Factors Affecting the Burden on Caregivers of Stroke Survivors in South Korea

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Factors Affecting the Burden on Caregivers of Stroke Survivors in South Korea Smi Choi-Kwon, RN, PhD, Hwa-Sung Kim, RN, MSN, Sun U. Kwon, MD, Jong S. Kim, MD ABSTRACT. Choi-Kwon S, Kim HS, Kwon SU, Kim JS. Factors affecting the burden on caregivers of stroke survivors in South Korea. Arch Phys Med Rehabil 2005;86:1043-8. Objective: To elucidate the factors related to the caregiver burden in stroke survivors in Seoul, Korea. Design: Cross-sectional study. Setting: Outpatient clinic of a university hospital in Korea. Participants: We randomly selected 340 stroke patients and evaluated them for 3 years poststroke. Among them, 147 caregivers and patients were finally interviewed. Interventions: Patients’ demographic data, neurologic symptoms, depression, emotional incontinence, and Modified Rankin Scale (MRS) score were assessed. In addition, primary caregivers’ demographic data, hours of care per day, relationship with the patients, health status, anxiety and depression, and the presence of alternative caregivers were assessed. Main Outcome Measures: Caregiver burden was evaluated with the Sense of Competence Questionnaire, which has 3 subdomains with a total of 27 items. Results: Caregiver burden score was high as compared with reports from Western society. Patient factors related to the burden scores were being unemployed (P⬍.05), the presence of diabetes mellitus (P⬍.05), aphasia (P⬍.01), dysarthria (P⬍.05), dysphagia (P⬍.01), cognitive dysfunction (P⬍.01), severe MRS score (P⬍.01), emotional incontinence (P⬍.05), and depression (P⬍.01). Caregiver factors related to high burden scores were being female (P⬍.05), unemployment (P⬍.01), being daughters-in-law (P⬍.01), anxiety (P⬍.01), depression (P⬍.01), and long caregiving hours (P⬍.05). On multivariate analysis, the most significant predictor for overall caregiver burden was caregiver anxiety followed by patient MRS score and caregivers being daughters-in-law. Caregiver depression, current employment status, and patient depression were also factors related to their burden. Conclusions: Caregiver anxiety, patient physical deficits, and caregivers being daughter-in-law are important factors related to the caregiver burden in our population. Strategies to reduce caregiver burden should be developed based on understanding of these factors. Key Words: Caregivers; Cerebrovascular disease; Depression; Rehabilitation. © 2005 by American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

From the College of Nursing, Seoul National University, Seoul, Korea (ChoiKwon); Cleveland Clinic Foundation, Cleveland, OH (HS Kim); and Department of Neurology, University of Ulsan, Asan Medical Center, Seoul, Korea (Kwon, JS Kim). Supported by the Korean Ministry of Health and Welfare (grant no. 03-PJ1-PG1CH06-0001). No party having a direct interest in the results of the research supporting this article has or will confer a benefit on the author(s) or on any organization with which the author(s) is/are associated. Reprint requests to Jong S. Kim, MD, Dept of Neurology, Asan Medical Center, Song-Pa PO Box 145, Seoul 138-600, South Korea, e-mail: [email protected]. 0003-9993/05/8605-9430$30.00/0 doi:10.1016/j.apmr.2004.09.013

ECAUSE OF STROKE’S debilitating and chronic nature, caring for stroke patients often puts great burdens on their B caregivers. The caregiving stress may lead to clinically sig1

nificant depression in caregivers,2-4 which in turn may hamper rehabilitation.5 Therefore, it is important to identify the level of caregiver burden and the factors that influence it. Caregiver burden can be perceived differently, depending on the society and culture in which the caregivers live. For instance, Korean culture places the elderly male at the head of the family, receiving loyalty from his offspring.6 Men predominantly provide the financial support for the family, whereas female family members usually stay at home and are responsible for the entire household.6 Therefore, chronic care for an illness such as stroke in an elderly family member may place a considerable burden on female caregivers.7 Unlike in Western countries, nursing homes and institutes for patients with chronic illness are generally unavailable in Korea, which could increase the burden of a caregiver.8 The aim of the present study was to identify the factors affecting caregiver burden in Seoul, Korea, measured approximately 3 years after stroke. METHODS From the stroke registry of Asan Medical Center, we randomly chose 340 stroke patients admitted between January 1994 and December 1998. All the patients underwent computed tomography and magnetic resonance imaging to confirm the presence of stroke. We excluded stroke patients who had transient ischemic attack without progression to stroke; those who had severe heart, liver, or renal diseases that may exert additional burden on caregivers; and those with a history of depression before their stroke. To homogenize the subject population, we also excluded patients with hemorrhagic stroke (including hypertensive intracerebral hemorrhage, subarachnoid hemorrhage, arteriovenous malformation) or strokes due to miscellaneous causes (moyamoya disease, venous infarction, arterial dissection) and patients younger than 45 years. This study protocol was approved by the institutional review board of the Asan Medical Center. From patients’ medical records, we obtained the neurologic examination results on admission and the Modified Rankin Scale9 (MRS) score at discharge. The assessment for caregiver burden was done at 1 to 5 years (average, 3.4y) after stroke onset. We first made a telephone call to the patients to obtain a verbal consent for the interview. If they agreed, patients were asked to visit the outpatient clinic of our hospital. If they were unable to attend, we made a home visit. The interview was administered by trained research nurses, using a structured questionnaire, to the patients and primary caregivers. Because the presence of patients could influence caregivers to modify their responses regarding the burden, caregivers’ perceived burden was assessed without patients present, after all patient information had been obtained. For patient information, demographic data and the presence of risk factors, motor impairment, sensory symptoms, aphasia, dysarthria, dysphagia, and recurrent stroke were recorded. Patients who reported a subsequent stroke were excluded from the Arch Phys Med Rehabil Vol 86, May 2005

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CAREGIVER BURDEN OF STROKE SURVIVORS, Choi-Kwon

study. The dependency in activities of daily living was recorded using the MRS, and the score was categorized as severe (4 –3) or mild (2– 0) for statistical purposes. Patients’ cognitive function was assessed using the Mini-Mental State Examination (MMSE), and dysfunction was considered to be present if the MMSE score was 23 or higher.10 Depression was considered present if patients met the major depression criteria published in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV).11 Emotional incontinence was considered present when both the patient and the primary caregivers living with the patient agreed that the patient had exhibited excessive and/or inappropriate laughing and/or crying on more than 2 occasions.11 Current economic status was categorized as good (monthly income, ⬎2 million Korean won [KRW$]), average (KRW$1–2 million), and poor (⬍KRW$1 million),12 and current employment status after stroke also was recorded. A primary caregiver was defined as “a person who lives with the patient and is most closely involved in taking care of him/her at home.”13(p844) The demographic data of the primary caregiver and information about the presence of an alternative caregiver, hours of care per day, and the relationship of the caregiver to the patient were obtained. Health status of the caregiver before and after the occurrence of the patient’s stroke was assessed using a self-rated global health item on a 3-point scale.14-16 The Hospital Anxiety and Depression Scale (HADS), which consists of 14 items (7 for anxiety, 7 for depression), each measured on a 4-point scale, was used to assess the level of depression and anxiety of the caregivers.17 We used the HADS rather than the DSM-IV to assess caregiver depression because we wanted to evaluate separately the effect of anxiety and depression on the caregivers’ burden. Depression or anxiety was considered present if the caregivers had a score greater than 10 in the depression or in the anxiety inventory, respectively.17 Scores between 8 and 10 were considered borderline. The caregivers’ perceived burden was assessed with the Sense of Competence Questionnaire (SCQ).5,18 The SCQ has 3 subdomains, with a total of 27 items: subdomain 1 (satisfaction with the impaired person as a recipient of care, 7 items), subdomain 2 (satisfaction with one’s own performance as a caregiver, 12 items), and subdomain 3 (consequences of involvement in care for the caregiver’s personal life, 8 items). Each item was graded with a 4-point rating scale. The burden scores for the total and the 3 subdomains were represented as the mean of each score, ranging from 1 to 4; the higher the score, the higher the burden. Statistics Data were analyzed with descriptive statistics, Student t tests, analysis of variance with a Scheffé post hoc test, and chi-square tests using the SPSS statistical package, version 11.0.a Multiple regression was used to analyze the association between related factors and perceived burdens of caregivers. RESULTS Characteristics of Patients and Caregivers Among 340 patients, 117 (34.4%) could not be reached by telephone. Among the remaining 223 patients, 45 (20.2%) had died, 18 (8.1%) did not give consent, and 6 (2.7%) had had a subsequent stroke, yielding 154 patients. An interview with the caregiver was performed in 147 cases (45 at the patient’s house, 102 in our outpatient clinic). The MRS score at the time of discharge differed between the patients who were reached Arch Phys Med Rehabil Vol 86, May 2005

via phone and included in the interview (mild in 81%) and those who were not (mild in 65%) (P⬍.01). Among the subjects included in this study, the MRS score at the time of discharge was not different from that at follow-up (mild in 80%) (table 1). The age of the primary caregivers ranged from 18 to 78 years (mean, 55y). Seventy-nine percent were women. Regarding their relationship to the patient, 103 (70%) were spouses, 21 (14%) were children, and 20 (14%) were daughters-in-law. Thirty-one (21%) had depression and 24 (16%) had borderline depression. Twenty-five (17%) had anxiety and 16 (11%) had borderline anxiety. There was a significant (P⬍.05) difference in the health status of caregivers before and after the patient’s stroke, suggesting the presence of deteriorating physical health status of the caregiver. Caregiver Burden and the Factors Affecting It We examined the relation between the level of caregivers’ overall burden and characteristics of both the caregivers and patients. As shown in table 1, patient factors related to a high level of caregiver burden included the patient being unemployed (P⬍.05); having diabetes mellitus (P⬍.05), aphasia (P⬍.01), dysarthria (P⬍.05), dysphagia (P⬍.01), cognitive dysfunction (P⬍.01), depression (P⬍.01), and/or emotional incontinence (P⬍.05); and/or a severe MRS (P⬍.01). Patients’ age, sex, level of education, marital status, and monthly income and the presence of hypertension, (P⬍.05), and sensory deficit were not related to caregivers’ burden scores. A significant relation was found between the depression of patients and that of their caregivers (P⬍.05). Caregiver factors related to high burden scores included the caregiver being female (P⬍.05), being unemployed (P⬍.01), being the patient’s daughter-in-law (P⬍.01), having more than 15 hours of caregiving a day (P⬍.05), anxiety (P⬍.01), depression (P⬍.01), and changes in health status (P⬍.05) (table 2). Whether caregivers’ sex was the same as the patients’ was not a factor related to the burden score. The overall burden scores and the scores for each item are listed in table 3. The mean overall burden score was 2.3, and the mean scores for each subdomain were 2.0, 2.2, and 2.8, respectively. A relatively high mean burden score was recorded in the following items: “worries all the time,” “responsibilities weigh heavily,” “could/should have done more for the patients,” and “not pleased about their interactions with the patients.” Because caregivers’ depression and anxiety were important factors in predicting the level of burden (see below), we examined the factors influencing caregivers’ depression and anxiety. The caregiver factors related to depression included being old (P⬍.05), being female (P⬍.05), being the patient’s daughter-in-law (P⬍.05), having a low level of education (P⬍.01), being single (P⬍.05), being unemployed (P⬍.05), caring for the patient without an alternative caregiver (P⬍.05), and having poor health (P⬍.05); the patient factors included aphasia (P⬍.05), dysphasia (P⬍.05), low MMSE score (P⬍.05), severe MRS score (P⬍.01), and the presence of depression (P⬍.05). Caregiver factors affecting their anxiety included being female (P⬍.05), having a low level of education (P⬍.01), being unemployed (P⬍.05), and currently being in poor health (P⬍.05); the patient factors included aphasia (P⬍.05) and severe MRS score (P⬍.05). Factors Related to Burden on Multiple Regression Models To understand the relative contributions of patient and caregiver factors in determining caregiver burden, we performed

CAREGIVER BURDEN OF STROKE SURVIVORS, Choi-Kwon Table 1: Patient Factors Affecting Caregiver Burden (Nⴝ147) Factors

Age Overall (y) ⱖ62 ⬍62 Sex Male Female Level of education Overall (y) ⱖ9.5 y ⬍9.5 y Marital status Married Single Employment status Employed Unemployed Current economic status Poor Average Good Hypertension Yes No Diabetes mellitus Yes No MRS score Mild Severe Sensory deficit Yes No Aphasia Yes No Dysarthria Yes No Dysphagia Yes No Cognitive dysfunction Yes No Emotional incontinence Yes No Depression Yes No

Values

Burden Scores

61.9⫾8.1 80 (54) 67 (46)

— 2.4⫾0.6 2.2⫾0.5

104 (71) 43 (29)

2.3⫾0.6 2.3⫾0.5

9.5⫾4.7 111 (76) 36 (24)

— 2.3⫾0.5 2.2⫾0.6

128 (87) 19 (13)

2.3⫾0.6 2.3⫾0.6

50 (34) 97 (66)

2.1⫾0.5 2.4⫾0.6

40 (27) 66 (45) 41 (28)

2.3⫾0.4 2.3⫾0.6 2.2⫾0.6

116 (79) 31 (21)

2.3⫾0.6 2.5⫾0.5

34 (23) 113 (77)

2.5⫾0.6 2.3⫾0.6

118 (80) 29 (20)

2.2⫾0.5 2.7⫾0.6

43 (29) 104 (71)

2.2⫾0.5 2.3⫾0.6

13 (8) 134 (92)

2.9⫾0.5 2.3⫾0.6

65 (44) 82 (56)

2.4⫾0.6 2.2⫾0.6

19 (13) 128 (87)

2.7⫾0.5 2.3⫾0.6

27 (18) 120 (82)

2.7⫾0.4 2.2⫾0.6

12 (8) 135 (92)

2.6⫾0.7 2.3⫾0.6

30 (20) 117 (80)

2.6⫾0.5 2.2⫾0.6

T Score or F Value

P

–2.115

NS

0.303

NS

2.517

NS

0.285

NS

–2.531

⬍.05

1.034

NS

–1.535

NS

2.389

⬍.05

–4.781

⬍.01

–0.991

NS

3.439

⬍.01

2.095

⬍.05

2.866

⬍.01

4.373

⬍.01

2.121

⬍.05

2.902

⬍.01

NOTE. Values are n (%) or mean ⫾ standard deviation (SD) unless otherwise noted. Abbreviation: NS, not significant.

multiple regression analysis. In this analysis, we included significant factors (P⬍.05) from the univariate analysis. We also included factors such as age, sex, and education of the caregivers, because these factors could influence the results. The results are summarized in table 4.

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Overall, 43% of the variation of burden scores was explained by the model. The predictors of overall burden included caregivers’ anxiety, patients’ MRS scores, caregivers being daughter-in-law, caregivers’ current employment status, caregivers’ depression, and patients’ depression. Important (explaining ⬎10% of the variation) factors contributing to the first subdomain of burden included caregivers being daughters-in-law, caregivers’ employment status, caregivers’ anxiety, patients’ dysphagia, and the sex of caregiver, whereas patients’ depression and caregivers’ depression were factors related to high burden scores in the second subdomain. Finally, patients’ MRS scores, hours of care a day, and caregivers’ health status after stroke were important factors affecting the third subdomain. DISCUSSION For assessment of caregiver strain, previous studies have used either depression and anxiety scales or the Bakas Caregiving Outcomes Scale.3,13,19,20 The Caregiver Strain Index and a self-rated burden questionnaire have also been reported as concise and simple.5 However, we chose the SCQ because it covers depression and anxiety as well as other aspects of burden.5 Moreover, it enabled us to assess caregiving-related problems in different subdomains.18 Although the SCQ has a floor effect,18 the effect was not obvious in our study, because our population had a higher burden score than that reported in a previous study using an identical scale.5 The reason that a higher total burden score was obtained in our study may be explained in 4 ways. First, caregiver burden was reported as lower when caring for young patients than for old ones.5 Therefore, an exclusion of young (⬍45y) patients in our study might have resulted in a high burden score. Second, our assessment was carried out in the chronic poststroke stage, and the prolonged care might have been more burdensome to caregivers. Third, because our patients were recruited from a large, tertiary hospital, patients with severe neurologic disability may have been overrepresented. Finally, we suspect that the high burden score in our study may reflect sociocultural differences. Long-standing patriarchal cultural traditions in Korea strongly emphasize loyalty to the elderly, particularly one’s parents. Therefore, caregivers may feel strong responsibility for their parents and easily worry that they are not caring for them properly. This was evidenced by high scores (3.34 and 3.32, respectively) on items 1 (responsibilities weigh heavily) and 6 (could/should have done more). A previous study of caregivers of elderly with dementia also reported that the Korean and Korean-American caregivers had higher levels of burden, depression, and anxiety than whites.21 We found that the patients’ aphasia, dysarthria, and cognitive dysfunction were factors related to the burden. This may reflect the communication problems between the patients and caregivers. This area has not been studied extensively because of the problems inherent in collecting information from such patients. However, our result is consistent with a previous report22 that caregiver strain was related to communication functions. We also found that unemployment of either patients or caregivers was a factor negatively affecting caregiver burden. Although this result suggests the negative influence of the financial burden, current economic status was not a factor affecting caregiver. Perhaps being unemployed is related to either a negative self-image or to long hours of care. Consistent with previous reports,3,23 the multivariate analysis showed that caregiver anxiety was the most important factor affecting the overall caregiver burden, followed by patients’ MRS score. On the other hand, caregivers’ physical health did not affect overall burden, implying that emotional rather than physical health is a primary factor affecting their burden. This Arch Phys Med Rehabil Vol 86, May 2005

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CAREGIVER BURDEN OF STROKE SURVIVORS, Choi-Kwon Table 2: Caregiver Factors Affecting Caregiver Burden Factors

Age Overall (y) ⱖ54.5 ⬍54.5 Sex Male Female Level of education Overall (y) ⱖ9.5 ⬍9.5 Employment status Employed Unemployed Hours of care/day ⬎ 15h ⬍ 15h Relationship to the patient Spouse Son Daughter Daughter-in-law Parent Presence of alternative caregiver Yes No Health before the stroke Good Average Poor Health after the stroke Good Average Poor Changes in health before/ after stroke Deteriorated Same or improved Anxiety Not anxious Borderline Very anxious Depression Not depressed Borderline Very depressed

Values

Burden Scores

T Score or F Value

P

NS 54.5⫾13.1 71 (48) 76 (52)

0.519 2.3⫾0.6 2.4⫾0.5

31 (21) 116 (79)

2.1⫾0.5 2.4⫾0.6

–2.301

⬍.05

NS 9.5⫾4.4 115 (78) 32 (22)

0.522 2.3⫾0.6 2.4⫾0.6

49 (33) 98 (67)

2.1⫾0.4 2.4⫾0.6

63 (43) 84 (57)

2.4⫾0.6 2.2⫾0.6

103 (70) 6 (4) 10 (7) 25 (17) 3 (2)

2.2⫾0.6* 2.2⫾0.4* 2.4⫾0.6* 2.8⫾0.4 2.4⫾0.2*

78 (53) 69 (47)

2.3⫾0.6 2.3⫾0.5

111 (75.5) 30 (20.4) 6 (4) 73 (49.7)

2.2⫾0.6 2.2⫾0.4 2.2⫾0.4 2.1⫾0.6

49 (33.3) 25 (17)

2.4⫾0.6 2.3⫾0.5

51 (35) 96 (65)

2.1⫾0.6 2.4⫾0.5

106 (72) 16 (11) 25 (17) 92 (63)

2.2⫾0.6 2.7⫾0.6† 2.7⫾0.8† 2.1⫾0.6

24 (16) 31 (21)

2.3⫾0.5 2.6⫾0.5‡

–2.715

⬍.01

2.298

⬍.05

4.413

⬍.01

0.510

NS

0.700

NS

1.360

NS

–2.288

⬍.05

6.663

⬍.01

2.740

⬍.01

NOTE. Values are n (%) or mean ⫾ SD unless otherwise noted. The results of Scheffé post hoc test: *significant compared with daughter-in-law; †significant compared with not anxious; ‡significant compared with not depressed.

interpretation was evidenced by a relatively high score (3.8) on item 13 (worries all the time). Nevertheless, caregivers’ physical status and the hours of care per day were factors related to subdomain 3. Our results showed that both caregivers’ and patients’ depression were important factors influencing overall burden and subdomain 2. Consistent with a previous study,24 we found that a significant relation existed between the patients’ depression and the depression of their caregivers. Depression of caregivers is prevalent during the acute stages as well as the chronic stages Arch Phys Med Rehabil Vol 86, May 2005

of stroke.2,4,25 Twenty-one percent of the caregivers were depressed, and 16% had borderline depression. Although none of the depressed subjects reported receiving treatment to alleviate depression and anxiety, caregivers’ depression may limit their role,25 worsen patients’ depressive symptoms,2 and negatively affect patients’ rehabilitation.2,5 Therefore, strategies to decrease depression in family caregivers may have to be developed.26 Contrary to previous studies,12,13 our results showed that physical disability of the patients was an important factor

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CAREGIVER BURDEN OF STROKE SURVIVORS, Choi-Kwon Table 3: Mean Burden Score Total SCQ (27 items)

Overall Subdomain 1 (7 items)* 8. Feels embarrassed 10. Patient appreciates care 14. Patient requests more than necessary 16. Feels resentful 25 Patient tries to have his/her own way 26. Feels annoyed 27. Feels manipulated Subdomain 2 (12 items)† 2. It is clear how much care patient needs 3. Capable to care 4. Could/should do more 5. Feels angry 6. Could/should have done more 7. Feels guilty 9. Feels nervous/depressed 11. Patient benefits from everything he/ she does 17. Feels not pleased about their interactions 18. Feels useful 19. Feels strained 23. Wishes for a better relationship Subdomain 3 (8 items)‡ 1. Responsibilities weigh heavily 12. Patient cannot be left alone 13. Worries all the time 15. Has enough time for him/herself 20. Health has suffered 21. Privacy is regarded 22. Social life has suffered 24. Patient relies only on his/her care

Burden Score

2.3⫾0.6 2.0⫾1.1 1.9⫾1.2 2.5⫾1.0 1.8⫾1.2 1.6⫾1.0 2.5⫾1.4 2.0⫾1.2 1.9⫾1.2 2.2⫾1.0 2.0⫾0.9 2.0⫾1.0 2.3⫾1.4 2.1⫾1.2 3.3⫾1.3 1.7⫾1.1 2.0⫾1.2 2.0⫾1.0 3.0⫾1.0 1.6⫾0.8 2.2⫾1.2 2.0⫾1.0 2.8⫾1.2 3.3⫾1.3 2.6⫾1.4 3.8⫾1.2 2.3⫾1.4 2.2⫾1.3 2.5⫾1.5 2.1⫾1.2 2.8⫾1.5

NOTE. Values are mean ⫾ SD. *Subdomain 1: satisfaction with the impaired person as a recipient of care. † Subdomain 2: satisfaction with one’s own performance as a caregiver. ‡ Subdomain 3: consequences of involvement in care for the personal life of the caregiver.

affecting the overall caregiver burden. The inconsistencies may reflect relatively severe residual physical disability in our population. (Twenty percent had a severe MRS score.) Patients’ MRS scores, along with long hours of care per day and caregivers’ health status after stroke, were significant factors affecting subdomain 3. We found that being the patient’s daughter-in-law was an important factor predicting the level of burden, especially that of subdomain 1. Being female was also a factor related to subdomain 1. Nevertheless, it appears less likely that these 2 results were caused purely by sex effect, because neither being a daughter nor caregiver’s sex being the same as or opposite to the patient’s was a factor related to the burden score. Our results, partly consistent with a previous study done in Korea,7 seem to reflect the strong household responsibility of daughters-in-laws in this paternalistic society. Study Limitations We recognize the limitations in our study. First, there was a high drop-out rate in the patient group, which could have

resulted because most of our subjects lived in Seoul. In this city of 12 million people, many move frequently, for various reasons, and it is difficult to track addresses and phone numbers. We noticed that the patients we successfully tracked down had a milder MRS score at the time of discharge than those we could not. Moreover, patients who died might have had a more severe physical condition than those included in our study. Because a patient’s MRS score was a factor affecting the caregiver burden, we might have underestimated the caregiver burden. We also did not consider the social support, social network, and spirituality of caregivers, which is reported to affect the level of caregivers’ emotion.6,25,27,28 Although we examined the general health status of the caregivers, we did not specifically examine the effect of the concomitant illnesses of patients or caregivers, such as degenerative arthritis and cataract, on caregiver burden. Finally, the assessment of caregiver burden was performed only once, and serial follow-up studies are required to understand the changing pattern of caregiver burden. CONCLUSIONS The present study showed that the caregiver’s anxiety, patient’s MRS score, caregiver being a daughter-in-law of the patient, and depression of caregivers and patients are important factors influencing the level of burden experienced by stroke caregivers in Korea. Strategies to reduce caregiver burden should be developed and these strategies should be based on understanding these differences. For instance, we may have to develop strategies to reduce caregivers’ depression and anxiety. It would be advisable to provide equivalent services for caregivers and their families, just as we have done in developing support groups for the stroke survivors.

Table 4: Forward Stepwise Regression Model Explaining Caregiver Burden Caregiver Burden

Total care burden scores Caregivers’ anxiety Patients’ MRS score Caregivers being daughters-in-law Caregivers’ depression Caregivers’ current employment status Patients’ depression Subdomain 1* Caregiver being daughter-in-law Caregivers’ current employment status Caregivers’ anxiety Patients’ dysphasia Sex of caregiver Subdomain 2† Patients’ depression Caregivers’ depression Subdomain 3‡ Patients’ MRS scores Hours of care per day Caregivers’ current health status

R2

C(p)

P

.1830 .1017 .0424 .0431 .0374

42.2885 25.0854 19.0810 7.8728 14.0128

⬍.01 ⬍.01 ⬍.05 ⬍.05 ⬍.05

.0283

4.5237

⬍.05

.1104 .0525

26.8493 0.1628

⬍.01 ⬍.05

.0397 .0395 .0398

17.3864 9.8108 13.5755

⬍.05 ⬍.05 ⬍.05

.0647 .0321

6.3655 3.6552

⬍.05 ⬍.05

.1809 .0707 .0381

21.0512 12.1656 8.3092

⬍.01 ⬍.05 ⬍.05

*Subdomain 1: satisfaction with the impaired person as a recipient of care. † Subdomain 2: satisfaction with one’s own performance as a caregiver. ‡ Subdomain 3: consequences of involvement in care for the personal life of the caregiver.

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CAREGIVER BURDEN OF STROKE SURVIVORS, Choi-Kwon

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Arch Phys Med Rehabil Vol 86, May 2005

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