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Dyadic approach to post-stroke hospitalizations: role of caregiver and patient characteristics.
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.
Type
Journal articlePermalink
https://hdl.handle.net/10161/22776Published Version (Please cite this version)
10.1186/s12883-019-1510-4Publication Info
Tyagi, Shilpa; Koh, Gerald CH; Luo, Nan; Tan, Kelvin B; Hoenig, Helen; Matchar, David
B; ... Tan, Chuen Seng (2019). Dyadic approach to post-stroke hospitalizations: role of caregiver and patient characteristics.
BMC neurology, 19(1). pp. 267. 10.1186/s12883-019-1510-4. Retrieved from https://hdl.handle.net/10161/22776.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Helen Marie Hoenig
Professor of Medicine
1. General Focus and Goals of Research: Dr. Hoenig's research focuses on rehabilitation,
and more specifically on assistive technology and teletechnology. Patient populations
of interest include geriatric patients with diverse medical problems including stroke,
spinal and/or musculoskeletal disorders. 2. Specific Approaches or Techniques: Randomized
controlled trials, epidemiological studies including large data base analyses and
survey research. Clinical trials include studies of t
David Bruce Matchar
Professor of Medicine
My research relates to clinical practice improvement - from the development of clinical
policies to their implementation in real world clinical settings. Most recently my
major content focus has been cerebrovascular disease. Other major clinical areas in
which I work include the range of disabling neurological conditions, cardiovascular
disease, and cancer prevention. Notable features of my work are: (1) reliance on
analytic strategies such as meta-analysis, simulation, decision analy
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