Two-year Outcomes of Older Persons with Stroke

Funded by: National Institutes of Health (NIH), National Institute of Child Health and Human Development (NIHCD
Project Period: 06/06 - 05/08

Project Summary: With 35%-45% of acute stroke survivors experiencing severe disability, understanding the long-term impacts of stroke on functional independence and quality of life is critical. The proposed study adds to previous research in this area by examining multiple dimensions of function at two years after stroke in a national cohort of 680 stroke victims over the age of 65. The aims of this research are: 1) to characterize changes in the domains of activities of daily living (ADLs), community living skills or instrumental activities of daily living (IADLs), social/role functioning, walking distance, self-reported health, and place of residence that occur two years following a stroke; and 2) to characterize changes in these outcomes between 90 days and two years after stroke. Pre-stroke status will be compared with two-year status to address the first aim, and 90-day status will be compared with two-year status to address the second aim. Through stratification and use of multivariate analyses, we will investigate whether subgroups of patients with specific traits experience different recovery trajectories. The proposed investigation will take advantage of a previously funded national study that involved: recruiting 69 sites in 30 states from which subjects were enrolled at the outset of rehabilitation (following their hospital stay); collecting pre-stroke and 90-day data on function and quality of life; and measuring outcome predictors such as social supports, depression, cognition, comorbidities, and neurologic findings. The proposed study will involve a telephone interview at two years on all live subjects, using computer assisted interviewing (CAI) software. Questions corresponding to 26 different functions will be grouped into four indices corresponding to ADLs, IADLs, walking distance, and social/role functioning. The other two outcomes include a global self-reported health measure and a dichotomous measure indicating nursing home residence.

Relevance: The proposed research will help inform providers and patients about the long-term impacts of stroke, and identify traits of stroke victims who are likely to experience greater gains in function over time. Insights gained from this research could lead to development of ways to improve the independence and well- being of older stroke survivors with functional disabilities.

Key Staff: Kramer, Holthaus, Epstein, Sandy

v