Measures of psychological stress and physical health in family caregivers of stroke survivors: a literature review.(Report)

Stroke is the third leading cause of death in United States following heart disease and cancer, although the survival rate for acute stroke has improved over recent years due to advancements in stroke treatment. It is estimated that about 80% of stroke survivors are discharged home and live for at least 5 years after experiencing a stroke, resulting in 5.5 million stroke survivors in the United States (National Family Caregiver Association, 2007; Rosamond et al., 2007). From this group, over one million experience significant long-term physical disabilities, resulting in survivors relying on family members to help them manage physical and cognitive dysfunction.

Stroke patients often experience significant functional limitations, cognitive impairments, urinary incontinence, and speech difficulties following stroke. These impairments may last indefinitely, requiring lifelong caregiver assistance. Even with paid formal assistance (i.e., home health aide), families are frequently faced with a multitude of stressors ranging from coordination of medical care to 24-hour care of their loved ones. Even more profound may be the grief associated with the changed relationship with the patient. This loss may be especially evident in spouses of stroke survivors. Studies have consistently demonstrated that family caregivers are at risk for developing depression, anxiety, sleep disturbances, poor quality of life, and health problems

In caregivers, particularly in caregivers of persons with dementia, the stress of providing care has been linked to sleep dysfunction (Brummett et al., 2006), altered cytokine levels (von et al., 2006), and greater coagulation (Mills et al., 2009) when compared with noncaregivers. Unfortunately, none of these works has been replicated in caregivers of persons with a stroke. Caregiving for stroke patients differs from that of dementia patients in that stroke caregivers are impacted suddenly and without warning. Perceived stress, use of coping mechanisms, and the psychological and physiological response to stress may be different when the stressor occurs abruptly rather than gradually. In addition to the health risks associated with stress, caregivers of stroke survivors may be particularly vulnerable to developing cardiovascular disease because they may have similar lifestyle risk factors (e.g., poor diet, sedentary lifestyle, and smoking habits) as the stroke patient. A better understanding of the interaction between stress and physical health in caregivers of stroke survivors is important in assisting clinicians in identifying caregivers who are at high risk for developing health problems and providing early interventions to minimize their risk.

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