Abstract
Objective: As limitations in activities of daily living are major components of many stroke outcome scales, we examined how well activity limitations predicted subjective well-being among stroke survivors in a nationally representative survey. Methods: Individuals with a self-reported history of stroke were identified from the National Health and Aging Trends Study. Subjective well-being (primary outcome) was assessed with a validated 7-item measure (higher = greater well-being) assessing emotions (cheerful, bored, full of life, and upset) and self-realization (purpose in life, self-acceptance, and environmental mastery). Activity limitations were defined by the receipt of help in any of 11 activities of daily living/instrumental activities of daily living. Multivariable linear regression assessed predictors of well-being including medical, physical, cognitive, psychological, and environmental factors. Results: A total of 738 stroke survivors age 65 or older were included (57% female, 9% African American, 6% Hispanic). Activity limitations were modestly associated with well-being after adjusting for demographic characteristics and availability of assistance (estimate-0.49, 95% confidence interval-0.61 to-0.37). However, in the fully adjusted model (R 2 = 0.28), neither activity limitations nor physical capacity was associated with subjective well-being. Predictors of lower well-being in the final model included depressive symptoms, chewing/swallowing problems, pain that limited activity, and restricted participation in valued life activities. Income and executive function were modestly associated with improved well-being, while comorbidities and communication technology access were not associated. Conclusions: Activity limitations were not associated with stroke survivors' subjective well-being after adjustment for other factors. While some predictors of well-being after stroke were identified, the determinants of well-being remained largely unexplained.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 944-950 |
| Number of pages | 7 |
| Journal | Neurology |
| Volume | 89 |
| Issue number | 9 |
| DOIs | |
| State | Published - Aug 29 2017 |
Funding
From the Stroke Program, Department of Neurology (D.B.Z., L.E.S., C.F., J.F.B.), and Institute for Social Research (V.A.F.), University of Michigan, Ann Arbor. Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article. D. Zahuranec is funded by NIH grants R01AG051827 and R01NS091112 and has received research support from NIH grant K23AG038731 and Medtronic. L. Skolarus is supported by NIH grants K23NS073685 and R01MD008879. She has also received hotel accommodations from the American Academy of Neurology and the American Neurologic Association for their national meeting. She received research support from the Blue Cross Blue Shield of Michigan Foundation and receives research support from the University of Michigan for stroke-related research. C. Feng reports no disclosures relevant to the manuscript. V. Freedman is funded by NIH grants R01MD008879 and U01AG032947. J. Burke is funded by NIH grants K08NS082597 and R01MD008879. Go to Neurology.org for full disclosures. Study funded by NIH grants R01MD008879 and U01AG032947. NIH staff participated in discussions about the design and conduct of NHATS. The NIH had no role in the design or conduct of this analysis; interpretation of the data; or preparation, review, or approval of the manuscript.
ASJC Scopus subject areas
- Clinical Neurology