BACKGROUND/RATIONALE:
Stroke is the leading cause of serious long-term disability in the United States (US), with over 4 million people living with the effects of stroke. Approximately 80,000 veterans are stroke survivors and it is estimated that between 9,000-11,000 veterans are hospitalized each year with a new stroke. Approximately 80% of stroke survivors are discharged home and live for at least five years post stroke, shifting a large amount of continuing care to informal caregivers.

OBJECTIVE(S):
The specific aims of the study were to (1) determine the relationships between veteran and caregiver characteristics, and positive and negative responses to stroke caregiving; and (2) identify predictors of caregivers' HRQoL and the desire to institutionalize veterans post stroke.

METHODS:
This two-year study used telephone survey methodology to obtain data from veteran stroke survivors and their informal caregivers. A Waiver of Authorization was obtained to contact veterans using the Functional Status and Outcomes Database (FSOD). The Physical Medicine and Rehabilitation Office (PM&R), which maintains the FSOD, identified and contacted the veterans and caregivers to obtain permission for participation in the survey. Veteran participants and their informal caregivers provided consent prior to participating in the telephone survey. The contact information for 400 veteran/caregiver dyads was sent to the University of Florida Survey Research Center (UFSRC).

FINDINGS/RESULTS:
The following provides a summary of the findings: Caregiver race, relationship to veteran and caregiver living situation were significant predictors of positive aspects (PA) of caregiving, a little studied aspect of caregiving. Non-white caregivers, caregivers who did not live with the veteran and spousal caregivers reported higher PA. Predictors of depression included caregiver race and total activities of daily living (ADL). Caregivers of veterans with higher ADL scores were 1.18 times more likely to report depression than caregivers with lower ADL. Veteran age, total ADL and caregiver employment status were predictors of caregiver injury. Social support moderated the relationship between PA of caregiving and caregiver's relationship to the veteran. The difference between race and social support was highly significant among those reporting depression. Caregivers who were female, older, and unemployed reported poorer general health (GH) compared to male caregivers, younger caregivers, and employed caregivers, respectively. After controlling for caregiver age, sex, and employment status, PA was not a significant predictor of GH. However, after controlling for caregiver age, sex and employment status, caregiver depression was a significant predictor of GH. Those reporting depression were 4.37 times more likely to have poorer GH than caregivers who did not report depression. Desire to institutionalize (DI) veterans post stroke was greater for white caregivers and working caregivers compared to non-white caregivers and unemployed caregivers, respectively. After controlling for caregiver race and employment status, PA was not a significant predictor of DI. Additionally, after controlling for caregiver race and employment status, caregiver depression, burden and injuries were not significant predictors of DI.

IMPACT:
Informal caregivers of veterans post stroke experience significant negative responses including high levels of depression, burden, and injuries. Results indicate that social support may be an important factor in sustaining caregivers especially for female caregivers. Injuries are a concern for older caregivers and those caring for veterans with higher ADL impairment. White caregivers are twice as likely to be depressed than non-white caregivigers and treatment may be needed. Veterans with white caregivers who work may be at higher risk for instituionalization. White caregivers of veterans post stroke need to be screened for depression and interventions should be aimed at preventing injuries and increasing social support, and health promoting behaviors.

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External Links for this Project

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PUBLICATIONS:

Journal Articles

1. Perrin PB, Heesacker M, Hinojosa MS, Uthe CE, Rittman MR. Identifying at-risk, ethnically diverse stroke caregivers for counseling: a longitudinal study of mental health. Rehabilitation Psychology. 2009 May 1; 54(2):138-49. [view]
2. Rittman MR, Sberna Hinojosa M, Findley K. Subjective Sleep Experience, Burden, Depression, and Health of Stroke Caregivers. The Journal of Neuroscience Nursing. 2009 Feb 1; 41(1):39-52. [view]
3. Dobbs D, Hayes J, Chapin R, Oslund P. The relationship between psychiatric disorders and the ability to age in place in assisted living. The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry. 2006 Jul 1; 14(7):613-20. [view]

Conference Presentations

1. Uphold CR, Van Puymbroeck AM, Sberna M, Rittman MR, Williams LS. Predictors of Positive Aspects of Caregiving and Depression Among Informal Caregivers of Stroke Survivors. Paper presented at: American Geriatrics Society Annual Meeting; 2007 May 4; Seattle, WA. [view]

DRA: Health Systems
DRE: Treatment - Observational
Keywords: Caregivers – not professionals, Home care, Stroke
MeSH Terms: none