Ethnic Differences in Informal Caregiving After Stroke

Stroke ◽  
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.

Abstract TMP44: Ethnic Differences in Informal Caregiving After Stroke: The Brain Attack Surveillance in Corpus Christi (BASIC) Project

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Cecilia N Hollenhorst ◽  
Lynda D Lisabeth ◽  
Linda C Gallo ◽  
Chia-Wei Hsu ◽  
Sehee Kim ◽  
...  
Keyword(s):  
Marital Status ◽  
Ethnic Differences ◽  
Mexican Americans ◽  
Stroke Care ◽  
Informal Caregiving ◽  
Population Based ◽  
Chi Square ◽  
Population Based Study ◽  
Corpus Christi ◽  
Occupational Goals

Background and Aims: We studied informal (non-paid) caregiving after stroke in a population-based study to determine if differences occurred between Mexican Americans (MAs) and non-Hispanic whites (NHWs). MAs are a less affluent population than NHWs. Family members who provide caregiving may need to interrupt educational and occupational goals to provide this care, which may perpetuate socioeconomic disparities between minority and majority populations. Methods: Between October, 2014 and December, 2016, stroke subjects in Texas, USA, were interviewed 90 days after stroke to determine if family or friends provided informal, unpaid caregiving, and for which activities of daily living (ADLs) they required help. Chi-square tests were used to assess the association of ethnicity and whom provided the caregiving, as well as ethnicity and the ADLs for which they required help. Ethnic differences between MAs and NHWs in receiving informal caregiving were determined using logistic regression. The odds ratio (OR, 95% CI) is reported with NHW as the referent group. Results: 473 subjects answered the caregiving questions. There were no significant differences among the two ethnic groups with respect to age, sex, NIHSS score, marital status, or insurance. MAs were more likely to require help compared with NHWs for walking (p=0.0008), bathing (p=0.0004), hygiene (p=0.0018), eating (p=0.0059), dressing (p<0.0001), moving (p=0.0015) and toileting (p=0.0007). Among all subjects, 144 (30%) received informal caregiving (35% of 300 MAs versus 22% of 173 NHWs). There were no significant ethnic differences among which family member provided the caregiving. MAs were more likely to have informal caregiving OR=1.87 (95% CI 1.11-3.13) adjusted for age, sex, NIHSS, education, insurance and marital status. Conclusions: In this population-based study, MAs required more help than NHWs for assistance with ADLs, and MAs were more likely to receive this help through informal, unpaid caregiving than NHWs. Efforts to help minority and low-resource populations provide stroke care are needed.

scholarly journals Factors related to post-stroke depression during the first 2 weeks after stroke

2020 ◽  
Vol 84 (1) ◽  
pp. 15-21
Author(s):  
Wataru Mitsunaga ◽  
Toshio Higashi ◽  
Takefumi Moriuchi ◽  
Masahiko Koyanagi ◽  
Yuuichirou Honda ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Activities Of Daily Living ◽  
Daily Living ◽  
Rating Scale ◽  
Functional Independence ◽  
Stroke Severity ◽  
Post Stroke ◽  
Assessment Scores ◽  
Scale Scores ◽  
Post Stroke Depression

Introduction This study aimed to clarify factors associated with post-stroke depression in patients with acute stroke within 2 weeks of onset. Method Eighty-eight patients with stroke were divided into post-stroke depression ( n = 49) and non-post-stroke depression ( n = 39) groups based on their Hamilton Depression Rating Scale scores. We evaluated stroke severity, upper limb function, activities of daily living, frontal lobe/cognitive function, and level of apathy. Activity levels were measured using an ActiGraph GT9X Link system. Mann–Whitney U-tests were used to determine differences between the two groups. Spearman’s rank correlation and logistic regression analyses were also performed. Results The post-stroke depression and non-post-stroke depression groups exhibited significant differences in National Institutes of Health Stroke Scale scores at admission and discharge; Functional Independence Measure exercise items, cognitive items, and total items at admission; Fugl-Meyer Assessment scores; and Apathy Rating Scale scores. Logistic regression indicated that Fugl-Meyer Assessment scores were associated with post-stroke depression. Conclusion Stroke severity, paralysis, and physical function/activities of daily living ability are associated with post-stroke depression in the acute phase. Our findings suggest that increases in physical impairment severity are associated with increased post-stroke depression risks. Rehabilitation professionals should focus on identifying post-stroke depression in early post-stroke stages.

A Longitudinal Study of Cognitive and Instrumental Activities of Daily Living Disablement Among the Oldest Mexican Americans

2021 ◽  
pp. 089826432110375
Author(s):  
Jiwon Kim ◽  
Jacqueline L. Angel ◽  
Sunshine M. Rote
Keyword(s):  
Activities Of Daily Living ◽  
Cognitive Decline ◽  
Mexican Americans ◽  
Daily Living ◽  
Oldest Old ◽  
Epidemiologic Study ◽  
Mobility Limitations ◽  
Limited Mobility ◽  
Community Activities ◽  
Instrumental Activities

Objectives Mexican Americans live longer on average than other ethnic groups, but often with protracted cognitive and physical disability. Little is known, however, about the role of cognitive decline for transitions in instrumental activities of daily living (IADL) disability and tertiary outcomes of the IADL disablement for the oldest old (after 80 years old). Methods We employ the Hispanic Established Populations for the Epidemiologic Study of the Elderly (2010–2011, 2012–2013, and 2016, N = 1,078) to investigate the longitudinal patterns of IADL decline using latent transition analysis. Results Three IADL groups were identified: independent (developing mobility limitations), emerging dependence (limited mobility and community activities), and dependent (limited mobility and household and community activities). Declines in cognitive function were a consistent predictor of greater IADL disablement, and loneliness was a particularly salient distal outcome for emerging dependence. Discussion These results highlight the social consequences of cognitive decline and dependency as well as underscore important areas of intervention at each stage of the disablement process.

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

Stroke ◽  
2001 ◽  
Vol 32 (suppl_1) ◽  
pp. 326-326
Author(s):  
Susan L Hickenbottom ◽  
Kenneth M Langa ◽  
Jeffrey S Kutcher ◽  
Mohammed U Kabeto ◽  
A. M Fendrick ◽  
...  
Keyword(s):  
Informal Care ◽  
Annual Cost ◽  
The Elderly ◽  
Informal Caregiving ◽  
National Study ◽  
Stroke Severity ◽  
Stroke Patients ◽  
Stroke Incidence ◽  
Stroke Treatment ◽  
The Us

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.

scholarly journals Racial/ethnic differences in activities of daily living disability in older adults with arthritis: A longitudinal study

2007 ◽  
Vol 57 (6) ◽  
pp. 1058-1066 ◽  
Author(s):  
Jing Song ◽  
Huan J. Chang ◽  
Manasi Tirodkar ◽  
Rowland W. Chang ◽  
Larry M. Manheim ◽  
...  
Keyword(s):  
Older Adults ◽  
Longitudinal Study ◽  
Activities Of Daily Living ◽  
Ethnic Differences ◽  
Daily Living ◽  
Racial Ethnic

Polyneuropathy relates to impairment in daily activities, worse gait, and fall-related injuries

Neurology ◽  
2017 ◽  
Vol 89 (1) ◽  
pp. 76-83 ◽  
Author(s):  
Rens Hanewinckel ◽  
Judith Drenthen ◽  
Vincentius J.A. Verlinden ◽  
Sirwan K.L. Darweesh ◽  
Jos N. van der Geest ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Linear Regression ◽  
Activities Of Daily Living ◽  
Daily Living ◽  
Health Assessment ◽  
Population Based ◽  
Daily Activities ◽  
Instrumental Activities ◽  
Gait Parameters ◽  
History Of

Objective:To extensively investigate the association of chronic polyneuropathy with basic and instrumental activities of daily living (BADL and IADL), falls, and gait.Methods:A total of 1,445 participants of the population-based Rotterdam Study (mean age 71 years, 54% women) underwent a polyneuropathy screening involving a symptom questionnaire, neurologic examination, and nerve conduction studies. Screening yielded 4 groups: no, possible, probable, and definite polyneuropathy. Participants were interviewed about BADL (Stanford Health Assessment questionnaire), IADL (Instrumental Activities of Daily Living scale), and frequency of falling in the previous year. In a random subset of 977 participants, gait was assessed with an electronic walkway. Associations of polyneuropathy with BADL and IADL were analyzed continuously with linear regression and dichotomously with logistic regression. History of falling was evaluated with logistic regression, and gait changes were evaluated with linear regression.Results:Participants with definite polyneuropathy had more difficulty in performing BADL and IADL than participants without polyneuropathy. Polyneuropathy related to worse scores of all BADL components (especially walking) and 3 IADL components (housekeeping, traveling, and shopping). Participants with definite polyneuropathy were more likely to fall, and these falls more often resulted in injury. Participants with polyneuropathy had worse gait parameters on the walkway, including lower walking speed and cadence, and more errors in tandem walking.Conclusions:Chronic polyneuropathy strongly associates with impairment in the ability to perform daily activities and relates to worse gait and an increased history of falling.

The Association Between Handgrip Strength and Diabetes on Activities of Daily Living Disability in Older Mexican Americans

2017 ◽  
Vol 30 (8) ◽  
pp. 1305-1318 ◽  
Author(s):  
Ryan P. McGrath ◽  
Brenda M. Vincent ◽  
Soham Al Snih ◽  
Kyriakos S. Markides ◽  
Brad P. Dieter ◽  
...  
Keyword(s):  
Body Weight ◽  
Confidence Interval ◽  
Activities Of Daily Living ◽  
Grip Strength ◽  
Muscle Weakness ◽  
Mexican Americans ◽  
Daily Living ◽  
Handgrip Strength ◽  
Joint Effects ◽  
Adl Disability

Objective: The aim of this study is to determine the independent and joint effects of muscle weakness and diabetes on incident activities of daily living (ADL) disability in older Mexican Americans. Method: A subsample of 2,270 Mexican Americans aged at least 65 years at baseline were followed for 19 years. Handgrip strength was normalized to body weight (normalized grip strength [NGS]). Weakness was defined as NGS ≤0.46 in males and ≤0.30 in females. Diabetes and ADL disability were self-reported. Results: Compared with participants that were not weak and did not have diabetes, those that had diabetes only, were weak only, and were both weak and had diabetes experienced a 1.94 (95% confidence interval [CI] = [1.89, 1.98]), 1.17 (CI = [1.16, 1.19]), and 2.12 (CI = [2.08, 2.16]) higher rate for ADL disability, respectively. Discussion: Muscle weakness and diabetes were independently and jointly associated with higher rates for ADL disability in older Mexican Americans.

Instrumental activities of daily living performance in healthy and cognitively intact seniors from a Brazilian sample and its relation to age and other socio-demographic variables

2012 ◽  
Vol 24 (5) ◽  
pp. 784-793 ◽  
Author(s):  
Pedro Fonseca Zuccolo ◽  
Renata Ávila ◽  
Eduardo Y. Nakano ◽  
Júlio Litvoc ◽  
Marcos A. Lopes ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Older People ◽  
Activities Of Daily Living ◽  
Functional Capacity ◽  
Daily Living ◽  
Demographic Variables ◽  
Community Dwelling ◽  
Medical Conditions ◽  
Instrumental Activities ◽  
Cognitively Intact

ABSTRACTBackground: Studies on functional capacity in community-dwelling older people have shown associations between declines in instrumental activities of daily living (IADL) and several factors. Among these, age has been the most consistently related to functional capacity independent of other variables. We aimed at evaluating the performance of a sample of healthy and cognitively intact Brazilian older people on activities of daily living and to analyze its relation to social-demographic variables.Methods: We conducted a secondary analysis of data collected for previous epidemiological studies with community-dwelling subjects aged 60 years or more. We selected subjects who did not have dementia or depression, and with no history of neurological diseases, heart attack, HIV, hepatitis or arthritis (n = 1,111). Functional capacity was assessed using the Brazilian version of the Older American Resources and Services Questionnaire (BOMFAQ). ADL performance was analyzed according to age, gender, education, and marital status (Pearson's χ2, logistic regression).Results: IADL difficulties were present in our sample, especially in subjects aged 80 years or more, with lower levels of education, or widowed. The logistic regression analysis results indicated that “higher age” and “lower education” (p ≤ 0.001) remained significantly associated with IADL difficulty.Conclusions: Functional decline was present in older subjects even in the absence of medical conditions and cognitive impairment. Clinicians and researchers could benefit from knowing what to expect from older people regarding IADL performance in the absence of medical conditions.

scholarly journals Frailty and incidence of activities of daily living disability among older Mexican Americans

2009 ◽  
Vol 41 (11) ◽  
pp. 892-897 ◽  
Author(s):  
S Al Snih ◽  
JE Graham ◽  
LA Ray ◽  
R Samper-Ternent ◽  
KS Markides ◽  
...  
Keyword(s):  
Activities Of Daily Living ◽  
Mexican Americans ◽  
Daily Living
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