Longitudinal Predictors of Caregiving Type in Elderly Stroke Survivors

Stroke survivors are older and living longer post-stroke than in the past. As a result, most are older and more likely to be disabled and depend upon formal and informal care to provide the support needed to remain in the community and prevent or delay permanent institutionalization. The purpose of this study was to examine longitudinal differences in the caregiving source among stroke survivors (n=477) over a six-year period guided by the Andersen and Aday Model. Three waves of data from the Health and Retirement/Assets and Health Dynamics Among the Oldest Old study (1998-2002) were used in this study. Clustered multinomial logistic regression was used to examine relationships between predictor variables in the model and caregiving source across waves. Approximately 30% of stroke survivors changed source of caregiving over the three waves of data collection. Additionally, need factors (ADL and IADL impairments) accounted for 40% of the explained variance in type of caregiver chosen. The predisposing (7-12%) and enabling (7-20%) factors accounted for equivalent amounts of the explained variance across the three waves. The results of this study have two policy implications for survivors of stroke. First, the limited number of transitions between different types of caregiving services indicates the length of commitment required of caregivers. Second, discharge planning in the hospital or acute rehabilitation provides a ‘teachable' moment where realistic options for LTC could be discussed and planned, knowing that whatever is chosen will be the arrangement for the caregiver and care receiver for a considerable period of time.