being particularly challenging. Secondly was the need for emotional support for stroke survivors and caregivers. Thirdly, contextual factors such as architectural barriers and lack of assistive products negatively impacted care and function. Lastly, the organisation of health and rehabilitation services negatively impacted home-based services and professional support. CONCLUSIONS With appropriate training, the CHWs can be pivotal in the training and support of family caregivers and stroke survivors. Care pathways and the role and scope of both CHWs and therapists in home-based stroke rehabilitation should be defined and restructured, including the links with formal services.
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Affiliation(s)
- Elsje Scheffler
- Division of Family Medicine and Primary Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town.
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16
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Seidlein A, Buchholz M, Salloch S, Buchholz I. Adequacy of care provision in long-term home nursing arrangements: A triangulation of three perspectives. Nurs Open 2020; 7:1634-1642. [PMID: 32802385 PMCID: PMC7424429 DOI: 10.1002/nop2.548] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/26/2020] [Accepted: 05/27/2020] [Indexed: 11/11/2022] Open
Abstract
Background A growing proportion of older people in Germany receive long-term care from informal and professional caregivers at home. Their personal assessment of the individual care situation is scarcely considered. Aim This study aimed to explore the subjective views of care recipients, informal and professional caregivers on the adequacy of care provision in long-term home care arrangements. Design and Methods Qualitative semi-structured face-to-face interviews were conducted with ten care recipients, ten professional caregivers and eight informal caregivers to capture their perspectives on the adequacy of the care received and delivered. Qualitative content analysis was applied using MAXQDA software. Results All groups highlighted that they perceive an underprovision of care, even though their explanations differed. The underprovision was mainly described regarding the quality rather than quantity of services. It occurs especially in interpersonal relationships and social inclusion, where the gap between the self-perceived current situation and the desires of those affected is most prominent. The ambivalent impact of home care on social participation becomes apparent. Perceptions of an overprovision of care range from the view that it appears mainly with respect to informal care to the statement that it is currently non-existent or generally impossible. Misprovision of care is experienced as serious whenever the interviewees face the challenge of preserving existing abilities or regaining certain skills.
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Affiliation(s)
- Anna‐Henrikje Seidlein
- Institute of Ethics and History of MedicineUniversity Medicine GreifswaldGreifswaldGermany
| | - Maresa Buchholz
- Department MethodsInstitute for Community MedicineUniversity Medicine GreifswaldGreifswaldGermany
| | - Sabine Salloch
- Institute of Ethics and History of MedicineUniversity Medicine GreifswaldGreifswaldGermany
| | - Ines Buchholz
- Department MethodsInstitute for Community MedicineUniversity Medicine GreifswaldGreifswaldGermany
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Supported cognitive-behavioural therapy self-help versus treatment-as-usual for depressed informal caregivers of stroke survivors (CEDArS): feasibility randomised controlled trial. COGNITIVE BEHAVIOUR THERAPIST 2020. [DOI: 10.1017/s1754470x20000239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Abstract
Demands placed on informal caregivers can result in an increased likelihood of experiencing common mental health difficulties that may affect their ability to undertake the caring role. Currently, however, few evidence-based interventions have been specifically developed for informal caregivers and available interventions are difficult to access. The Improving Access to Psychological Therapies (IAPT) programme aims to improve access to evidence-based psychological therapies for all groups and may therefore present an opportunity to meet informal caregiver needs. Located within the MRC Complex Intervention Framework, a Phase II feasibility randomised controlled trial (RCT) examines key methodological, procedural and clinical uncertainties associated with running a definitive Phase III RCT of an adapted written cognitive behavioural therapy (CBT) self-help intervention for informal caregivers of stroke survivors. Recruitment was low despite different recruitment strategies being adopted, highlighting significant challenges moving towards a Phase III RCT until resolved. Difficulties with study recruitment may reflect wider challenges engaging informal caregivers in psychological interventions and may have implications for IAPT services seeking to improve access for this group. Further attempts to develop a successful recruitment protocol to progress to a Phase III RCT examining effectiveness of the adapted CBT self-help intervention should be encouraged.
Key learning aims
After reading this article, readers should be able to:
(1)
Consider key feasibility issues with regard to recruitment and attrition when running a randomised controlled trial of an adapted written cognitive behavioural therapy (CBT) self-help intervention for informal caregivers of stroke survivors.
(2)
Understand potential barriers experienced by an informal caregiving population to accessing psychological interventions.
(3)
Appreciate implications for clinical practice to enhance access to IAPT services and low-intensity CBT working with an informal caregiver population.
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18
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Seidlein AH, Salloch S. Who Cares About Care? Family Members as Moral Actors in Treatment Decision Making. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2020; 20:80-82. [PMID: 32618502 DOI: 10.1080/15265161.2020.1754506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
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Panzeri A, Rossi Ferrario S, Vidotto G. Interventions for Psychological Health of Stroke Caregivers: A Systematic Review. Front Psychol 2019; 10:2045. [PMID: 31551881 PMCID: PMC6743500 DOI: 10.3389/fpsyg.2019.02045] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 08/21/2019] [Indexed: 02/03/2023] Open
Abstract
Background: The increasing number of stroke patients (SPs) requires informal caregivers to bear a high burden of responsibilities and heavy (di)stress. Moreover, these issues could lead to the development of serious psychological problems (e.g., depressive and/or anxious) that in turn could give rise to poor health-related quality of life outcomes. However, although the value of psychological interventions has been widely recognized for SPs, the scientific literature lacks an updated synthesis of interventions addressing the psychological health of their caregivers. Aim: The aim of this review is to summarize the interventions for the psychological health of stroke caregivers and provide a resume of literature-based evidence of their efficacy. Method: A literature review from 2005 to date was conducted in three online databases: PubMed, Scopus, and Google Scholar. Eligibility criteria for studies were (A) English language, (B) caregivers and patients aged 18 years or above, (C) SP's caregiver beneficiating of a specific intervention, and (D) outcome measures addressing depressive and/or anxiety symptomology, quality of life, well-being, or burden. Results: Across the selected 45 studies, substantial differences are observable in three main categories: (a) type of intervention (b) techniques, and (c) operators. Interventions' advantages and results are discussed. Overall, studies using psychological techniques, such as cognitive-behavioral therapy, coping skill-training, and problem-solving therapy, showed their usefulness and efficacy in reducing the caregivers' depressive and anxious symptoms, and burden. Interventions led by psychologists and tailored to meet caregivers' specific needs showed more positive outcomes. Conclusion: This review underlines the usefulness of psychological interventions aimed at reducing the psychological burden, such as anxious and depressive symptomatology, of SPs' informal caregivers. Hence, psychological interventions for caregivers should be integrated as part of the stroke rehabilitation process to improve informal caregivers' and patients' quality of life and well-being.
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Affiliation(s)
- Anna Panzeri
- Psychology and Neuropsychology Unit, Istituti Clinici Scientifici Maugeri, Veruno, Italy
- General Psychology Department, Università degli Studi di Padova, Padova, Italy
| | - Silvia Rossi Ferrario
- Psychology and Neuropsychology Unit, Istituti Clinici Scientifici Maugeri, Veruno, Italy
| | - Giulio Vidotto
- General Psychology Department, Università degli Studi di Padova, Padova, Italy
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20
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Caton S, Koivunen ER, Allison C. Internet use for family carers of people with intellectual disabilities: A literature review and thematic synthesis. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2019; 23:446-468. [PMID: 31496385 DOI: 10.1177/1744629519874214] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Being a family carer can be rewarding but can also lead to mental and physical exhaustion as well as feelings of social exclusion and isolation. Research has shown that the use of the Internet and online forums can provide an immediate place to find information and reassurance and that forum use can be an empathetic place to share experiences and seek emotional support. This article details a systematic literature search of research on carers of people with intellectual disabilities and/or autism using the Internet. A thematic synthesis of the resulting papers identified that online forums give carers a sense of agency by providing a place to go for informational support that may not be elsewhere. Carers also enjoyed the safe community of solidarity and emotional support that online forums provide. An important finding is the lack of published papers in this area with the inclusion of just eight papers.
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Affiliation(s)
- Sue Caton
- Manchester Metropolitan University, UK
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21
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Rohde D, Gaynor E, Large M, Conway O, Bennett K, Williams DJ, Callaly E, Dolan E, Hickey A. Stroke survivor cognitive decline and psychological wellbeing of family caregivers five years post-stroke: a cross-sectional analysis. Top Stroke Rehabil 2019; 26:180-186. [PMID: 30907273 DOI: 10.1080/10749357.2019.1590972] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Family members frequently provide long-term care for stroke survivors, which can lead to psychological strain, particularly in the presence of cognitive decline. OBJECTIVES To profile anxious and depressive symptoms of family caregivers at 5 years post-stroke, and to explore associations with stroke survivor cognitive decline. METHODS As part of a 5-year follow-up of the Action on Secondary Prevention Interventions and Rehabilitation in Stroke (ASPIRE-S) cohort of stroke survivors, family members completed a self-report questionnaire. Symptoms of anxiety and depression were assessed using the HADS-A and CES-D. Cognitive decline in stroke survivors was assessed from the caregiver's perspective using the IQCODE, with cognitive performance assessed by the MoCA. Data were analyzed using logistic regression models. RESULTS 78 family members participated; 25.5% exhibited depressive symptoms, 19.4% had symptoms of anxiety. Eleven stroke survivors (16.7%) had evidence of cognitive decline according to both the IQCODE and MoCA. Family members of stroke survivors with cognitive decline were significantly more likely to report symptoms of depression [age-adjusted OR (95% CI): 5.94 (1.14, 30.89)] or anxiety [age-adjusted OR (95% CI): 5.64 (1.24, 25.54)] than family members of stroke survivors without cognitive decline. CONCLUSIONS One-fifth of family caregivers exhibited symptoms of anxiety and one-quarter symptoms of depression at 5 years post-stroke. Stroke survivor cognitive decline was significantly associated with both depressive and anxious symptoms of family caregivers. Family members play a key role in the care and rehabilitation of stroke patients; enhancing their psychological wellbeing and identifying unmet needs are essential to improving outcomes for stroke survivors and families.
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Affiliation(s)
- Daniela Rohde
- a Population Health Sciences , Royal College of Surgeons in Ireland , Dublin , Ireland
| | - Eva Gaynor
- b Department of Medicine , Royal College of Surgeons in Ireland , Dublin , Ireland
| | - Margaret Large
- c Clinical Research Centre , Royal College of Surgeons in Ireland, Beaumont Hospital , Dublin , Ireland
| | - Orla Conway
- a Population Health Sciences , Royal College of Surgeons in Ireland , Dublin , Ireland
| | - Kathleen Bennett
- a Population Health Sciences , Royal College of Surgeons in Ireland , Dublin , Ireland
| | - David J Williams
- d Geriatric and Stroke Medicine , Royal College of Surgeons in Ireland, Beaumont Hospital , Dublin , Ireland
| | - Elizabeth Callaly
- e Geriatric Medicine , Mater Misercordiae University Hospital , Dublin , Ireland
| | - Eamon Dolan
- f Geriatric Medicine , Connolly Hospital , Dublin , Ireland
| | - Anne Hickey
- a Population Health Sciences , Royal College of Surgeons in Ireland , Dublin , Ireland
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22
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Lu Q, Mårtensson J, Zhao Y, Johansson L. Living on the edge: Family caregivers' experiences of caring for post-stroke family members in China: A qualitative study. Int J Nurs Stud 2019; 94:1-8. [PMID: 30928717 DOI: 10.1016/j.ijnurstu.2019.02.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 02/18/2019] [Accepted: 02/23/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Globally, one-third of the 15 million people with stroke suffer permanent physical, cognitive, and emotional impairment. Because of traditional Chinese culture and the limited development of the primary healthcare system, most stroke survivors are cared for and live with their family after hospital discharge. However, previous literature shows a lack of qualitative studies on family caregivers' experience of caring for their relatives in China. OBJECTIVES The aim of this study was to explore the experience of family caregivers taking care of stroke survivors in China. METHODS An explorative design was used wherein qualitative semi-structured interviews were conducted with family caregivers in China. Family caregivers were selected from one city and three communities using a purposive sampling method until no new data were generated (n = 26). A thematic analysis was used for the data analysis in this study. FINDINGS Family caregivers' experience was described as living on the edge, which pulled their lives in multiple directions, created an unstable situation, and reduced their well-being and health. The participants believed they had total responsibility and felt that this was expected from both themselves and society. Little external understanding and insufficient support was emphasised, resulting in the caregivers feeling all alone, drained by caring, and like prisoners in their own lives. The family caregivers had to face all of the family events and make all of the decisions by themselves. They expressed love for their family members with stroke, but this was often overshadowed by feelings of sadness, depression, sensitivity, and anger. This resulted in an inability to see how things could improve and in the family caregivers being uncertain about the future. CONCLUSION All of these findings increased understanding and added knowledge of this topic that has been seldom studied in China. Healthcare authorities and professionals should recognise and understand the lives and situations of family caregivers since their relatives had a stroke to further identify their difficulties and needs. Appropriate and effective support, both from government and society, should be planned and implemented for family caregivers to relieve them from caring for their relatives with stroke and maintaining the quality of their own lives.
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Affiliation(s)
- Qi Lu
- School of Health and Welfare, Jönköping University, Jönköping, Sweden; School of Nursing, Tianjin Medical University, China.
| | - Jan Mårtensson
- School of Health and Welfare, Jönköping University, Department of Nursing, Box 1026, SE-551 11, Jönköping, Sweden.
| | - Yue Zhao
- School of Nursing, Tianjin Medical University, No. 22 Qixiangtai Road, Heping District, Tianjin, 300070, China.
| | - Linda Johansson
- School of Health and Welfare, Jönköping University, Institute of Gerontology, Box 1026, SE-551 11, Jönköping, Sweden.
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Affiliation(s)
- Jennifer Moye
- a New England GRECC , VA Boston Healthcare System , Jamaica Plain , Massachusetts , USA
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