Shared Care Arrangement of Older Adults with Stroke

Abstract

Objective: Stroke is one of the key factors that contributes to disability which put on heavy burden for health and social care worldwide. From 2015 to 2017, the number of stroke survivors living in the community has increased by 11% in Hong Kong (Census and Statistics Department, 2015; 2017). The objective of the present study was to examine care arrangement of older adults with stroke and its association with distress of primary caregivers. Methodology: A sub-sample of assessment data using MDS-HC from a large cohort of community-dwelling older adults applying for public long-term care services in Hong Kong from 2015 and 2016 calendar year was selected. The inclusion criteria were 1) 65 years or older; 2) stroke; 3) had a spouse or off-spring as a primary caregiver; 4) first assessment; and 5) living at home. A total of 3,315 applicants contributed to the active dataset for the present study. Findings: Around fifty percent of older adults with stroke were taken cared by both primary and secondary caregivers; while about twenty percent were taken cared either by primary caregivers only, or by a combination of a primary caregiver, a secondary caregiver, and community services. After controlling covariates, for both spousal caregivers and offspring caregivers, when there were secondary caregivers or share care by using community services, the primary caregivers were more likely (OR = 2.234, 2.212) to be distressed. For the spousal caregivers, if the care recipients had more severe depression issues, the caregivers were more likely (OR = 1.183) to be distressed. For the offspring caregivers, if the elderly had more severe cognition issues (OR = 1.148) or received longer informal help during the weekdays (OR = 1.025), the caregivers were more likely to be distressed. Implications: Three clinical implications could be generated: 1) set families adopting shared care arrangements as a prioritized target group; 2) for spouse primary caregivers, care recipients showing depressive symptoms were recommended for prioritized interventions; and 3) for offspring primary caregivers, care recipients showing cognitive impairment symptoms were recommended for prioritized interventions.