Author:
Tyagi Shilpa,Koh Gerald C. H.,Luo Nan,Tan Kelvin B.,Hoenig Helen,Matchar David B.,Yoong Joanne,Chan Angelique,Lee Kim En,Venketasubramanian N.,Menon Edward,Chan Kin Ming,De Silva Deidre Anne,Yap Philip,Tan Boon Yeow,Chew Effie,Young Sherry H.,Ng Yee Sien,Tu Tian Ming,Ang Yan Hoon,Kong Keng He,Singh Rajinder,Merchant Reshma A.,Chang Hui Meng,Yeo Tseng Tsai,Ning Chou,Cheong Angela,Ng Yu Li,Tan Chuen Seng
Abstract
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.
Funder
Health Services Research Competitive Research Grant, National Medical Research Council, Singapore
Publisher
Springer Science and Business Media LLC
Subject
Neurology (clinical),General Medicine
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