Sharon K. Ostwald

Stress Experienced by Stroke Survivors and Spousal Caregivers During the First Year After Discharge from Inpatient Rehabilitation

Abstract Purpose: This study describes levels of stress in stroke survivors and spousal caregivers and identifies predictors of stress in couples during their first year at home. Method: The Perceived Stress Scale (PSS) was administered to 159 stroke survivors and caregivers at discharge and at 3, 6, 9, and 12 months. Other variables tested included stroke survivor function (FIM™), health status, mutuality, stroke impact (SIS), caregiver coping (F-COPES), support (MOS Social Support Survey), and preparedness. Repeated measures analyses of PSS scores were conducted with linear mixed models for stroke survivors and caregivers. Results: PSS scores for stroke survivors and caregivers were positively correlated (p < .01). Scores decreased significantly over the year, but caregivers had higher scores initially and decreased less. Stroke survivor function was a significant predictor of stress for both survivors and caregivers. Preparation was the most powerful predictor of stress in caregivers, whereas mutuality was the strongest predictor for stroke survivors. Good health, social support, and coping were associated with less stress. Conclusions: Stress is increased by poor function and mediated by internal and external buffers including health, the dyadic relationship, coping ability, and social support. More research using a dyadic research approach is needed to better understand stress within couples.

Predictors of Life Satisfaction in Stroke Survivors and Spousal Caregivers After Inpatient Rehabilitation

&NA; A global measure of life satisfaction has become increasingly important as an adjunctive outcome of healthcare interventions for people with disabilities, including those caused by stroke. Life satisfaction of stroke survivors may affect caregiving spouses, as well. The purpose of this study was to identify, among many physical and psychosocial variables, specific variables that were associated with life satisfaction at 12 months after discharge from inpatient rehabilitation, and variables that were predictive of life satisfaction 1 year later (at 24 months). Between 12 and 24 months, life satisfaction decreased for stroke survivors, while it increased for caregiving spouses. The relationship between the couple (mutuality) was the only variable that was a significant predictor of life satisfaction for both stroke survivors and their spouses.

Long-term health-related quality of life of stroke survivors and their spousal caregivers.

ABSTRACTBecause treatment for stroke has improved, individuals are living longer with the effects of a stroke. The resulting long-term impairment can affect both stroke survivors’ and their caregivers’ health-related quality of life (HRQOL). Few studies have examined the HRQOL of stroke survivors and their caregivers greater than 2 years poststroke. The stroke survivors and their spousal caregivers (n = 30 dyads) who had previously completed a 12-month study after discharge from inpatient rehabilitation were assessed at 3–5 years poststroke. The HRQOL and related outcomes were measured for stroke survivors and caregivers. Data from baseline to 12 months were used in conjunction with data from this study. Linear mixed models were used to analyze the change in repeated measures over time. Multiple linear regression was used to analyze the relationship of generic HRQOL to related psychosocial outcomes. The stroke survivors were an average of 4.68 years poststroke. The mean age for stroke survivors and caregivers was 70.8 and 64.9 years, respectively. Most stroke survivors were men (80%) and non-Hispanic White (70%). Among stroke survivors, depression decreased from baseline to 12 months (p = .04) but increased from 12 months to the end of follow-up (p = .003). The caregivers’ depression decreased from baseline to all time points (p = .015). Stroke-specific HRQOL showed statistically significant (p < .03) decreases between 12 months and end of follow-up. Increased number of illnesses and older age were associated with caregivers’ lower physical HRQOL score (p = .004). Higher depression was associated with lower mental HRQOL score for both caregivers and stroke survivors (p = .003 and p = .011, respectively). Both stroke survivors and caregivers continue to experience negative stroke-related health outcomes for many years after the initial stroke; some of these outcomes even worsen over time. These findings illustrate the need for ongoing psychological and medical evaluation for both long-term stroke survivors and caregivers. Development and testing of targeted behavioral interventions are also warranted.

Years of life with good and poor mental and physical function in the elderly

A population of Roman Catholic sisters (nuns) were divided into a high education group (i.e. at least a Bachelors degree) and a low education group (i.e. less than a Bachelors degree). Prevalence data on 132, 75-94 year old, sisters indicated that the high-educated had better mobility and hand coordination, stronger handgrip, better distant and near visual acuity, and fewer mental impairments than the low-educated group. Life table analyses on 154 sisters indicated that the high-educated lived an average of 3.28 years longer after age 75 than the low-educated. Years of life with relatively good and poor mental and physical function after age 75 were estimated by a mathematical model that used mortality and prevalence data. According to the model, high-educated sisters lived an average of 3.57 years longer with good function and 0.29 of a year less with poor function than low-educated sisters.

Medications, Comorbidities, and Medical Complications in Stroke Survivors: The CAReS Study

&NA; 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 prescriptions for 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 nurses 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.

Evidence-based educational guidelines for stroke survivors after discharge home.

Stroke survivors today are discharged home from the hospital more quickly than in the past because of shifting economic realities. Survivors continue to experience significant impairments after discharge and families may be poorly prepared for the full extent of caregiving responsibilities. This article describes 39 comprehensive educational guidelines that have been tested with 72 stroke survivors and families during 1,150 home visits throughout the first 6 months after discharge from inpatient rehabilitation. Two case studies illustrate use of the guidelines with stroke survivors and their families.

The longitudinal and dyadic effects of mutuality on perceived stress for stroke survivors and their spousal caregivers

Objective: Functional impairment resulting from a stroke frequently requires the care of a family caregiver, often the spouse. This change in the relationship can be stressful for the couple. Thus, this study examined the longitudinal, dyadic relationship between caregivers’ and stroke survivors’ mutuality and caregivers’ and stroke survivors’ perceived stress. Method: This secondary data analysis of 159 stroke survivors and their spousal caregivers utilized a cross-lagged, mixed models analysis with the actor–partner interdependence model to examine the dyadic relationship between mutuality and perceived stress over the first year post-discharge from inpatient rehabilitation. Results: Caregivers’ mutuality showed an actor effect (β = −3.82, p < 0.0001) but not a partner effect. Thus, caregivers’ mutuality influenced ones own perceived stress but not the stroke survivors’ perceived stress. Stroke survivors’ perceived stress showed a partner effect and affected caregivers’ perceived stress (β = 0.13, p = 0.047). Caregivers’ perceived stress did not show a partner effect and did not significantly affect stroke survivors’ perceived stress. Conclusion: These findings highlight the interpersonal nature of stress in the context of caregiving for a spouse. Caregivers are especially influenced by perceived stress in the spousal relationship. Couples should be encouraged to focus on positive aspects of the caregiving relationship to mitigate stress.

Cost associated with stroke: outpatient rehabilitative services and medication.

Abstract Purpose: This study aimed to capture direct costs of outpatient rehabilitative stroke care and medications for a 1-year period after discharge from inpatient rehabilitation. Methods: Outpatient rehabilitative services and medication costs for 1 year, during the time period of 2001 to 2005, were calculated for 54 first-time stroke survivors. Costs for services were based on Medicare reimbursement rates. Medicaid reimbursement rates and average wholesale price were used to estimate medication costs. Results: Of the 54 stroke survivors, 40 (74.1%) were categorized as independent, 12 (22.2%) had modified dependence, and 2 (3.7%) were dependent at the time of discharge from inpatient rehabilitation. Average cost for outpatient stroke rehabilitation services and medications the first year post inpatient rehabilitation discharge was

The stress of dementia: View from the inside

17,081. The corresponding average yearly cost of medication was

Who Is caring for the caregiver? Promoting spousal caregiver's health.

5,392, while the average cost of yearly rehabilitation service utilization was