Quality of Life Among Family Caregivers for Stroke Patients Discharged from Hospital within Six Months in Northern Taiwan

Sunday, 27 July 2014

Yu-Hsia Tsai, RN, MS
PhD Candidate, Department of Nursing, College of Medicine (National Taiwan University), Chang Guang University, Kweshan Hsiang, Taiwan
Hsueh-Erh Liu, PhD, RN
School of Nursing, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan


The aims of this study were to assess the QoL of caregivers who took care of home-bound stroke patients discharged from hospital within 6 months and to identify its associated factors. 


This was a cross-sectional study. Participants: Name lists of stroke patients discharged within 6 months were provided by several agents located in a suburban county in the northern Taiwan. Process: After screening by the selection criteria, participants were contacted by phone call first and then completed the questionnaires by face-to-face interview at their home. Instruments: The instruments selected for data collection were Caregiver Quality of Life Index (CQLI), patients’ characteristics (including Barthel Index, BI; Short Portable Mental Status Questionnaire, SPMSQ), caregivers’ characteristics (including Caregiver Strain Index, CSI), and family resources. Data analysis: All data was managed by PSSPC-Win18.0. Descriptive statistics (means, frequencies, and percentage) were used to describe the distribution of each variable. The results of Kolmogorov-Smirnov test showed that none of these variables were normally distributed (p>.05). Therefore, non-parametric statistical analysis (Spearman correlation, Mann-Whitney test, Kruskal-Wallis test) was performed. In addition, multiple regression was performed to identify the predictors of the caregivers’ QoL. The significant level of this study was 0.05.


A total of 184 family caregivers completed questionnaires. Most patients were characterized as: elderly (67.3±12.3 years old), male (61.4%), married (81%), and unemployed (62.5%), first being diagnosed as stroke (70.1%), no surgery (91.3%), no intubation (89.7%), no rehabilitation (65.2%), not using devices (52.7%), no need for institutional care (BI ≥ 60, 72.8%), and intact cognitive function (SPMSQ> 5, 77.7 % ). Participants’ average duration of hospitalization was 16.5 days (SD= 21.3, range= 2 to 214 days). Most family caregivers were characterized as: middle age (49±13.7 years old), female (67.9%), high school educated (52.2%), married (84.8%), non-spouse (58.2%), co-resident (83.7%), fair health (54.3%), and their CSI was ≥ 7 (the mean score of CSI was 6.2±4.7, ranging from 0 to 13). The family resources were characterized as: most family income was around NT $20,000 to 60,000 per month (47.8%), major payer was patients’ offspring (50.5%), and the average number of co-resident family were 4.2 ± 2.6 (range: 0-22) persons. Most family had someone to help (81%), but no hired caregiver to share with their caregiving tasks (77.2%). The total CQLI was 255.1±53.9 (ranging from 0 to 400). The total CQLI were associated with patients’ characteristics (employment, using devises, BI, SPMSQ); caregivers’ characteristics (education, self-perceived health, CSI); and family resources (monthly family income, became major payer for medical fees, hired other caregiver or not).The CSI was negatively correlated with the overall CQLI (r = -.31, p<.01). Multiple regression revealed the following factors determined the caregivers’ QoL: poor and fair self-perceived health of the caregivers, CSI score, monthly family income below NT $20,000 and 2-60,000, and medical fees paid by spouse were significant predictors of the CQLI. These factors explained 33% of the total variance in this regression model. 


 Caregivers’ care strains were correlated with their QoL. Caregivers with poorer self-rated health condition, with higher CSI, lower monthly family income, and patient’s spouse who paid patient’s medical fees reported a lower QoL. Caregivers’ characteristics and their financial situations are the main factors of caregivers’ QoL among these stroke patients. In order to improve stroke caregivers’ QoL, facilitating communities’ care system and providing appropriate assistance for medical fee for these long-term stroke patients would decrease caregivers’ care strains and physical burden. Thus, caregivers’ issues should be considered in discharge planning and community care system.