Spouses of Stroke Survivors Report Reduced Health-Related Quality of Life Even in Long-Term Follow-Up

Abstract

A stroke has often a widespread effect on the daily life of the family. Because of its heterogeneity, stroke may affect the lives of the spouses differently. 1 The situation for spouses as caregivers during the first 2 years after the stroke is well studied , 2,3 whereas the long-term effects are less well known. 4 In addition, most studies examined spouses of older stroke survivors , whereas less is known about the lives of younger families. The spouse of a midlife stroke survivor often has responsibilities related to family and a professional life 5 ; therefore, their lives are affected differently. Supporting a partner is often perceived as natural and important, 6 but it may also be demanding and affect the health of the caregiver. 2 Previous studies, mostly concerning the short-term perspective, have shown that the health-related quality of life (HRQoL) of caregivers to stroke survivors is negatively affected. 7 According to those studies, the most important determinants of the HRQoL of the caregivers are their own age and the functional status of the stroke survivor. However, in a long-term perspective, successive changes may occur in the status of the stroke survivor, as well as in the adaptation of the spouses to the new situation. Knowledge is limited concerning caregivers' HRQoL and the determinants of caregivers' HRQoL in the long-term perspective. Therefore, the objectives of this study were (1) to explore the HRQoL of spouses of younger stroke survivors 7 years after stroke onset and (2) to identify predictors of HRQoL of spouses based on demographic features and stroke-related variables. Subjects and Methods Subjects Data on stroke survivors, controls, and spouses were collected from the 7-year follow-up of the Sahlgrenska Academy Study on Ischemic Stroke (SAHLSIS). 8 The database covers 600 consecutively recruited patients diagnosed with ischemic stroke before the age of 70 within 4 stroke units in western Sweden between 1998 and 2003 and 600 age-and sex-matched controls who were selected randomly from a group of participants in a population-based health survey. For both stroke cases and controls, recurrent stroke and deaths between SAHLSIS baseline and follow-up have been identified using the Swedish Cause of Death Register and the National Patient Register. 9 For the 7-year follow-up, Background and Purpose-The consequences for the family of stroke survivor are generally studied in a short-term perspective. The aim of this study was to assess long-term aspects of health-related quality of life among spouses of stroke survivors. Methods-Data on stroke survivors, controls, and spouses were collected from the 7-year follow-up of the Sahlgrenska Academy Study on Ischemic Stroke (SAHLSIS). The health-related quality of life of spouses was assessed by the Short Form-36, and the characteristics of stroke survivors were assessed using the National Institutes of Health Stroke Scale, the Mini-Mental State Examination, the Hospital Anxiety and Depression Scale, the Barthel Index, and the modified Rankin Scale. Results-Dyads of 248 stroke survivors aged <70 at stroke onset and 245 dyads of matched controls were included. Spouses of stroke survivors and spouses of controls had a median age of 64 and 65, respectively; proportion of men was 35% and 34%, respectively. The spouses of stroke survivors reported lower scores in all the mental domains (P=0.045; P<0.001), as well as in the domains of general health (P=0.013) and physical role (P=0.006), compared with the spouses of controls. Predictors of poor physical health of the spouses were their own age and the level of global disability of the stroke survivor. Predictors of poor mental health of the spouses were depressive symptoms, cognitive impairment, and global disability among the stroke survivors. Conclusions-The health-related quality of life of spouses of stroke survivors is reduced not only during the first years but also in the long-term perspective. (Stroke. 2015;46:2584-2590.