BMC Neurology (Nov 2019)

Dyadic approach to post-stroke hospitalizations: role of caregiver and patient characteristics

  • Shilpa Tyagi,
  • Gerald C. H. Koh,
  • Nan Luo,
  • Kelvin B. Tan,
  • Helen Hoenig,
  • David B. Matchar,
  • Joanne Yoong,
  • Angelique Chan,
  • Kim En Lee,
  • N. Venketasubramanian,
  • Edward Menon,
  • Kin Ming Chan,
  • Deidre Anne De Silva,
  • Philip Yap,
  • Boon Yeow Tan,
  • Effie Chew,
  • Sherry H. Young,
  • Yee Sien Ng,
  • Tian Ming Tu,
  • Yan Hoon Ang,
  • Keng He Kong,
  • Rajinder Singh,
  • Reshma A. Merchant,
  • Hui Meng Chang,
  • Tseng Tsai Yeo,
  • Chou Ning,
  • Angela Cheong,
  • Yu Li Ng,
  • Chuen Seng Tan

DOI
https://doi.org/10.1186/s12883-019-1510-4
Journal volume & issue
Vol. 19, no. 1
pp. 1 – 12

Abstract

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Abstract Aim To study the association of caregiver factors and stroke patient factors with rehospitalizations over the first 3 months and subsequent 3–12 months post-stroke in Singapore. Methods Patients with stroke and their caregivers were recruited in the Singapore Stroke Study, a prospective yearlong cohort. While caregiver and patient variables were taken from this study, hospitalization data were extracted from the national claims database. We used Poisson modelling to perform bivariate and multivariable analysis with counts of hospitalization as the outcome. Results Two hundred and fifty-six patient with stroke and caregiver dyads (N = 512) were analysed, with patients having spouse (60%), child (29%), sibling (4%) and other (7%) as their caregivers. Among all participants, 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 a 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 the 3-month point was associated with the higher subsequent rate of hospitalization. Conclusion Recommendations include the adoption of a dyadic or holistic approach to post-stroke care provision by healthcare practitioners, giving due importance to both patients with stroke and their caregivers, 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.

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