Changes in disability and wellbeing after stroke

Wellbeing reflects whether individuals are living meaningful, satisfying lives. While disability is common after stroke, prior studies have largely examined its cross-sectional relationship with wellbeing and rarely account for pre-stroke wellbeing. Thus, the relationship between new disability and post-stroke wellbeing is unclear.

We conducted a longitudinal analysis of community-dwelling older adults (age ≥ 65) from the National Health and Aging Trends Survey. Stroke survivors were identified using self-reported incident stroke. Disability was defined as receipt of help for any of the 7 self-care and mobility activities. The outcome was post-stroke well-being, measured using domains of emotion and self-realization. We used multilevel linear regression to examine associations between changes in receipt of help from pre- to post-stroke and post-stroke wellbeing, adjusting for baseline disability, pre-stroke wellbeing, time since stroke and psychosocial covariates.

Among 661 stroke survivors, each additional activity requiring help after stroke was associated with lower post-stroke well-being (β=-0.38; 95% CI -0.48 to -0.29, p < 0.01). In contrast, baseline disability was not associated with post-stroke wellbeing (β=-0.08; 95% CI -0.24 to 0.07, p = 0.30). Pre-stroke wellbeing was associated with post-stroke wellbeing (β=0.76; 95% CI 0.70-0.82), p < 0.01). Well-being declined over time, decreasing by 0.13 points for each additional year after stroke (β = -0.13, 95% CI -0.16 to -0.09).

An increase in activities needing help after stroke was associated with lower well-being, whereas baseline disability was not. Although pre-stroke well-being predicted post-stroke well-being, well-being continued to decline over time, suggesting it may be amenable to intervention.