Life After a Stroke Event : With Special Reference to Aspects on Prognosis, Health and Municipality Care Utilization, and Life Satisfaction Among Patients and Their Informal Caregivers

Abstract: Objectives. The aim of this thesis was to study the prognosis, health care utilization and health situation in stroke patients, and informal caregiver burden during the first post-stroke year. Material and methods. 390 patients, 65 years or older, discharged from hospital after a stroke, were followed with repeated patient interviews, patient record and register data, and hospital staff and informal caregiver questionnaires. Results. Prognosis assessments performed by hospital staff at discharge regarding the course of events during the following year were highly accurate and were mainly influenced by the patient’s pre- and post-morbid state. The risk of dying or having a new stroke decreased rapidly during the early post-morbid phase. Health care utilization, in hospitals as well as in primary health care, and municipal social service support was considerably higher after the stroke than before, but the utilization of services was lower than previously reported. Health problem prevalence according to interview and record scrutiny was modest, peaked early after discharge and then declined. Support from informal caregivers increased significantly after discharge and remained high during the first post-stroke year. The support given was mainly determined by patient functional ability, distance to patient, relation to patient, municipal social service support provided, and patient sex. The informal caregivers reported considerable strain and burden, with significantly higher levels of anxiety and depression than the stroke patients. Moreover, there was a parallel between the patient’s and the caregiver’s situation regarding anxiety, emotional and social situation, and home, social and outdoor activities. Conclusion. Hospital staff prognosis assessments of patient outcomes during the next year were highly accurate. Risk of recurrence and mortality, and health problem prevalence was high in the early post-stroke period, and than declined. Health care utilization and municipality social support increased over time. Informal caregivers reported considerable strain and burden.