Factors decreasing caregiver burden to allow patients with cerebrovascular disease to continue in long-term home care.

BACKGROUND: This study attempted to assess continued long-term home care by examining patients' independent activities of daily living (ADLs) and caregivers' free time. METHODS: We surveyed the main caregivers of 52 patients with cerebrovascular disease with continuous home care from 1999 to 2010. Survey items were patients' ADLs, the frequency of use of care services, care requirements, and caregiver sense of burden. We compared the survey results between years. RESULTS: ADLs of excretory control, verbal expression, verbal comprehension, and range of activities showed significant deterioration from 1999 to 2010. Patient need for care increased significantly but use of care services did not. Main caregivers were typically spouses who aged together with the patients. Main caregivers rarely changed; occasionally, a son or daughter-in-law became the main caregiver. Patients typically required less than 3 hours of care daily, which did not change over time. Caregivers had significantly more difficulty maintaining their own health in 2010 than 1999. However, they did not identify increases in difficulties with housework or coping with work. They felt that caregiving was a burden but did not indicate that the family relationship had deteriorated. CONCLUSIONS: Regardless of degree of independence of patients' ADLs, caregiver burden was severe. To decrease caregiver burden, it is necessary to use care services, reduce care time, and allow caregivers free time. In addition, it is possible to continue long-term home care by maintaining their relationships.

Gender differences in long-term functional outcome after first-ever ischemic stroke.

OBJECTIVE: Recent studies have demonstrated gender differences in functional outcome after stroke. However, the underlying reasons for differences have been inconsistent. The present study examined whether gender differences in long-term functional outcomes exist among surviving patients with first-ever ischemic stroke and with individual subtypes of stroke. METHODS: A total of 997 patients (654 men, 343 women) were followed for 5 years after discharge. Patients were assigned to 4 subtypes of ischemic stroke (atherothrombotic, lacunar, cardioembolic and unclassified infarction). Functional outcomes were expressed as locomotor activity, assessed using a questionnaire delivered by mail 1 and 5 years after stroke. Locomotor function was classified into 5 categories according to the grade of disability. RESULTS: Women showed significantly worse locomotor function than men at both 1 and 5 years (p < 0.001 and p < 0.01, respectively). Furthermore, significant gender differences in functional outcome were observed in all subtypes of ischemic stroke at 1 and 5 years after stroke. Logistic regression analysis revealed that gender was a significant determinant for functional outcome at 1 and 5 years after stroke (p < 0.01 and p < 0.001, respectively). No significant gender difference was seen in the rate of stroke recurrence. Women also showed a worse survival ratio after stroke than men (p < 0.01). CONCLUSION: The present study demonstrated significantly worse functional outcomes for women than for men at 1 and 5 years after stroke. Gender differences in long-term functional outcomes by subtypes of ischemic stroke were also significant.

The influence of age on pressure perception of static and moving two-point discrimination in normal subjects.

The purpose of the present study was to determine the effect of age on digital pressure perception as measured by two-point discrimination (2PD) testing. The subjects were 177 normal volunteers ranging in age from 20 to 79 years. Perceptible pressure of static and moving 2PD was measured on the index finger and little finger, using the Pressure-specifying Sensory Device. The threshold of pressure perception increased significantly with advancing age in both static and moving 2PD tests. There was a marked increase in subjects older than 60 years. Pressure perception was significantly higher for static 2PD than for moving 2PD in subjects 70-79 years of age. The threshold of pressure perception for static and moving 2PD gradually increased with advancing age, and was markedly elevated in subjects older than 60 years.

[Health-related quality of life assessed by EuroQol in caregivers of home care stroke patients].

The purpose of this study was to identify significant factors influencing health-related quality of life (HRQOL) of caregivers for home care patients with stroke. Subjects were 150 caregivers and 167 stroke patients who required help in activities of daily living (ADL) after discharge. HRQOL of caregivers and patients was assessed using a EuroQol utility score obtained by mailed questionnaire. The questionnaire also included the following items; caregiver's relationship to the patient, age, nursing care hours, family support, patient's functional changes after discharge, stroke recurrence, ADL, public nursing care insurance, care levels, and number of services patients received. The mean QOL score of 0.82 +/- 0.18 for caregivers was significantly higher than that of 0.57 +/- 0.20 for patients. Multiple regression analysis revealed that the significant factors influencing caregiver's QOL were caregiver's age and family support for caregivers, and anxious/depressed state, pain/discomfort state, and failure of memory of the patients. In addition, a significant correlation of QOL score was observed between patients and caregivers in the pain/discomfort and anxious/depressed states. The results of our study suggested that the alleviation of the patient's depressive state after stroke and the family's active support to caregivers played an important role for improving caregiver's QOL.

Vertical gaze palsy associated with bilateral ptosis following right putaminal hemorrhage.

Previous reports suggest that right hemispheric lesions may produce a variety of disorders in eye opening, including bilateral eyelid ptosis. More recently, bilateral ptosis and a severe deficit of upward gaze while preserving the downward gaze have been reported in patients with right hemispheric infarction. In the present report, we describe 2 patients who showed downward gaze palsy in addition to upward gaze palsy, accompanied by bilateral ptosis following right putaminal hemorrhage. The 2 patients displayed acute onset of similar ocular manifestations, such as difficulty in eye opening, upward and downward gaze palsy, and conjugate horizontal deviation in addition to left hemiparesis. The principal cause of difficulty in eye opening was considered to be bilateral ptosis. Computed tomography performed on admission revealed a moderate-sized hematoma in the right putamen. There was no evidence of midbrain involvement. These ocular symptoms were restored within a few weeks after the onset of stroke. The ocular manifestations noted in our patients suggest that the descending pathways arising from the supranuclear centers to the midbrain, which control vertical movement of the eyes and the eyelids, may be impaired by putaminal hemorrhage. To our knowledge, this is the first report of such ocular manifestations in the right hemispheric lesion.