Developmental trajectory of care dependency in older stroke patients.

Abstract

Stroke is the leading cause of death in China. Older stroke survivors often have other chronic conditions, not only musculoskeletal deterioration due to age, but also changes in body image that can be brought on by stroke and other diseases, making them unable to take good care of themselves and dependent on others. The degree of dependency affects the rehabilitation progress of stroke survivors and shows dynamic changes that need to be recognized. This study investigates the trajectory of dependency changes in older stroke patients with comorbidities and analyze the influencing factors. Grounded in the Chronic Illness Trajectory Framework (CITF), a longitudinal study was conducted from February 2023 to October 2023, tracking 312 older stroke patients with comorbidities admitted to two tertiary hospitals in Guangzhou. Care dependency levels were assessed using Care Dependency Scale on admission day 5 (T0), at discharge (T1), 1 month post-discharge (T2), and 3 months post-discharge (T3). Growth Mixture Model were utilized to identify trajectory categories, and both univariate analysis and multivariate logistic regression methods were employed to explore factors associated with different developmental trajectories. A total of four developmental trajectories were fitted, C1 (high independence-slow increased group, 52.0%), C2 (moderate independence-rapid increased group, 13.0%), C3 (moderate independence-slow increased group, 25.0%), and C4 (low independence-increased and decreased group, 10.0%). Length of hospital stay, place of residence, level of social support, residual functional impairments, NIHSS score, and BI index independently influence the trajectory categories. There is heterogeneity in care dependency among older stroke patients with comorbidities. Most patients gradually reduce their dependency and become more independent, but others remain dependent for an extended period of time. It is recommended to focus on patients who live in rural areas, have low social support, have high admission NIHSS scores and have residual functional impairment, and provide them with personalized continuity of care and rehabilitation services in order to reduce care dependency and the burden of care, and to improve patients' quality of life.