A National Study of the Quantity and Cost of Informal Caregiving for the Elderly with Stroke

56 Background: As the US population ages, increased stroke incidence will result in higher stroke-associated costs. While estimates of direct costs exist, little information is available regarding informal caregiving costs for stroke patients. Objective: To determine a nationally representative estimate of the quantity and cost of informal caregiving for elderly stroke patients. Methods: We used data from the first wave (1993) of the Asset and Health Dynamics (AHEAD) Study, a longitudinal study of people over 70 living in the community, to determine average weekly hours of informal caregiving. Multivariate and logistic regression analyses were performed to examine association of stroke and other covariates and assess the probability of receiving informal care. Average annual cost for informal caregiving was calculated. Results: Of the 7443 respondents, 656 (6%) reported a history of stroke. Of those, 375 (57%) reported stroke-related health problems (SRHP). After adjusting for cormorbid conditions, social support and sociodemographics, the proportion of patients receiving informal care increased with stroke severity, and there was a significant association of weekly hours of caregiving with stroke category (p<0.01). Using the mean 1998 wage for a home health aide ($8.20/hr.) as the value for family caregiver time, the expected yearly caregiving cost per stroke ranged from $3500 to $7600, which would result in an annual cost of more than $5.7 billion for stroke-related informal caregiving in the US. Conclusions: The economic burden of informal caregiving following stroke has not been studied previously. Informal caregiving occurs frequently; associated costs are substantial and should be considered when estimating the cost of stroke treatment.

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Ethnic Differences in Informal Caregiving After Stroke

Stroke ◽

10.1161/strokeaha.120.032740 ◽

2021 ◽

Author(s):

Lewis B. Morgenstern ◽

Cecilia N. Hollenhorst ◽

Linda C. Gallo ◽

Chia-Wei Hsu ◽

Sehee Kim ◽

...

Keyword(s):

Logistic Regression ◽

Activities Of Daily Living ◽

Informal Care ◽

Ethnic Differences ◽

Mexican Americans ◽

Daily Living ◽

Logistic Models ◽

Stroke Care ◽

Informal Caregiving ◽

Stroke Severity

Background and Purpose: Informal (unpaid) caregiving usually provided by family is important poststroke. We studied whether the prevalence of informal caregiving after stroke differs between Mexican Americans (MAs) and non-Hispanic Whites (NHWs). Methods: Between October 2014 and December 2018, participants in the BASIC (Brain Attack Surveillance in Corpus Christi) project in Nueces County, Texas, were interviewed 90 days after stroke to determine which activities of daily living they required help with and whether family provided informal caregiving. Ethnic differences between MAs and NHWs were determined by logistic regression. The logistic models were stratified by formal (paid) care status. Odds ratios (95% CIs) are reported with NHW as the referent group. Fisher exact tests were used to assess the association of ethnicity with relationship of caregiver and with individual activities of daily living. Results: Eight hundred thirty-one patients answered the caregiving questions. Of these, 242 (29%) received family caregiving (33% of MAs and 23% of NHWs), and 142 (17%) received paid caregiving (21% of MAs and 10% of NHWs). There were no ethnic differences in stroke severity. In logistic regression analyses, among those without formal, paid care, MAs were more likely to have informal caregiving (odds ratio, 1.75 [95% CI, 1.12–2.73]) adjusted for age, National Institutes of Health Stroke Scale, prestroke modified Rankin Scale, and insurance. No ethnic differences in informal care were found among those who had formal care. There were no differences between ethnic groups in which family members provided the informal care. MAs were more likely to require help compared with NHWs for walking ( P <0.0001), bathing ( P <0.0001), hygiene ( P =0.0012), eating ( P =0.0004), dressing ( P <0.0001), ambulating ( P =0.0304), and toileting ( P =0.0003). Conclusions: MAs required more help poststroke than NHWs for assistance with activities of daily living. MAs received more help for activities of daily living through informal, unpaid caregiving than NHWs if they were not also receiving formal, paid care. Efforts to help minority and low-resource populations provide stroke care are needed.

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Impact of COVID-19 on stroke admissions, treatments, and outcomes at a comprehensive stroke centre in the United Kingdom

Neurological Sciences ◽

10.1007/s10072-020-04775-x ◽

2020 ◽

Author(s):

Nishita Padmanabhan ◽

Indira Natarajan ◽

Rachel Gunston ◽

Marko Raseta ◽

Christine Roffe

Keyword(s):

National Institutes Of Health ◽

University Hospital ◽

Stroke Severity ◽

Stroke Patients ◽

Stroke Treatment ◽

Patient Demographics ◽

The United Kingdom ◽

Significant Difference ◽

Ischaemic Attack ◽

Provision Of Care

Abstract Introduction The coronavirus disease (COVID-19) pandemic has changed routine clinical practice worldwide with major impacts on the provision of care and treatment for stroke patients. Methods This retrospective observational study included all patients admitted to the Royal Stoke University Hospital in Stoke-on-Trent, UK, with a stroke or transient ischaemic attack between March 15th and April 14th, 2020 (COVID). Patient demographics, characteristics of the stroke, treatment details and logistics were compared with patients admitted in the corresponding weeks in the year before (2019). Results There was a 39.5% (n = 101 vs n = 167) reduction in admissions in the COVID cohort compared with 2019 with more severe strokes (median National Institutes of Health Stroke Scale (NIHSS) 7 vs 4, p = 0.02), and fewer strokes with no visible acute pathology (21.8 vs 37.1%, p = 0.01) on computed tomography. There was no statistically significant difference in the rates of thrombolysis (10.9 vs 13.2%, p = 0.72) and/or thrombectomy (5.9 vs 4.8%, p = 0.90) and no statistically significant difference in time from stroke onset to arrival at hospital (734 vs 576 min, p = 0.34), door-to-needle time for thrombolysis (54 vs 64 min, p = 0.43) and door-to-thrombectomy time (181 vs 445 min, p = 0.72). Thirty-day mortality was not significantly higher in the COVID year (10.9 vs 8.9%, p = 0.77). None of the 7 stroke patients infected with COVID-19 died. Conclusions During the COVID-19 pandemic, the number of stroke admissions fell, and stroke severity increased. There was no statistically significant change in the delivery of thrombolysis and mechanical thrombectomy and no increase in mortality.

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The effect of socioeconomic status on informal caregiving intensity of adult females for parents: Evidence from a national study in China

10.21203/rs.3.rs-17557/v1 ◽

2020 ◽

Author(s):

Yi Wang ◽

Jiajia Li ◽

Lulu Ding ◽

Yuejing Feng ◽

Xue Tang ◽

...

Keyword(s):

Logistic Regression ◽

Informal Care ◽

High Intensity ◽

Multinomial Logistic Regression ◽

Informal Caregiving ◽

Family Characteristics ◽

National Study ◽

Education Attainment ◽

Nutrition Survey ◽

Low Intensity

Abstract Background Few studies explored the effect of SES of caregivers on informal caregiving in China, especially from a female perspective. The purpose of this study was to empirically examine how the SES of female caregivers affects the amount of informal care they provide for parents in China. Methods The data used in this study was derived from the China Health and Nutrition Survey (CHNS). Informal caregivers were divided into three categories: non-caregivers (0 hrs/week), low-intensity caregivers (less than 10 hrs/week), and high-intensity caregivers (more than 10 hrs/week). Chi-square tests and one-way analysis of variance (ANOVA) were used to compare the SES of the women between non-, low-, and high-intensity caregivers. Multinomial logistic regression analysis was used to calculate relative risk ratios (RRR) for various SES variables to assess the relation of SES on the likelihood of a low- and high-intensity caregiving in the household, adjusting for age, marital status, family characteristics and wave. Results Of the 2741 respondents, high-intensity and low-intensity caregivers accounted for 16.42% and 21.38% respectively. Multinomial logistic regression results found that the likelihood of being a high-intensity caregiver vs. a non-caregivers increased as the caregiver’s education attainment increased. Urban females were 1.34 times more likely than their rural counterparts to provide low-intensity care vs. no care ( p <0.05) and were 1.34 times more likely to provide high-intensity care vs. no care ( p <0.05). Employed females were 1.27 times more likely than those non-employed to provide low-intensity care vs. no care ( p <0.05). Conclusions Differences in SES were found between high-intensity caregivers and low-intensity caregivers. Women with higher SES (higher education attainment, higher incomes, and urban Hukou ) were more likely to provide high-intensity informal care, and women who were employed and with urban Hukou were more likely to provide low-intensity care.

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Faktor Faktor Risiko terjadinya Pneumonia pada Stroke Akut di RSUP Dr Hasan Sadikin Bandung

Jurnal Neuroanestesi Indonesia ◽

10.24244/jni.v10i3.269 ◽

2021 ◽

Vol 10 (3) ◽

pp. 151-161

Author(s):

Novi Fatni Muhafidzah ◽

◽

Sobaryati Mansur ◽

Emmy Hermiyanti Pranggono ◽

Yusuf Wibisono ◽

...

Keyword(s):

Risk Factors ◽

Infarct Size ◽

Acute Stroke ◽

Primary Data ◽

Neurogenic Pulmonary Edema ◽

Stroke Severity ◽

Stroke Patients ◽

Anterior Circulation ◽

Stroke Treatment ◽

Large Infarct

Risk Factors of Pneumonia in Acute Stroke at Hasan Sadikin Hospital Bandung Abstract Background and Objective:Pneumonia is the most common non neurological complications in acute stroke (22%) that increase mortality rate, length of stay and hospitalization cost. It is necessary to identified risk factors for pneumonia including neurogenic pulmonary edema (NPE) for better prevention and early intervention. The purpose of this study is to determine risk factors of pneumonia (including NPE) in acute stroke patients at Hasan Sadikin General Hospital Bandung. Subject and Methods: Prospective observational descriptive study, consecutive sampling method, during September – October 2019. Primary data collected from acute stroke patients such as stroke severity, type, location and size of stroke, treatment during hospitalizataion, comorbidities (including NPE). Pneumonia was diagnosed based on Central for Disease Control Prevention (CDC) criteria, NPE based on Davison criteria. Results: 30 patients (28.3%) with pneumonia in acute stroke patients. Pneumonia were commonly found in NGT insertion (90%), dysphagia (64,71%), total anterior circulation infarct (TACI) (61,54%), large infarct size (61,54%), GCS 9-12 (50%) and NIHSS 16-20 (50%). NPE only found in 6,60% acute stroke patients, 57,14% of them developed pneumonia. Conclusions: Pneumonia in acute stroke patients is more often found in NGT insertion, dysphagia, TACI location, large infarct size, lower GCS and more severe stroke degree.

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COVID-19 Impact on Acute Ischemic Stroke Treatment at 9 Comprehensive Stroke Centers across Los Angeles

Cerebrovascular Diseases ◽

10.1159/000516908 ◽

2021 ◽

pp. 1-8

Author(s):

M. Maximillian Padrick ◽

Navdeep Sangha ◽

Laurie Paletz ◽

James Mirocha ◽

Sonia Figueroa ◽

...

Keyword(s):

Los Angeles ◽

Goodness Of Fit ◽

Demographic Data ◽

Lower Percentage ◽

Stroke Severity ◽

Goodness Of Fit Test ◽

Skilled Nursing ◽

Stroke Incidence ◽

Stroke Treatment ◽

The Impact

Objective: To describe the impact of COVID-19 on acute cerebrovascular disease care across 9 comprehensive stroke centers throughout Los Angeles County (LAC). Methods: Volume of emergency stroke code activations, patient characteristics, stroke severity, reperfusion rates, treatment times, and outcomes from February 1 to April 30, 2020, were compared against the same time period in 2019. Demographic data were provided by each participating institution. Results: There was a 17.3% decrease in stroke code activations across LAC in 2020 compared to 2019 (1,786 vs. 2,159, respectively, χ2 goodness of fit test p < 0.0001) across 9 participating comprehensive stroke centers. Patients who did not receive any reperfusion therapy decreased by 16.6% in 2020 (1,527) compared to 2019 (1,832). Patients who received only intravenous thrombolytic (IVT) therapy decreased by 31.8% (107 vs. 157). Patients who received only mechanical thrombectomy (MT) increased by 3% (102 vs. 99). Patients who received both IVT and MT decreased by 31.8% (45 vs. 66). Recanalization treatment times in 2020 were comparable to 2019. CSCs serving a higher proportion of Latinx populations in the eastern parts of LAC experienced a higher incidence of MT in 2020 compared to 2019. Mild increase in stroke severity was seen in 2020 compared to 2019 (8.95 vs. 8.23, p = 0.046). A higher percentage of patients were discharged home in 2020 compared to 2019 (59.5 vs. 56.1%, p = 0.034), a lower percentage of patients were discharged to skilled nursing facility (16.1 vs. 20.7%, p = 0.0004), and a higher percentage of patients expired (8.6 vs. 6.3%, p = 0.008). Conclusion: LAC saw a decrease in overall stroke code activations in 2020 compared to 2019. Reperfusion treatment times remained comparable to prepandemic metrics. There has been an increase in severe stroke incidence and higher volume of thrombectomy treatments in Latinx communities within LAC during the pandemic of 2020. More patients were discharged home, less patients discharged to skilled nursing facilities, and more patients expired in 2020, compared to the same time frame in 2019.

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Abstract TP180: Outcomes in the Elderly Post-Endovascular Therapy in a Community Setting

Stroke ◽

10.1161/str.51.suppl_1.tp180 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Mai N Nguyen-huynh ◽

Janet Alexander ◽

Catherine Lee ◽

Melissa Meighan ◽

Alexander Flint ◽

...

Keyword(s):

Acute Stroke ◽

Healthcare System ◽

Endovascular Therapy ◽

Community Setting ◽

The Elderly ◽

Study Cohort ◽

Stroke Patients ◽

Vessel Occlusion ◽

Integrated Healthcare ◽

Stroke Treatment

Background: Risks and benefits of thrombectomy in elderly stroke patients remained unclear. We evaluated outcomes in the elderly who underwent endovascular therapy (EST) in a large integrated healthcare system. Methods: In 2016, our integrated healthcare system launched a new standardized acute telestroke care workflow for all 21 stroke centers. It included immediate evaluation by a stroke neurologist via video, expedited IV alteplase treatment, rapid CT angiographic investigation, and expedited transfer and EST for patients with large vessel occlusion (LVO). From January 2016 through December 2018, our study cohort included adult members who had EST within our care system. We compared patient characteristics, door-to-needle (DTN) times, door-to-groin (DTG) times, inpatient and 90-day mortality between those treated with EST aged <80 to those ≥80 years. Multivariable logistic regression model was used to assess whether being ≥80 years was associated with a higher 90-day mortality adjusting for demographics, co-morbidities, and DTG time. Results: There were 291 acute stroke patients who underwent EST [Table]. The older subgroup had a higher percentage of female and higher rates of atrial fibrillation. They were more likely to arrive by EMS, to have a higher initial NIHSS and to have a faster DTN time. Average DTG times and inpatient mortality rates were not different between groups. The elderly had a higher rate of 90-day mortality. In multivariate model, being elderly was associated with higher 90-day mortality (OR=2.56, 95% CI 1.29-5.09, p=0.007). Conclusions: For those who underwent EST in a large community setting with a standardized approach to acute stroke treatment, being elderly was associated with a higher risk of 90-day mortality. Further data analyses are being carried out with additional co-morbidities, inpatient complications, and 90-day functional outcome to better understand outcomes in older patients undergoing EST.

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Abstract 2722: Anti-hypertensive Treatment Prolongs tPA Door-to-treatment Time: Secondary Analysis Of The Increasing Stroke Treatment Through Interventional Behavior Change Tactics (INSTINCT) Trial.

Stroke ◽

10.1161/str.43.suppl_1.a2722 ◽

2012 ◽

Vol 43 (suppl_1) ◽

Author(s):

Lesli E Skolarus ◽

Phillip A Scott ◽

James F Burke ◽

Eric E Adelman ◽

Shirley M Frederiksen ◽

...

Keyword(s):

Treatment Time ◽

Secondary Analysis ◽

Secondary Data ◽

Educational Interventions ◽

Stroke Severity ◽

Stroke Patients ◽

Treatment Delays ◽

Stroke Treatment ◽

Stroke Risk Factors ◽

Propensity Matching

Background/Purpose: Increased time to tPA treatment is associated with worse outcomes. Thus, identifying modifiable treatment delays may improve stroke outcomes. We hypothesized that pre-thrombolytic anti-hypertensive treatment (AHT) may prolong door to treatment time (DTT). Methods: Secondary data analysis of consecutive tPA-treated patients at 24 randomly selected Michigan community hospitals in the INSTINCT trial. DTT among stroke patients who received pre-thrombolytic AHT were compared to those that did not receive pre-thrombolytic AHT. We then calculated a propensity score for the probability of receiving pre-thrombolytic AHT using a logistic regression model with covariates including demographics, stroke risk factors, antiplatelet or beta blocker as home medication, stroke severity (NIHSS), onset to door time, admission glucose, pretreatment systolic and diastolic blood pressure, EMS usage and location at time of stroke. A paired t-test was then performed to compare the DTT between the propensity matched groups. A separate generalized estimating equations (GEE) approach was also used to estimate the differences between patients receiving pre-thrombolytic AHT and those that did not while accounting for within hospital clustering. Results: A total of 557 patients were included in INSTINCT, however onset, arrival or treatment times were not able to be determined in 23, leaving 534 patients for this analysis. The unmatched cohort consisted of 95 stroke patients who received pre-thrombolytic AHT and 439 stroke patients who did not receive AHT from 2007-2010 ( table ). In the unmatched cohort, patients who received pre-thrombolytic AHT had a longer DTT (mean increase 9 minutes; 95% confidence interval (CI) 2-16 minutes) than patients who did not receive pre-thrombolytic AHT. After propensity matching (table), patients who received pre-thrombolytic AHT had a longer DTT (mean increase 10.4 minutes, 95% CI 1.9 - 18.8) than patients who did not receive pre-thrombolytic AHT. This effect persisted and its magnitude was not altered by accounting for clustering within hospitals. Conclusion: Pre-thrombolytic AHT is associated with modest delays in DTT. This represents a feasible target for physician educational interventions and quality improvement initiatives. Further research evaluating optimum hypertension management pre-thrombolytic treatment is warranted.

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A national study of the quantity and cost of informal caregiving for the elderly with stroke

Neurology ◽

10.1212/wnl.58.12.1754 ◽

2002 ◽

Vol 58 (12) ◽

pp. 1754-1759 ◽

Cited By ~ 58

Author(s):

S. L. Hickenbottom ◽

A. M. Fendrick ◽

J. S. Kutcher ◽

M. U. Kabeto ◽

S. J. Katz ◽

...

Keyword(s):

The Elderly ◽

Informal Caregiving ◽

National Study

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The Investigation on the Burden of Neurology Residents to Manage the Patient who Received Thrombolytic Treatment in the Emergency Department with Hyperacute Stroke

Journal of the Korean Neurological Association ◽

10.17340/jkna.2021.4.6 ◽

2021 ◽

Vol 39 (4) ◽

pp. 305-311

Author(s):

Hyun Joon Lee ◽

Dong Hoon Shin ◽

Kwang Ik Yang ◽

Im-Seok Koh ◽

Kyung Bok Lee ◽

...

Keyword(s):

Emergency Department ◽

Acute Stroke ◽

Teaching Hospitals ◽

Stroke Patients ◽

Stroke Incidence ◽

Average Hospital ◽

Stroke Treatment ◽

Hyperacute Stroke ◽

Number Of Patients ◽

Hospital Beds

Background: Because Korea is the fastest aging country, the stroke incidence is increasing rapidly. We investigate the trend of the number of patients with acute stroke in recent years and estimate the burden of the neurologist to treat the acute stroke patient visited the emergency department.Methods: We requested a questionnaire survey to all teaching hospitals on the number of hospital beds, the number of stroke patients who visited the emergency department, the number of stroke patients in charge of the neurologist, and the number of days on duty of residents from 2016 to 2019.Results: Of 69 teaching hospitals, 41 hospitals answered the survey. The average hospital beds per hospital were increased annually from 909 to 916. The average patients who visited the emergency department with stroke and were in charged to neurologists were rapidly increased from 799 to 867 per hospital. In particular, the number of patients with hyperacute cerebral infarction requiring the thrombolytic administration or mechanical thrombectomy were rapidly increased from 105 to 131. On the other hand, the average number of residents per hospital was decreased from 5.1 to 4.8. Therefore, the days on duty per resident were increased from 74 to 77.Conclusions: The number of acute stroke patients, especially, hyperacute stroke required the rapid cooperation and high labor were increasing rapidly in recent years. However, because the number of residents were decreased, the burden was increasing. To improve the quality of acute stroke treatment, it is necessary to increase the number of residents.

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Satisfaction in dementia and stroke caregivers: a comparative study

Revista Latino-Americana de Enfermagem ◽

10.1590/s0104-11692009000500004 ◽

2009 ◽

Vol 17 (5) ◽

pp. 620-624 ◽

Cited By ~ 10

Author(s):

Margarida Sotto Mayor ◽

Oscar Ribeiro ◽

Constança Paúl

Keyword(s):

Comparative Study ◽

The Elderly ◽

Informal Caregiving ◽

Cross Sectional Study ◽

Sectional Study ◽

Stroke Patients ◽

Cross Sectional ◽

Interpersonal Dynamics ◽

Satisfaction Index

Informal caregiving to the elderly is associated with the presence of both difficulties and positive rewards, but the latter have been considered less systematically in gerontological literature. In this cross-sectional study, we compared satisfaction of caregivers of demented (n=70) and stroke patients (n=44) by means of the Carer's Assessment of Satisfaction Index (CASI) and also compared their depression levels. Findings revealed the presence of satisfaction deriving from intrapersonal dynamics (elderly as main beneficiary) and from interpersonal dynamics (caregiver as main beneficiary) in dementia situations, and the presence of satisfaction deriving from intrapersonal dynamics (caregiver as main beneficiary) in stroke situations. Both subgroups of caregivers revealed similar yet significant levels of depression. The need for a better understanding of satisfaction experiences in dementia and stroke caregivers is highlighted.

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