Changes in Frailty, Depression, and Loneliness among Stroke Survivors and Their Spouses

Stroke often substantially impacts a person's physical, psychological, and social wellbeing. The impact on carers and family can also be considerable, but is less often quantified. We aimed to measure changes in physical, psychological, and social health status (assessed using frailty, depression, and loneliness) before and following a stroke among survivors and their spouses compared to age- and sex-matched controls who had not experienced a stroke themselves or within their household.

We used data from three population longitudinal ageing surveys (Health and Retirement Survey [HRS], USA; Survey of Health, Ageing and Retirement in Europe [SHARE]; and the English Longitudinal Study of Ageing [ELSA]). Participants aged ≥50 were surveyed at 2-yearly intervals along with their household. We identified people who had survived a stroke occurring after their initial visit (and so had data collected both pre- and post-stroke) as well as their spouses. Stroke participants were included regardless of whether they had a spouse or not. We also identified age-, sex-, and survey wave-matched controls and their spouses. We assessed frailty using a cumulative deficit frailty index, depression using the Centre for Epidemiological Studies Depression (CES-D) Scale or the Euro-Depression Scale, and loneliness using a single question ("do you feel lonely?") - each measured at both time points. We assessed change in frailty and depression scores using (generalised) linear mixed regression models (with a logistic link function for loneliness) adjusted for age and sex.

There were 5,399 participants experiencing stroke and 3,013 spouses, 16,197 matched controls, and 8,249 control spouses. People with stroke had higher baseline (pre-stroke) levels of frailty, depression, and loneliness than matched controls. The average change in frailty index values following a stroke was greater than controls (3.17 deficits, 95% confidence interval [95% CI]: 3.03-3.31). Spouses of stroke survivors did not show significant changes in frailty. Both stroke survivors and their spouses, on average, showed increases in depression scores which were greater than controls (0.18 standard deviations increase [95% CI: 0.14-0.21] for stroke survivors versus controls and 0.12 [95% CI: 0.07-0.17] for spouses versus control spouses). The odds of becoming lonely were greatest for spouses of stroke survivors compared to control spouses (odds ratio 5.07 [95% CI: 2.74-9.41]); however, the changes in loneliness among stroke survivors were not significantly different from controls (1.35 [95% CI: 0.95-1.91]).

Stroke does not just affect the individual, but it also affects families. The psychosocial sequalae of stroke should be proactively managed, with family actively involved in post-stroke support strategies.