Quality of life trajectories among stroke survivors and the related changes in caregiver outcomes : A growth mixture study

Objectives
To identify the distinct quality of life (QOL) trajectories among stroke survivors, and to evaluate the associations with their caregivers’ burden, anxiety, and depression.

Design
This was a longitudinal dyadic study.

Settings
Stroke survivors and their informal caregivers were enrolled upon discharge from several rehabilitation hospitals, and they were followed during this multisite longitudinal study.

Participants
The stroke survivors (N=405, mean age=70.7y) included older adult men (52.0%), most of whom (80.9%) had had ischemic strokes. The caregivers (n=244, mean age=52.7y) included mostly women (65.2%), most of whom were the survivors’ children (50.0%) or spouses (36.1%).

Interventions
Not applicable.

Main Outcome Measures
Latent growth mixture modeling was used to identify the distinct QOL trajectories among the stroke survivors over the course of 12 months of recovery. The longitudinal associations between the stroke survivor QOL trajectories and the caregivers’ burden, anxiety, and depression were evaluated. A multinomial regression was then used to identify the predictors of the various survivor QOL trajectories.

Results
Three distinct survivor QOL trajectories were identified: high and slightly improving QOL, moderate and slightly worsening QOL, and markedly improving QOL. The caregivers’ burden, anxiety, and depression mirrored the survivors’ QOL trajectories. In the multinomial models, an older survivor age, hemorrhagic stroke, lower education, and coexisting chronic obstructive pulmonary disease or thyroid disease were significantly associated with a moderate and slightly worsening QOL trajectory. Women and blindness were associated with a markedly improving QOL survivor trajectory.

Conclusions
A survivor’s QOL trajectory after a stroke was associated with their caregiver’s burden, anxiety, and depression. Those survivors belonging to the moderate and slightly worsening QOL trajectory and their caregivers, in particular, need special care, because they are at risk for the worst outcomes.