Caregiver compliance and feelings of burden in poststroke home care

Measures used to assess burden among caregivers of stroke patients: a review

Objective: To describe measures used to evaluate the burden of caregiving experienced by caregivers of stroke patients and their clinimetric properties.

Design: A review of the literature was conducted to examine burden scales with regard to concept, feasibility, internal consistency, validity, reliability and responsiveness.

Results: The literature search resulted in 45 measures of caregiver outcomes, including 16 different measures of caregiver burden. About half of the scales were used only once and were not further described. Nearly all instruments measure the various dimensions of burden (competency, negative feelings, social relations, participation problems, physical and mental health and economic aspects), but not in the same proportions. Most measures showed good internal consistency, and validity was demonstrated for all measures except one. However, not much is known about the reliability and responsiveness of these measures.

Conclusions: No measure has proven superiority above others. Future research should focus on comparisons between existing instruments and on their reliability and responsiveness.

The stress experienced by caregivers of stroke survivors: is it all in the mind, or is it also in the body?

With a growing awareness that caring for an individual disabled by stroke may lead to stress-related health problems, fifteen major studies of the health status of carers of stroke survivors have been conducted since 1979. Although general stress theory indicates that stress-related health problems may be physical or psychological, in most of the studies reviewed psychological health is emphasized. Possible explanations for this bias are outlined in the present paper including: (a) how the backgrounds of the investigators involved may have influenced the nature of their research; (b) the effect of differences in the availability of standardized physical and psychological health measures; and (c) the possibility that the stress experienced by carers of stroke victims is primarily psychological. The commentary concludes with suggestions for future research to redress the imbalance and discusses some of the methodological difficulties potentially involved.

Home care of patients with amyotrophic lateral sclerosis (ALS)

Optimal home care maximizes function and quality of life for patients with ALS. We designed a survey to study home care in the ALS population. Ninety-eight patients with ALS completed our survey. Of these, 24 receive non-hospice home care, nine hospice home care, and seven both hospice and non-hospice home care. Fifty-eight patients receive no outside help. Patients receiving hospice are older than those receiving non-hospice home care (68.9 vs. 57.7 years, P<0.05). Patients with home care assistance have a mean ALS Functional Rating Scale (ALS FRS) score of 13, and those without home care assistance have a mean score of 26 (P<0.0001). Patients receiving non-hospice home care assistance have a median of 16 h/week of care, while those with hospice receive 5.5 h/week (P=0.05). Patients on Medicaid receive more hours of home care than those with any other insurance (median 61 vs. 3.4 h/week with Medicare and 5 h/week with commercial insurance, P=0.008). Primary caregivers spend a median of 11 h/day caring for patients despite having home care assistance. Forty-two and 48% of primary caregivers feel physically and psychologically unwell, respectively. Home care received by patients with ALS often is inadequate and too late to relieve the burden placed on family caregivers.