Differences in Fracture Incidence According to Caregiver Type in Stroke Survivors

To assess whether the type of primary caregiver is a risk factor of the incidence of fracture among older adults who have survived a stroke.

Data from 4282 stroke survivors in the National Health Insurance Service-Senior Cohort (2002-2013) were used in this study. We categorized type of primary caregiver as none, spouse/family caregiver, and formal caregiver. The incidence of fracture within the year postdischarge was used as the outcome variable. These data were subjected to a survival analysis using the Cox proportional hazard model.

Of the 4282 stroke survivors, 308 (7.2%) experienced a fracture during the 1-year follow-up period. According to type of primary caregiver, the adjusted hazard ratio (HR) of fracture was lower among those whose caregiver was a spouse (HR = .68, 95% confidence interval [CI], .48-.96] and those with a formal caregiver (HR = .59, 95% CI, .36-.97) compared to stroke survivors with no caregiver. In particular, those with a family or formal caregiver who were being cared for in nursing facilities were less likely to be associated with fracture than those with no caregiver.

The adjusted HR of fracture among stroke survivors was lower among those with primary caregivers compared to those without them. Thus, the government should monitor and allocate the appropriate attention to stroke survivors after discharge in order to ensure that they obtain the needed health care, especially for stroke survivors who are without a primary caregiver.