Abstract 3861: The Effect of Stroke Survivor and Caregiver Family Function and Mutuality on Post Stroke Depression

Background: Post-stroke depression is common among both stroke survivors and their caregivers. This secondary data analysis explored the effect that stroke survivor and caregiver family function and mutuality, a measure of the perceived positive aspects of the caregiving relationship, had on the depression of spousal dyads over the first 12 months post discharge from inpatient rehabilitation. Methods: Longitudinal meditational analysis was employed to examine the mediating effect of mutuality on the dyads’ perception of family function and caregiver and stroke survivor depression over time. The model was estimated in MPlus version 6.1 using bootstrap estimation with 1000 draws. The final structural model had good model fit to the data with a chi square ( df= 16; N = 132) of 17.55, p =.35, a comparative fit index (CFI) of 0.996, and root mean square error of approximation (RMSEA) of 0.027 (CI = 0-.087). Results: This study included 159 stroke survivors and their spousal caregivers who were an average (standard deviation) age of 66.4 (9.1) and 62.5 (10.5) years, respectively. The majority of stroke survivors were predominately male and non-Hispanic white, although almost 40% of the sample was represented by ethnic minorities. Mutuality was not found to mediate the relationship between caregivers’ and stroke survivors’ perception of family function at baseline and their own or their partners’ depression at 12 months as hypothesized. However, caregivers who perceived healthier family functioning at baseline and stroke survivors who had higher perceived mutuality at 12 months had lower depression at one year post discharge from inpatient rehabilitation (-.117, p=.048; -1.007, p=.034, respectively). Additionally, caregiver mutuality at 6 months, but not at baseline or 12 months, was found to be inversely related to caregiver depression at 12 months (-1.06, p=.04). Conclusions: This study highlights the importance of focusing on the relational aspects of stroke. A stroke does not only happen to the stroke survivor. It affects his or her family, and it oftentimes changes the life of both the stroke survivor and their spousal caregiver. Health professionals should encourage couples who have experienced a stroke to focus on the positive aspects of the caregiving relationship to mitigate post-stroke depression.

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Abstract TP373: Advancing Stroke Recovery Through Social and Emotional Support

Stroke ◽

10.1161/str.48.suppl_1.tp373 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Mary Amatangelo ◽

Janet Prvu Bettger ◽

Karen J Collins ◽

Barry Jackson ◽

Elaine Miller ◽

...

Keyword(s):

Social Support ◽

Family Caregivers ◽

Well Being ◽

Stroke Survivor ◽

Support Needs ◽

Stroke Survivors ◽

Caregiver Depression ◽

Post Stroke ◽

Post Stroke Depression ◽

Health And Well Being

Background: Post-stroke disability often disrupts family roles and responsibilities. Role reversal, in combination with the disabilities, is emotionally taxing and physically fatiguing for both the stroke survivor and the family caregiver. Depression can result and when left undermanaged can lead to poor health outcomes. Research has shown social support is an important factor in recovery, post-stroke and caregiver depression. Studies have indicated high levels of social support are associated with faster functional recovery and more extensive recovery in stroke survivors. Also, that social support is independently associated with the presence and severity of post stroke depression and that positive social interaction is a significant contributor to variance in initial post stroke depression. Purpose: The purpose of this critical review was to examine the research literature on the relationships of social support and coping strategies with health-related outcomes among stroke survivors and their family caregivers. Methods: Twenty-five articles published between 2000 and 2016, identified by key terms related to stroke survivor and caregiver emotional and adjustment support needs, social support, depression and effective interventions, were reviewed. Results: We found overwhelming evidence that attention to stroke survivor and caregiver social network can advance recovery and improve the health and well being of both stroke survivors and caregivers. Knowledge gaps and focus on emotional and adjustment support needs are not being adequately met by community-based health services. This points to an important need for changes in practice to acclimate stroke survivors and their family caregivers to their new life roles, but also the need for more rigorous studies. Conclusions: In addition to more research, there is a critical need for changes in facilitating transitions of care to meet the emotional and adjustment needs in the stroke population. Encouraging health professionals to screen for social network presence and size and promoting support-seeking behavior may help advance recovery and improve the health and well being of stroke survivors and family caregivers.

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Post-Stroke Depression and Its Effect on Functional Outcomes during Inpatient Rehabilitation

Journal of Neurosciences in Rural Practice ◽

10.1055/s-0041-1731958 ◽

2021 ◽

Author(s):

Gurumayum Sonachand Sharma ◽

Anupam Gupta ◽

Meeka Khanna ◽

Naveen Bangarpet Prakash

Keyword(s):

Outcome Measures ◽

Functional Outcomes ◽

Rating Scale ◽

Tertiary Care ◽

Depression Scale ◽

Inpatient Rehabilitation ◽

University Hospital ◽

Post Stroke ◽

Significant Difference ◽

Post Stroke Depression

Abstract Objective The aim of the study is to observe the effect of post-stroke depression on functional outcomes during inpatient rehabilitation. Patients and Methods The design involved is prospective observational study. The location involved is Neurological Rehabilitation unit in a tertiary care university hospital. The study period ranges from October 2019 to April 2020. The participants involved are the patients with first ever stroke, male and female with age ≥18 years and duration less than 1 year. All participants were assessed at admission and after 14 sessions of inpatient rehabilitation by depression subscale of Hospital Anxiety and Depression Scale (HADS-D) and Hamilton Depression Rating Scale (HDRS). The stroke outcomes measures used were: Barthel Index (BI), Scandinavian Stroke Scale (SSS), and Modified Rankin Scale (MRS). Results There are a total of 30 participants (18 males) with median stroke duration of 90 days. The median age of the patients was 58 years. Sixteen patients had ischemic and 14 had hemorrhagic stroke. Out of these, 57% (n = 17) had symptoms of depression (HADS-D >7). Participants in both groups (with and without depression) showed improvement in all the functional outcome measures (BI, SSS, MRS) at the time of discharge as compared with admission scores. The changes in the outcome measures were statistically significant within groups (p < 0.05) but not significant between the groups (p > 0.05). Conclusion The post-stroke depression is common among stroke survivors of less than 1 year duration. There was no significant difference in the functional outcomes between stroke patients with depression and those without depression with inpatient rehabilitation program.

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Role of caregiver factors in outpatient medical follow-up post-stroke: observational study in Singapore

BMC Family Practice ◽

10.1186/s12875-021-01405-z ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Shilpa Tyagi ◽

Gerald Choon-Huat Koh ◽

Nan Luo ◽

Kelvin Bryan Tan ◽

Helen Hoenig ◽

...

Keyword(s):

Observational Study ◽

Management Strategies ◽

Stroke Survivor ◽

Stroke Survivors ◽

Post Stroke ◽

Memory Problems ◽

Healthcare Needs ◽

Stroke Study

Abstract Background Outpatient medical follow-up post-stroke is not only crucial for secondary prevention but is also associated with a reduced risk of rehospitalization. However, being voluntary and non-urgent, it is potentially determined by both healthcare needs and the socio-demographic context of stroke survivor-caregiver dyads. Therefore, we aimed to examine the role of caregiver factors in outpatient medical follow-up (primary care (PC) and specialist outpatient care (SOC)) post-stroke. Method Stroke survivors and caregivers from the Singapore Stroke Study, a prospective, yearlong, observational study, contributed to the study sample. Participants were interviewed 3-monthly for data collection. Counts of PC and SOC visits were extracted from the National Claims Database. Poisson modelling was used to explore the association of caregiver (and patient) factors with PC/SOC visits over 0–3 months (early) and 4–12 months (late) post-stroke. Results For the current analysis, 256 stroke survivors and caregivers were included. While caregiver-reported memory problems of a stroke survivor (IRR: 0.954; 95% CI: 0.919, 0.990) and caregiver burden (IRR: 0.976; 95% CI: 0.959, 0.993) were significantly associated with lower early post-stroke PC visits, co-residing caregiver (IRR: 1.576; 95% CI: 1.040, 2.389) and negative care management strategies (IRR: 1.033; 95% CI: 1.005, 1.061) were significantly associated with higher late post-stroke SOC visits. Conclusion We demonstrated that the association of caregiver factors with outpatient medical follow-up varied by the type of service (i.e., PC versus SOC) and temporally. Our results support family-centred care provision by family physicians viewing caregivers not only as facilitators of care in the community but also as active members of the care team and as clients requiring care and regular assessments.

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Factors Associated with Post-Stroke Depression in Chinese Stroke Survivors

Journal of Stroke and Cerebrovascular Diseases ◽

10.1016/j.jstrokecerebrovasdis.2021.106076 ◽

2021 ◽

Vol 30 (11) ◽

pp. 106076

Author(s):

Janita P C Chau ◽

Suzanne H S Lo ◽

Jie Zhao ◽

Kai Chow Choi ◽

Simon K Y Lam ◽

...

Keyword(s):

Stroke Survivors ◽

Factors Associated ◽

Post Stroke ◽

Post Stroke Depression

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Traveling the Path to Stroke Caregiver Readiness

Innovation in Aging ◽

10.1093/geroni/igaa057.819 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 255-255

Author(s):

Barbara Lutz ◽

Michelle Camicia

Keyword(s):

Internal Consistency ◽

Transitional Care ◽

Inpatient Rehabilitation ◽

Stroke Care ◽

Stroke Survivor ◽

Case Managers ◽

Post Discharge ◽

Rehabilitation Care ◽

Care Plans ◽

Emotional Strain

Abstract Family members are often poorly prepared to assume the caregiving role post-stroke leaving them feeling overwhelmed, frustrated, and abandoned by the healthcare system leading to physical, mental, and emotional strain. To address this, we developed and tested the Preparedness Assessment for the Transition Home after stroke (PATH-s) instrument based on a theoretical framework for improving stroke caregiver readiness. Consecutive studies were conducted over the past 10 years to 1) develop the caregiver readiness theoretical model identifying gaps in caregiver preparation in 80 interviews with caregivers and stroke survivors as they transitioned home from inpatient rehabilitation care; 2) develop and validate the PATH-s instrument with 183 caregiver-stroke survivor dyads, and 3) develop and implement a corresponding catalogue of interventions developed in consultation with 5 expert rehabilitation nurse case managers to improve stroke caregiver readiness. The Improving Caregiver Readiness Model has 2 preparedness domains; commitment and capacity and six sub-domains. In a factor analysis each domain/sub-domain subscale in the PATH-s demonstrated satisfactory internal consistency (a=0.69-0.86). The overall mean score was 3.11 (range 1.68 to 4.00) with high internal consistency reliability (a=0.90). The PATH-s is highly correlated with the Preparedness for Caregiving Scale. The stroke survivor’s total FIM score at discharge had a small but significant correlation with the PATH-s. Case managers find the PATH-s results and corresponding interventions helpful in tailoring transitional care plans. Caregivers worldwide describe the negative impacts of providing stroke care post-discharge. The Path to Stroke Caregiver Readiness Program shows promise for improving stroke caregiver preparation for discharge home.

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Abstract 87: Assessment of Stroke Caregiver Readiness: A Primary Prevention Strategy

Stroke ◽

10.1161/str.43.suppl_1.a87 ◽

2012 ◽

Vol 43 (suppl_1) ◽

Author(s):

Barbara J Lutz ◽

Mary Ellen Young

Keyword(s):

Primary Prevention ◽

Family Caregivers ◽

Family Members ◽

Inpatient Rehabilitation ◽

Stroke Survivors ◽

Post Discharge ◽

Readiness Assessment ◽

Increased Risk ◽

Transition Home

Introduction: More than 3.5 million family caregivers provide assistance with activities and instrumental activities of daily living for stroke survivors living at home. Studies consistently indicate that stroke family caregivers are inadequately assessed and under prepared for their new caregiver roles and responsibilities as stroke survivors transition home from inpatient rehabilitation. Several tools exist to assess caregivers once they have assumed the caregiving role, however, there are no tools assess stroke caregiver readiness prior to discharge. Research has indicated the need for a thorough and systematic pre-discharge assessment of the caregiver’s ability to assume the caregiving role. The purpose of this presentation is to describe ten critical stroke caregiver readiness assessment domains and to discuss their relevance for long-term outcomes for stroke survivors and family caregivers. Methods: In this grounded theory study, data were collected from19 persons with stroke and 19 family caregivers. Semi-structured interviews were conducted during inpatient rehabilitation and within 6 months post-discharge. First interviews focused on expectations for recovery and caregiving needs post-discharge. Follow-up interviews focused on how families managed the transition from rehabilitation to home and how their initial expectations matched the reality of their post-discharge experience. Interviews were analyzed using dimensional analysis and coded in NVivo data management software. Findings: Participants indicated that stroke was an overwhelming, life changing crisis event. Family members felt abandoned, isolated, and under prepared to assume the fulltime caregiving role as stroke survivors transitioned home. They described using ineffective or risky caregiving strategies that resulted in safety and health issues for both stroke survivors and caregivers. Ten pre-discharge caregiver readiness assessment domains were identified in the interviews and a corresponding stroke caregiver readiness assessment interview guide was developed. Conclusion: Stroke survivors and family caregivers are extremely vulnerable as they transition home from inpatient rehabilitation leaving them at risk for poorer health, depression, and increased risk for injury. In order to prevent these deleterious outcomes, caregivers should be assessed, and potential areas of risk identified and addressed prior to discharge from inpatient rehabilitation. As new interventions are developed to improve survival rates for persons with stroke, we must also develop and implement primary prevention strategies for family members who are called upon to provide care following discharge to protect their health and improve the long-term recovery outcomes for the stroke survivor.

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LACK OF EMPHASIS ON PSYCHOLOGICAL REHABILITATION FOR STROKE PATIENTS

Pakistan Journal of Rehabilitation ◽

10.36283/pjr.zu.1.1/009 ◽

2012 ◽

Vol 1 (1) ◽

pp. 2

Author(s):

Samina Masood Haider

Keyword(s):

Emotional Difficulties ◽

Stroke Survivors ◽

Stroke Patients ◽

Post Stroke ◽

Post Stroke Depression ◽

The Many ◽

Over Time

It has been observed that most of the patients are not aware of the dilapidating affects of post stroke depression on their recovery, survival and a return to normal activities of life. The lack of emphasis on psychological rehabilitation for stroke patients is a source of concern for me and I would like to bring to your attention about the facts regarding the implications of proper psychological rehabilitation is not undertaken. Stroke survivors report a range of emotional difficulties, most common being fear, anxiety, frustration, anger, sadness and a sense of grief for their physical and mental losses. Usually these feelings may fade over time however, some patients may struggle with adjusting to the many changes following stroke. When this happens these feelings can develop into depression. It is estimated that approximately one-third of stroke1 survivors develop post-stroke depression (PSD)

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Association among depression, cognitive impairment and executive dysfunction after stroke

Dementia & Neuropsychologia ◽

10.1590/s1980-57642012dn06030007 ◽

2012 ◽

Vol 6 (3) ◽

pp. 152-157 ◽

Cited By ~ 13

Author(s):

Luisa Terroni ◽

Matildes F.M. Sobreiro ◽

Adriana B. Conforto ◽

Carla C. Adda ◽

Valeri D. Guajardo ◽

...

Keyword(s):

Cognitive Impairment ◽

Neuropsychological Tests ◽

Executive Dysfunction ◽

Stroke Survivors ◽

Stroke Patients ◽

Adequate Treatment ◽

Post Stroke ◽

Quantitative Studies ◽

Post Stroke Depression ◽

The Relationship

ABSTRACT The relationship between depression and cognitive impairment, frequent after stroke, is complex and has not been sufficiently elucidated. Objective: To review the relationship between post-stroke depression and cognitive impairment. Methods: We performed a PubMed database search spanning the last ten years, using the terms post-stroke depression, cognitive dysfunction, cognitive impairment and neuropsychological tests. Our target studies were original quantitative studies that investigated the relationship between post-stroke depression (PSD) and cognitive impairment in stroke patients. Articles published in English, Spanish, Italian and Portuguese were considered. Selection criteria were the use of neuropsychological tests to assess cognitive function, and of either instruments to diagnose major depression, or scales to assess depressive symptoms, within the first three months after stroke. Results: Six original quantitative studies fulfilled the criteria. The prevalence of PSD within the first three months after stroke ranged from 22% to 31%. Incidence ranged from 25% to 27% and was evaluated in only two studies. PSD was associated with increased cognitive impairment. Cognitive impairment was reported in 35.2% to 87% of the patients. Post-stroke cognitive deficits were reported mostly in executive function, memory, language, and speed of processing. Conclusion: Executive dysfunction and depression occur in stroke survivors, are frequently coexistent, and also associated with worse stroke prognosis. Healthcare professionals need to address and provide adequate treatment for depression and executive dysfunctions in stroke patients early in the first three months after stroke. Future studies should evaluate the efficacy of programs evaluating the early detection and treatment of PSD and executive dysfunction in stroke survivors.

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Abstract WP203: Frequency of Post-stroke Depression Among Hypertensive Black and Hispanic Stroke Survivors

Stroke ◽

10.1161/str.50.suppl_1.wp203 ◽

2019 ◽

Vol 50 (Suppl_1) ◽

Author(s):

Adebayo O Ogunlade ◽

Leydi Payano ◽

Jennifer Joseph ◽

Stephen K Williams ◽

Tanya Spruill ◽

...

Keyword(s):

Stroke Survivors ◽

Post Stroke ◽

Post Stroke Depression

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Association of Functional Outcome and Post Stroke Depression amongAssociation of Functional Outcome and Post Stroke Depression among Stroke Survivor after Three Months Onset: A Preliminary Study

Jurnal Keperawatan Soedirman ◽

10.20884/1.jks.2019.14.1.888 ◽

2019 ◽

Vol 14 (1) ◽

pp. 31

Author(s):

Fitria Handayani ◽

Setyowati Setyowati ◽

Dwi Pudjonarko ◽

Dian Ratna Sawitri ◽

Hastaning Sakti ◽

...

Keyword(s):

Quality Of Life ◽

Functional Outcome ◽

Barthel Index ◽

Rating Scale ◽

Stroke Survivor ◽

Nursing Intervention ◽

Research Committee ◽

Post Stroke ◽

Post Stroke Depression

Background The Post Stroke Depression (PSD) prevalence of stroke survivor after three months onset was ranged from 17% to 37%. Depression led to fatigue, low quality of life, severe morbidity, and mortality. Functional Outcome influence depression on stroke survivor. However, correlation between functional state level and depression among stroke survivor after three months onset has not been established. ObjectiveThis study was aimed to investigate the correlation of executive functional outcome and PSD among stroke survivor after three months onset. MethodThis study was a correlation study. The participants were 44 stroke ischemic patients after three months onset. Participants were recruited in an outpatient unit. PSD was measured using The GRID-Hamilton Rating Scale for Depression 17 (GRID-HAMD 17) and Functional Outcome was measured using Barthel Index (BI). The reliability of GRID-HAMD 17 was .776. Both instruments were conducted on backward translation in to bahasa. Data was examined using simple linier regression analyses. The ethical approval was obtained from the Ethical Research Committee of the Medical Faculty Diponegoro University and Tugurejo Semarang Hospital. ResultsThe presence of PSD were 56.82. The median of HAMD-GRID-17 was 10.38 ± 7.58, and Barthel Index was 69.56 ± 21.69. The Barthel Index showed positive correlation with HAMD-GRID-17 (?= -.41 ?=.006). The Functional Outcome determined PSD as much as 16.8 %. ConclusionModerate association demonstrated the correlation between Functional Outcome and PSD. Nursing intervention should consider these two variables for an optimum quality of life among stroke survivors.

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