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At least 19 recordsLinked to original sources

PubMed2006

Caregiving in rural African American families for older adult stroke survivors.

Stroke disproportionately affects African Americans, but stroke caregiving research on this group is missing from the literature. The purpose of this grounded theory study was to examine rural African American family caregiving for older adult stroke survivors. Eight African American families participated in the study. The sample included 8 stroke survivors, 8 primary caregivers, and 18 secondary caregivers. Data were generated through interactive interviews and focused observations that took place in caregivers' or stroke survivors' homes. A multistep data analysis technique incorporating the constant comparative method was used to uncover the basic social psychological problem of transitions and a four-stage basic social process of striking a balance. The families coped with the transitions of stroke caregiving by using strategies termed here deciding to care, dividing care, protective care, and coming to terms. The substantive theory of caregiving provides nurses with a framework to help rural African American families care for their older relatives who have experienced stroke.

Adaptation, Psychological↗

PubMed2002

Measuring health outcomes in stroke survivors.

Stroke frequently results in psychologic distress and activity limitations across multiple domains of functioning. However, most stroke outcome measurement tools and clinical trial endpoints are narrowly focused on neurologic symptom status and physical aspects of functioning, and rarely assess other important components of health. In this article, I discuss the limitations in the measurement of nonfatal stroke outcomes; propose a minimum set of fundamental assessment domains comprising a comprehensive assessment of health status in stroke survivors; and describe the conceptual development of the Burden of Stroke Scale, a comprehensive, patient-reported measure of functioning and well-being for stroke survivors.

Cognition↗

PubMed2002

'Seeking': a key activity for new family carers of stroke survivors.

Stroke is one of the major causes of disability in the United Kingdom and considerable numbers of stroke survivors need help and support from family carers. The sudden and unexpected nature of stroke means that there is very little time for family members to prepare for a caring role. This paper draws on data from 37 interviews with 14 new carers of stroke survivors and highlights the uncertainty and lack of confidence that family members experience in adopting a caring role. During the initial period following the stroke carers engage in a number of different 'seeking' activities in order to try and ensure that they feel competent, confident and safe to provide care and that they understand the likely future demands they may face. Rather than being facilitated by staff, carers' efforts often go unnoticed or are overlooked, resulting in carers feeling that they are 'going it alone'. Staff need to be more aware of carers' 'seeking' behaviour and actively encourage the formation of partnerships with family members.

Adult↗

PubMed2006

Medial temporal atrophy rather than white matter hyperintensities predict cognitive decline in stroke survivors.

Stroke is an important risk factor for dementia, but the exact mechanisms involved in cognitive decline remain unclear. In this study, we related baseline MRI brain measures with later cognitive decline. Seventy-nine stroke survivors aged 75+ years without dementia were recruited 3-month post-stroke. They underwent yearly neuropsychological assessments and had an MRI at baseline and 2 years. Medial temporal lobe atrophy (MTA) was scored and volume of white matter hyperintensities (WMH) was measured at baseline. The rate of ventricular enlargement was measured by comparing the baseline and repeat images. Linear regression indicated that memory loss was related to both baseline memory and MTA (p=0.001; standardized regression coefficient beta=-0.35) but not WMH volume. The only independent predictor of ventricular enlargement was MTA (p=0.003; beta=0.47). However, no baseline MRI variable differed between those who did (18%) and did not (82%) develop dementia. The association of MTA but not WMH with subsequent cognitive decline and increasing brain atrophy suggests a greater role for Alzheimer type than vascular pathology in delayed cognitive impairment after stroke.

Aged↗

PubMed2005

Health-related quality of life of Turkish stroke survivors.

Stroke is a major, chronically disabling neurological disease, which often radically and permanently changes the lives of the victims. Improvement of motor coordination and the degree of independence achieved in activities of daily living have been the usual criteria used to measure outcome in stroke rehabilitation. The objective of our study is to compare health-related quality of life (HRQOL) between stroke patients 6 months after rehabilitation and a control group who did not have any major illness. The associations of several factors with the quality of life were also examined. Sixty consecutive stroke patients and 58 healthy control participants were included in the study. Functional independence measure (FIM), Nottingham health profile (NHP) and demographic variables were used as the main outcome measures. There were significant improvements in both motor coordination and functional status as measured by FIM at discharge and also 6 months after stroke and these variables were significantly associated with the HRQOL. The NHP, which is a validated quality-of-life measurement in Turkish patients, was used and the scores were compared with the healthy control participants. The scores of NHP domains (energy level, emotional reactions, sleep, social isolation and physical mobility) of the stroke patients were higher than those of the healthy group (P<0.01). Age, marital status, lesion side and multiple stroke history showed no significant correlation with NHP scores. Being a woman, lower educational status, tendency to depression and the presence of several comorbidities were significantly correlated with the NHP scores. Stroke survivors in our society have lower HRQOL than healthy individuals. HRQOL is correlated with the functional status in the stroke population. Additionally, the reduced HRQOL after stroke appears to be related to several demographic properties such as sex, education, comorbidities and psychological factors.

Adult↗

PubMed2004

Informal carers' experience of caring for stroke survivors.

BACKGROUND: Stroke is the third most common cause of death in industrialized countries and a major cause of adult disability. However, the burden of caring for stroke survivors usually rests with family members who have neither chosen nor volunteered for the role of 'carer'. AIMS: This paper reports on a study which aimed to describe the experience of caring for a stroke survivor at one year after stroke in Scotland. STUDY DESIGN: Semi-structured, taped interviews were conducted with 90 carers of stroke survivors one year after stroke and the data analysed using NUD*IST. The interviews were part of a larger study, which included the administration of a range of valid and reliable multidimensional instruments to both carers and stroke survivors. The interview prompt schedule had been developed and tested in a previous study. FINDINGS: Although a medical emergency, stroke was not always diagnosed or treated as such by either the public or general practitioners. Initially most carers found that they lacked the knowledge and skills to care for the stroke survivor at home and so they had to learn how to obtain the information and assistance required. Carers had to adapt to the changes that stroke effected in the stroke survivor and seek alternative ways of securing the resources they needed for managing their lives. They thought that they had not been prepared adequately for the caring role or assessed satisfactorily in terms of whether they could manage given their skill level, age and/or health status. CONCLUSIONS: A public health campaign to educate and inform that stroke is a medical emergency is required if stroke disability is to be minimized. The use of new technologies should be considered in facilitating carers' learning how to care. There is a need to test alternative models of stroke follow-up in multi-centre studies that are holistic and place the carer-stroke survivor at the centre of care.

Adaptation, Psychological↗

PubMed1999

Quality of life of stroke survivors.

Adaptation to stroke requires complex, long-term change in stroke survivors' lives. This study aimed at identifying those factors that influence quality of life (QOL) of geriatric stroke survivors 1-3 years post-discharge. The objectives were: to describe the overall quality of life of stroke survivors; to examine the relationships between sociodemographic variables, neurological variables, functional status, social support, perceived health status, depression, and overall QOL; and to determine the best predictors of QOL. Data were collected on 50 stroke survivors using a cross-sectional design and standardized questionnaires, including the Quality of Life Index, the Functional Independence Measure, the Social Support Inventory for Stroke Survivors and the Centre for Epidemiologic Studies Depression Scale. The overall quality of life of the study participants was low. The most important predictors of QOL were depression, marital status, quality of social support, and functional status. Depression was the strongest predictor of QOL. By employing a multi-dimensional perspective, this study confirmed that adaptation to stroke involves much more than physical function. Thus, rehabilitation programs for this group would be more effective if they are based upon a holistic approach.

Activities of Daily Living↗

PubMedDate not supplied

Caregiver perspectives of memory and behavior changes in stroke survivors.

Post-stroke memory and behavior changes (MBC) are associated with negative outcomes for stroke survivors and caregivers. This article describes the types of MBC that occur most frequently and caregivers' responses to these behaviors. Data were obtained through in-person interviews and administration of questionnaires to 132 caregivers of first-time stroke survivors 3-9 months after stroke. MBC were measured with a modified version of a Memory and Behavior Problems checklist. On average, caregivers reported 7.7 +/- 3.6 (range 0-17) behaviors. Common stroke survivor MBC included appearing sad or depressed, interrupting the caregiver, and being restless or agitated. These MBC were distressing to caregivers. Caregivers may not recognize some MBC as potential symptoms of depression. In addition, caregiver misunderstanding of the amount of control survivors may have over some behaviors has implications for rehabilitation and caregivers' responses to these changes.

Adult↗

PubMed1995

Psychosocial and health status in stroke survivors after 14 years.

BACKGROUND AND PURPOSE: Most studies of long-term survival and assessment of health status in survivors of stroke are hospital based and are often based only on a relatively short follow-up. This study was aimed at evaluating survival of acute stroke after 14 years. We also assessed psychosocial and health status among the long-term stroke survivors. METHODS: This study is a follow-up of the Finnish part of the collaborative World Health Organization Stroke Study that took place during 1972 through 1974. All survivors were interviewed by telephone after being sent a structured questionnaire approximately 14 years after the initial stroke attack. Information on clinical history, socioeconomic situation, self-reported functional capacity, psychosomatic status, perceived mental status, and perceived health was collected. RESULTS: Of the 1241 persons who had been entered in the stroke register from 1972 through 1974, 241 (19.4%) were still alive after 14 years. Participation rate in the telephone interview was 83.4%. Over 80% of all stroke survivors lived at home or with relatives at the time of interview. Functional capacity was good in about two thirds of the stroke survivors. Only 10% to 15% of all respondents felt depressed. About half of both men and women aged 64 years or younger perceived their health as good, while only 25% of men aged 65 years or over did. CONCLUSIONS: Most stroke survivors did not need institutionalized care in the long term. Although a large proportion of them suffered from various somatic diseases, their functional capacity was found to be good.

Activities of Daily Living↗

PubMed2001

Quality of life of stroke survivors: a research synthesis.

Stroke is the third leading cause of death and a major cause of disability in the United States. Individuals experiencing a completed stroke are faced with a multitude of challenges to restore their highest quality of life within the limitations of residual impairment. This research synthesis provides a summary of previous research on quality of life for stroke survivors. Research studies for inclusion in the review were identified by conducting a search of computerized databases through August 2000 and by using the ancestry method of reviewing reference lists from relevant publications. Thirty-nine studies were identified that focused on stroke survivors' quality of life during the recovery process. Stroke survivors' overall quality of life varied based on the country where the study was implemented. Variables positively associated with stroke survivors' quality of life were independence with activities of daily living, increased functional ability, social support, and healthcare resources. Variables negatively associated with stroke survivors' quality of life were psychological impairment, severity of impairment, severity of aphasia, inappropriate reactions to illness and pessimism, and inability to return to work. Specifically, 22% to 73% of the variance in stroke survivors' quality of life was primarily explained by presence of depression; functional ability, especially the upper extremities; and socialization, in particular, leisure activities. Implications for professional nursing practice to enhance stroke survivors' quality of life include encouraging independence, managing depression, and fostering interpersonal relationships. Areas for future research include longitudinal studies, rigorous psychometric assessment of quality of life instruments, and intervention studies.

Aged↗

PubMed2004

Medical complications experienced by a cohort of stroke survivors during inpatient, tertiary-level stroke rehabilitation.

OBJECTIVE: To identify the most common medical complications experienced by stroke survivors during inpatient, tertiary-level stroke rehabilitation. DESIGN: Prospective, descriptive analysis. SETTING: A tertiary-level, 23-bed, inpatient stroke rehabilitation unit in Nova Scotia, Canada. PARTICIPANTS: All stroke survivors (N=133) admitted for tertiary-level stroke rehabilitation during a 1-year period. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The attending physiatrist determined the presence or absence of specific complications during the interdisciplinary team conference held during the week of discharge for each patient. RESULTS: The 4 most common medical complications were depression (26%), shoulder pain (24%), falls (20%), and urinary tract infection (UTI) (15%). Other less common complications included back and hip pain (5%), gastrointestinal disturbances (4%), and pneumonia (2%). Seizures, pressure ulcers, and shoulder-hand syndrome each occurred in 1.5% of the population. CONCLUSIONS: Depression, shoulder pain, falls, and UTIs are common complications experienced by stroke survivors during inpatient rehabilitation. Heightened awareness of these potential complications may lead to prevention or to earlier recognition and improved management of these conditions.

Accidental Falls↗

PubMedDate not supplied

Medications, comorbidities, and medical complications in stroke survivors: the CAReS study.

Stroke survivors enter rehabilitation units with many medical comorbidities and often experience significant complications during their stays. The 97 stroke survivors discharged home in this study received prescriptionsfor a mean of 11.3 medications from 5.4 different drug classifications. There were significant correlations between the number of comorbidities and after stroke complications and the number of different classifications of drugs that were ordered. This article (1) identifies the types of medications prescribed for stroke survivors who are being discharged home from rehabilitation, (2) explores correlations between medication prescriptions and the number of stroke-related comorbidities and medical complications, (3) identifies the cost of medications and the potential effect of medication costs on stroke survivors, and (4) discusses the nurse's role in preparing stroke survivors and their caregivers for medication use after discharge. Rehabilitation nurses bear the major responsibility for teaching stroke survivors and their caregivers about their discharge medications.

Aged↗

PubMed1998

Dependence and perceived difficulty in daily activities in community-living stroke survivors 2 years after stroke: a study of instrumental structures.

BACKGROUND AND PURPOSE: There is a need for better understanding of the structure of instruments for functional outcome assessment after discharge from rehabilitation. One purpose of the study was to contribute to the analysis of instrumental dimensionality. Another purpose was to compare disability in stroke patients within the younger age range 2 years after onset of stroke with that at discharge with respect to both dependence and patients' perceived difficulty and to extend the assessments with instrumental activities. METHODS: We studied 68 stroke survivors aged 18 to 71 years at onset (59% aged <55 years) by means of interviews in their home, using activities from the Functional Independence Measure (FIM) and Instrumental Activity Measure (IAM) for ratings of dependence and perceived difficulty. Rasch analysis was used to construct calibrated linear measures and to evaluate the level of fit. RESULTS: Acceptable models for comparison of dependence between discharge and follow-up were found for the physical and the social-cognitive items in FIM. However, personal care and social-cognitive items showed an increased level of dependence at follow-up compared with at discharge. A combination of physical activities from FIM and IAM also gave acceptable models for both dependence and perceived difficulty, and the hierarchical orders of activities are presented. In general, there was agreement between the ratings of dependence and perceived difficulty, but with some discrepancies. Men found it harder to be independent in such instrumental activities as cooking and cleaning than women; the opposite was true for small-scale shopping and locomotion outdoors. Subjects aged > or =55 years had slightly higher level of dependence and perceived difficulty in IAM activities than those below that age. CONCLUSIONS: Changes in the hierarchical order of activities should be taken into account in follow-up studies. Differences in the environment between hospital and home, as well as differences in support and motivation, might explain the relatively larger degree of dependence at follow-up compared with at discharge and indicate the need for further rehabilitation efforts. Instrumental activities could be combined with FIM activities in a model. For individual items, ratings of both dependence and perceived difficulty may provide further insight into the disablement process.

Activities of Daily Living↗

PubMed2005

Differences in disability among black and white stroke survivors--United States, 2000-2001.

Stroke is a leading cause of serious, long-term disability in the United States and was responsible for an estimated 53.6 billion dollars in direct and indirect costs during 2004. Stroke survivors can experience residual physical, psychological, and social impairment; nearly 45% of all stroke survivors aged > or =65 years have moderate or severe disability. Furthermore, persons in certain racial/ethnic populations experience disparities in stroke-related disability. To assess the prevalence of functional limitations among U.S. adult stroke survivors and to examine potential racial/ethnic disparities in stroke-related disability, CDC analyzed National Health Interview Survey (NHIS) data from 2000-2001. The results of this analysis indicated that black stroke survivors had greater activity limitations than white stroke survivors. To increase the quality and length of life among stroke survivors and to eliminate disparities in stroke incidence, greater efforts are needed to implement stroke prevention and intervention activities among black populations, particularly young to middle-aged adults. Increasing public awareness of stroke-related warning signs and encouraging patients to seek immediate treatment might reduce stroke-related disabilities and costs.

Activities of Daily Living↗

PubMed2000

Quality of life among stroke survivors evaluated 1 year after stroke: experience of a stroke unit.

BACKGROUND AND PURPOSE: We sought to study overall and domain-specific quality of life in stroke survivors 1 year after stroke and to identify variables that could predict quality of life after stroke. METHODS: We followed up for 1 year a cohort of 118 patients consecutively admitted to our stroke unit at San Carlos University Hospital in Madrid, Spain. The final series at 1-year follow-up consisted of 90 survivors (41 women and 49 men; mean age, 68 years; range, 32 to 90 years). A cross-sectional, descriptive design was developed. Patients completed a questionnaire that included socioeconomic variables, Hamilton Rating Scale for Depression, Sickness Impact Profile (SIP), Short Form 36, Frenchay Index, Barthel Index, Rankin Scale, and Scandinavian Stroke Scale. Independent variables were sex, age, functional status, motor impairment, and depression. We developed an ANOVA model for statistical analysis. RESULTS: We interviewed 79 patients with ischemic and 11 with hemorrhagic stroke. Thirty-eight percent of patients scored in the depressed range. Variables related to depression were status as a housewife, female sex, inability to work because of disability, and diminished social activity (P:<0.0001). Mean total SIP (24.3), SIP psychosocial dimension (27.5), and SIP physical dimension (21.2) were correlated with disability, female sex, motor impairment, and depression (P:<0.0001). CONCLUSIONS: Functional status and depression were identified as predictors of quality of life. Patients independent in their activities of daily living suffered from a deterioration of the psychosocial dimension of the SIP.

Activities of Daily Living↗

PubMed1990

Dementia in stroke survivors in the Stroke Data Bank cohort. Prevalence, incidence, risk factors, and computed tomographic findings.

We determined the prevalence of dementia in 927 patients with acute ischemic stroke aged greater than or equal to 60 years in the Stroke Data Bank cohort based on the examining neurologist's best judgment. Diagnostic agreement among examiners was 68% (kappa = 0.34). Of 726 testable patients, 116 (16%) were demented. Prevalence of dementia was related to age but not to sex, race, handedness, educational level, or employment status before the stroke. Previous stroke and previous myocardial infarction were related to prevalence of dementia although hypertension, diabetes mellitus, atrial fibrillation, and previous use of antithrombotic drugs were not. Prevalence of dementia was most frequent in patients with infarcts due to large-artery atherosclerosis and in those with infarcts of unknown cause. Computed tomographic findings related to prevalence of dementia included infarct number, infarct site, and cortical atrophy. Among 610 patients who were not demented at stroke onset, we used methods of survival analysis to determine the incidence of dementia occurring during the 2-year follow-up. Incidence of dementia was related to age but not sex. Based on logistic regression analysis, the probability of new-onset dementia at 1 year was 5.4% for a patient aged 60 years and 10.4% for a patient aged 90 years. With a multivariate proportional hazards model, the most important predictors of incidence of dementia were a previous stroke and the presence of cortical atrophy at stroke onset.

Aged↗

PubMed2005

Upper limb recovery after stroke: the stroke survivors' perspective.

PURPOSE: This study investigated stroke survivors' perspective of upper limb recovery after stroke. The aim was to determine factors other than medical diagnosis and co-morbidities that contribute to recovery. The objectives were to explore how stroke survivors define recovery, identify factors they believe influence recovery and determine strategies used to maximize upper limb recovery. METHOD: A qualitative study consisting of three focus groups and two in-depth interviews was conducted with stroke survivors (n = 19) and spouses (n = 9) in metropolitan, regional and rural Queensland, Australia. Data were analysed using principles of grounded theory. RESULTS: Stroke survivors maximize upper limb recovery by 'keeping the door open' a process of continuing to hope for and work towards improvement amidst adjusting to life with stroke. They achieve this by 'hanging in there', 'drawing on support from others', 'getting going and keeping going with exercise', and 'finding out how to keep moving ahead'. CONCLUSIONS: This study provides valuable insight into the personal experience of upper limb recovery after stroke. It highlights the need to develop training strategies that match the needs and aspirations of stroke survivors and that place no time limits on recovery. It reinforces the benefits of stroke support groups and advocates their incorporation into stroke recovery services. These findings can be used to guide both the development and evaluation of stroke survivor centred upper limb training programmes.

Adult↗

PubMed2004

Time and difficulty of tasks provided by family caregivers of stroke survivors.

Family caregivers of stroke survivors are at risk for negative health outcomes such as depression, psychosocial impairments, and even mortality as a result of providing care. Shortened hospital stays have contributed to the urgent need for caregivers to manage difficult and time-consuming tasks required for the care of stroke survivors in the home setting. The purposes of this study were to (a) identify which tasks were perceived as most time-consuming and difficult, (b) determine which of these tasks were most predictive of mood and other negative caregiver outcomes, and (c) evaluate the psychometric properties of the Oberst Caregiving Burden Scale (OCBS) as a measure of tasks in stroke caregivers. A cross-sectional design was employed using mailed questionnaires from 116 family caregivers of stroke survivors featuring the OCBS, the Profile of Mood States Short Form, and the Bakas Caregiving Outcomes Scale. The tasks perceived as most time-consuming and difficult, which also were predictive of mood and other negative caregiver outcomes, were managing finances, managing behaviors, and providing emotional support. Strong psychometric properties of the OCBS were found at both item and subscale levels. Developing an individual profile using the OCBS items may help to target individual support interventions for caregivers. Suggested interventions include referring caregivers to resources for tasks that fall outside the scope of nursing practice, supporting caregivers with tasks such as providing emotional support or managing behavioral problems, and encouraging caregivers to seek care for their own physical, emotional, or social needs.

Adult↗