Peck Hoon is a PhD candidate at the Saw Swee Hock School of Public Health, National University of Singapore. She also holds a MPH in Clinical Epidemiology from the school, and trained as a physical therapist at the University of Sydney, Australia. As an experienced therapist who has work in different clinical areas, settings and countries, she has a keen interest in improving rehabilitation service delivery, and the management and outcome of patients, particularly those in the geriatric population. She has spearheaded several service improvements and changes, and has worked on clinical research projects from which findings have been published, and translated into clinical practice. In line with her interest, her PhD work focuses on exploring the effect of caregivers on outcomes in stroke survivors. When she’s not dispensing therapy advice, supporting people and good causes, or pouring over journal articles to prepare for her next research paper, Peck loves to be out: strolling, rambling or just sitting in a nice spot, whilst appreciating the beauty of being in the present moment.
Do Caregivers Affect Patient Outcomes in the First Year of Stroke?
Background and aims:
Stroke is a disabling condition. Commonly, stroke survivors live with residual disability and associated dependency. With the prevalence of stroke increasing due to population aging and advances in stroke management, caregiver support is decidedly vital in enabling the growing number of stroke survivors to remain in the community. Though caregivers are a group well-positioned to influence a patient’s recovery, there is surprisingly limited literature on whether they make a difference to patients’ outcomes, particularly beyond the subacute setting. Therefore, the aims of this study were to (i) examine the association between caregiver availability and a range of outcomes including patient cognition, depression level, function and quality of life, longitudinally in the first year post stroke; and (ii) ascertain whether caregiver identity makes difference among those with caregivers.
This was a one year, prospective, cohort study of 634 recent, stroke patients recruited from all tertiary hospitals in Singapore. Outcome measures included Mini-Mental State Exam, Center for Epidemiologic Studies Depression Scale, Modified Barthel Index, and EuroQol-5D. The exposures of interest were caregiver availability and identity, explored in separate models. Measurements were done at baseline, 3 months and 12 months post-stroke.
In our cohort, 89.0% (n=564) had identified primary caregivers, of which 56.6% were cared for by their spouses, 31.6% by their own children or parents, and 11.9% by other caregivers. All groups demonstrated changes in all outcomes over time, particularly in the first 3 months post stroke. In terms of the association between caregiver availability and the outcomes of interest, no significant between-group differences were found for all the outcomes at all time points measured (interaction effect all p> 0.05). Similarly, no significant differences in outcomes at all time points were demonstrated between the different caregiver identity groups.
Contrary to previous studies done in the subacute setting, stroke survivors without caregivers achieved similar physical, cognitive, mood and quality of life outcomes than those with caregivers in the first year of stroke. Caregiver identity was also not found to be associated with the outcomes studied. These results suggest that there are other factors that need to be considered when exploring the relationship between caregiver and long-term patient outcomes. As there is a growing reliance on caregivers in this aging population, future studies should continue to explore these relationships with more depth to identify the key, modifiable elements of caregivers and caregiving that can influence a patient’s recovery.