Caring for a family member with dementia is generally regarded as a chronically stressful process, with potentially negative physical health consequences. However, no quantitative analysis has been conducted on this literature. The authors combined the results of 23 studies to compare the physical health of caregivers with demographically similar noncaregivers. When examined across 11 health categories, caregivers exhibited a slightly greater risk for health problems than did noncaregivers. However, sex and the health category assessed moderated this relationship. Stronger relationships occurred with stress hormones, antibodies, and global reported health. The authors argue that a theoretical model is needed that relates caregiver stressors to illness and proffers moderating roles for vulnerabilities and resources and mediating roles for psychosocial distress and health behaviors.

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Is caregiving hazardous to one's physical health? A meta-analysis.

There is no agreed single measure of physical disability for use either clinically or in research. It is argued that acceptance of a single standard measure of activities of daily living (ADL) might increase awareness of disability, improve clinical management of disabled patients, and might even increase acceptance of published research. The Barthel ADL Index is proposed as the standard index for clinical and research purposes. Its validity, reliability, sensitivity, and utility are discussed. The Barthel Index is as good as any other single simple index and should be adopted as the standard against which future indices are compared. The temptation to use variations on the standard Barthel Index should be resisted.

The Barthel ADL Index: A standard measure of physical disability?

Background and Purpose— Although depression is an important sequelae of stroke, there is uncertainty regarding its frequency and outcome Methods— We undertook a systematic review of all published nonexperimental studies (to June 2004) with prospective consecutive patient recruitment and quantification of depressive symptoms/illness after stroke Results— Data were available from 51 studies (reported in 96 publications) conducted between 1977 and 2002 Although frequencies varied considerably across studies, the pooled estimate was 33% (95% confidence interval, 29% to 36%) of all stroke survivors experiencing depression Differences in case mix and method of mood assessment could explain some of the variation in estimates across studies The data also suggest that depression resolves spontaneously within several months of onset in the majority of stroke survivors, with few receiving any specific antidepressant therapy or active management Conclusions— Depression is common among stroke patients, with the 

Predictors of Depression after Stroke: A Systematic Review of Observational Studies

Mood disorders in the medically ill: scientific review and recommendations.

A conceptual framework that identifies psychological and behavioral features associated with antecedents, experiences, and consequences of volunteerism is presented, and an inventory that measures 5 specific motivations for AIDS volunteerism is developed and cross-validated. Then a field study of 116 AIDS volunteers is presented in which a helping disposition, volunteer motivations, and social support (as antecedents), and personal satisfaction and organizational integration (as experiences) are used to predict duration of service over 2 1/2 years. Structural equation analyses indicate that dispositional helping influences satisfaction and integration but not duration of service, whereas greater motivation and less social support predict longer active volunteer service. The model is generalized to the prediction of perceived attitude change. Implications for conceptualizations of motivation, theoretical issues in helping, and practical concerns of volunteer organizations are discussed.

https://psycnet.apa.org/journals/psp/68/4/671.pdf

Sustained helping without obligation: Motivation, longevity of service, and perceived attitude change among AIDS volunteers.

A method of assessing general (i.e. other than personal care) activities of stroke patients is described: the Frenchay Activities Index (FAI), a scale comprising 15 individual activities summed to give an overall score from 0 (low) to 45 (high). Data from 976 patients with acute stroke were analysed to establish the validity and reliability of the index, and to give information on the level of activities seen before stroke, at 6 months and 1 year post-stroke. Factors related to a lower overall score included loss of functional (ADL) ability, more depression, a lower IQ and, at 1 year, being female.

Social activities after stroke: Measurement and natural history using the Frenchay Activities Index

A community study on stroke registered 976 patients. Over 60% of survivors at three weeks, six months and 12 months after the stroke were assessed for depressed mood, using the Wakefield self-assessment depression inventory, and on other functional and social activities. At each point, 25-30% of those assessed were depressed; over 50% of patients depressed at three weeks remained so at one year. Factors associated with depression included loss of functional independence, a low level of other activities, a low reasoning ability, and being female and living with someone; path analysis showed that most depression was not explained by these factors. Few depressed patients at six months were on antidepressant medication.

Depressed mood after stroke. A community study of its frequency.

Information from a two year, longitudinal study on a community sample of patients with acute stroke was analysed to determine the effects of the stroke on the mood of the chief carer (the person living with the patient). Increased anxiety was the most commonly reported change six months after stroke. Significant depression was seen in 11-13% of carers over the first two years after stroke. The patient9s functional disability was associated with depression in the carer over the first year but not at two years. A perceived poor recovery by the patient, a low level of general activities by the patient, and depression in the patient were also associated with depression in the carer within the first year. At two years after stroke none of the measured factors were related to a carer9s level of depression. Carers of patients who have suffered stroke showed anxiety and emotional distress unrelated to the patient9s physical disability after two years. More help from stroke support groups for carers is perhaps needed.

Effects of living with and looking after survivors of a stroke.

Four hundred and thirty-eight stroke patients from a community register covering a period of 28 months were interviewed at one year post-stroke. Of 144 (34%) living at home who had been driving prior to their stroke, 82 (58%) did not resume post-stroke. Assessments of arm function, walking, functional ability and IQ showed ex-drivers to be significantly more disabled than drivers. Stopping driving was associated with a loss of social activities and with a higher frequency of depression amongst ex-drivers when compared with drivers. This was despite 79% of ex-drivers having easy access to alternative car transport. Extending mobility allowance to the 49 (60%) ex-drivers over 65 years old at the time of their stroke might ease their situation. More appropriate assessments would be needed to establish whether ex-drivers would benefit from retraining or car adaptations to enable them to return to driving.

https://journals.sagepub.com/doi/pdf/10.1177/014107688607900404

Driving after a Stroke

The use of community services by stroke patients was investigated one year after their stroke. Survivors from a register of all patients from a defined community were followed up one year after their stroke. Four hundred and thirty six of the 492 survivors were seen: 301 lived at home with someone, 82 lived at home alone, and 53 were in long-stay care. One hundred and forty seven (38%) of those at home were visited by one or more community services, the major ones being district nurse (73), home help (73), day centres (42), and meals on wheels (30). Analysis suggests that these services reach the patients who need most help. However, some 57 (19%) disabled patients are being looked after at home without any outside help.

https://jech.bmj.com/content/jech/40/2/161.full.pdf

J Legh-Smith

Papers

Social activities after stroke: Measurement and natural history using the Frenchay Activities Index

Depressed mood after stroke. A community study of its frequency.

Effects of living with and looking after survivors of a stroke.

Driving after a Stroke

Services for stroke patients one year after stroke.