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Long-term unmet needs and associated factors in stroke or TIA survivors: An observational study
Muideen T Olaiya1, Dominique A Cadilhac1, Joosup Kim1
1From Stroke and Ageing Research (M.T.O., D.A.C., J.K., V.K.S., N.E.A., T.P., A.G.T.), Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton; Stroke Division (D.A.C., J.K., N.E.A.), Florey Institute of Neuroscience and Mental Health, Heidelberg; Menzies Institute for Medical Research (M.R.N., V.K.S.), Hobart; Department of Epidemiology and Preventive Medicine (M.R.N., S.M.F.), Monash University, Melbourne; School of Medicine (M.R.N.), University of Tasmania, Hobart; Department of Neurosciences (C.F.B.), Box Hill Hospital; Department of Medicine (R.P.G.), Epworth Healthcare, Monash University, Richmond; and Department of Neurology (J.F.), Alfred Hospital, Melbourne, Australia.
Objective:
To extensively investigate long-term unmet needs in survivors of stroke or TIA and to identify factors associated with these unmet needs.
Methods:
Community-dwelling adults were invited to participate in a survey ≥2 years after discharge for stroke/TIA. Unmet needs were assessed across 5 domains: activities and participation, environmental factors, body functions, post-acute care, and secondary prevention. Factors associated with unmet needs were determined with multivariable negative binomial regression.
Results:
Of 485 participants invited to complete the survey, 391 (81%) responded (median age 73 years, 67% male). Most responders (87%) reported unmet needs in ≥1 of the measured domains, particularly in secondary prevention (71%). Factors associated with fewer unmet needs included older age (incident rate ratio [IRR] 0.62, 95% confidence interval [CI] 0.50-0.77), greater functional ability (IRR 0.33, 95% CI 0.17-0.67), and reporting that the general practitioner was the most important in care (IRR 0.69, 95% CI 0.57-0.84). Being depressed (IRR 1.61, 95% CI 1.23-2.10) and receiving community services after stroke (IRR 1.45, 95% CI 1.16-1.82) were associated with more unmet needs.
Conclusions:
Survivors of stroke/TIA reported considerable unmet needs ≥2 years after discharge, particularly in secondary prevention. The factors associated with unmet needs could help guide policy decisions, particularly for tailoring care and support services provided after discharge.
