Changes is frailty and depression among stroke survivors and their spouses: A longitudinal analysis of three ageing research cohorts

Problem

Stroke often substantially impacts a person’s physical and psychological wellbeing. The impact on carers and family can also be considerable but is less often quantified. This project aims to measure changes in physical and psychological health status (assessed using frailty and depression) before and after a stroke for both the stroke survivor and their spouses and compare these to people who had not experienced a stroke themselves or within their household.

Approach

We used data from 3 population longitudinal ageing surveys (Health and Retirement Survey [HRS], USA; Survey for Health, Ageing and Retirement in Europe [SHARE]; and the English Longitudinal Study of Ageing [ELSA]). Participants aged ≥50 were surveyed at 2-yearly intervals along with their household. We identified people who had survived a stroke occurring after their initial visit (and so had data collected both pre- and post-stroke). We also identified spouses of stroke survivors, and a comparator group for whom neither they nor their spouse had reported a stroke. We assessed frailty using the Rockwood frailty index (composed of 46 age-related health deficits including comorbidities, symptoms and functional limitations), and depression using the CES-D (Centre for Epidemiological Studies Depression Scale) or the Euro-Depression Scale. These were assessed at 2 time-points 2 years apart (pre- and post-stroke for stroke survivors and their spouses and between 2012/13 and 2014/15 for comparators, corresponding to the mid-point of follow-up). We assessed change in frailty and depression scores using a linear mixed regression models adjusted for age and sex.

Findings

There were 97,578 participants (5705 stroke survivors, 4304 spouses of stroke survivors, and 87573 comparators). Compared to people who had not experienced a stroke, the average change in frailty index values was greater for stroke survivors (0.083, 95% confidence interval 0.077-0.088) and also for their spouses (0.013, 0.007 to 0.02). These increases correspond to 4 additional deficits in stroke survivors and 1 additional deficit in their spouses. Stroke survivors and their spouses, on average, also saw increases in depression scores which were greater than those of the comparator group (0.41-point greater increase [0.34 to 0.48] for stroke survivors and 0.23-point greater increase [0.14 to 0.32] for their spouses).

Consequences

Both stroke survivors and their spouses experience more rapid progression of frailty and a greater worsening in depression symptoms over time than the general population. Support for stroke survivors should be responsive to the physical and psychological impact of the condition. In addition, there is also a need to support carers and family members, who may also experience impacts in physical and mental health which should be actively identified. Primary care is well positioned to respond to this need. However, this is likely to require time, awareness and relational continuity, which should be prioritised.