Health Services Research
Rehospitalizations post-stroke are frequent, and often the emphasis is placed on stroke patient characteristics like age, functional status, stroke severity as potential determinants. However, it is important to acknowledge that stroke is a life changing event, not just for the patient but also for their family caregivers. A family caregiver can be a spouse, sibling, adult-child, distant family, or friends who provide care for the stroke patient. With competing work, familial, and personal obligations, an imbalance often occurs in the family caregiver’s capacity to care, and the caregiving demands leading to caregiver role strain and the potential ripple effect on stroke patient outcomes. Therefore, it is important to study post-stroke rehospitalization from a dyadic perspective, including both caregiver and patient factors. Very few studies, if any, adopted a dyadic perspective in studying rehospitalization post-stroke, with co-residing status, caregiver burden, and social support as the main caregiver characteristics explored.
In this presentation, we will explore the association of both caregiver and stroke patient factors with post-stroke rehospitalizations in an Asian setting. We recruited stroke patients and their caregivers from tertiary hospitals after the index stroke episode and prospectively followed them for one year, collecting clinical, social, and financial information via face-to-face or telephone interviews at regular intervals. We extracted the data on hospitalizations from the national claims database. We analysed 256 stroke patient and caregiver dyads and found both patient (e.g., recurrent stroke) and caregiver factors (e.g., social support in the form of paid helpers, caregiver burden, etc.) were associated with rehospitalizations after stroke. We will share our results in the presentation, along with preliminary findings from our follow-up qualitative study to expand our understanding and knowledge gained from the quantitative analysis. We will discuss the implications of our findings, reiterate the relevance of adoption of stroke patient-caregiver dyadic approach to studying healthcare utilization and elaborate on some of the practical implications from our work.
Objective : To study the association of caregiver factors and patient factors with post-stroke hospitalizations in an Asian setting.
Design : Cohort study with a yearlong follow-up. Data was collected via face-to-face or telephone interviews over 3-monthly intervals. Follow-up was 65.5% at 3-months.
Setting : Hospitalized care and general community.
Participants (or Animals, Specimens, Cadavers):
Consecutively sampled stroke patients and their caregivers recruited from all five tertiary hospitals in Singapore after index-stroke.
Interventions : Not applicable.
Main Outcome Measure(s) : Hospitalizations over one-year post-stroke extracted from national claims data.
256 stroke patient and caregiver dyads (N=512) were analyzed, with patients having spouse (60%), adult-child (29%), sibling (4%) and other (7%) as their caregivers. Among all subjects, 89% of index strokes were ischemic, 57% were mild in severity and more than half (59%) of the patients had moderate or severe disability post-stroke as measured on the Modified Rankin Scale. Having social support in the form of a foreign domestic worker for general help of caregiver reduced the hospitalization rate over 3 months post-stroke by 66% (IRR: 0.342; 95% CI: 0.180, 0.651). Compared to having a spousal caregiver, those with an adult-child caregiver had an almost three times greater rate of hospitalizations over 3-12 months post-stroke (IRR: 2.896; 95% CI: 1.399, 5.992). Higher reported caregiving burden at 3-month point was associated with higher subsequent rate of hospitalization.
Our study demonstrated the significance of caregiver factors, especially caregiver burden, caregiver identity and social support in rehospitalization post-stroke. Recommendations include adoption of stroke patient-caregiver dyadic approach, integrating caregivers in the healthcare system to extend the care continuum to include informal care in the community and provision of timely support for caregivers.