Age and Ageing Advance Access originally published online on March 19, 2007
Age and Ageing 2007 36(3):316-322; doi:10.1093/ageing/afm014
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Clinical determinants of long-term quality of life after stroke
1 Division of Health and Social Care, King's College, London, UK
2 Department of Elderly Medicine, University Hospital Lewisham, London, UK
3 Department of Elderly Medicine, Guys and St Thomas' Hospitals Foundation Trust, London, UK
Address correspondence to: M. D. Patel. Tel: (+44) 20 8333 3000; Fax (+44) 20 8333 3381. Email: mehool.patel{at}uhl.nhs.uk
Objectives: to determine factors that independently predict health-related quality of life (HRQOL) 1 and 3 years after stroke.
Methods: subjects numbering 397, from a population-based register of first-ever strokes were assessed for HRQOL using the Short Form 36 (SF36) 1 year after stroke. Physical (PHSS) and mental health (MHSS) summary scores were derived from the eight domains of HRQOL in the SF36. Multivariate stepwise regression analyses were conducted to determine independent predictors of these scores; ß coefficients with 95% CI were obtained.ß coeficient is the difference between average value of the variable (e.g. male) and average value under consideration (e.g. female). Demographic and stroke risk factors, neurological impairments and cognitive impairment (MMSE <24) were included in the models. Similar analyses were undertaken on 150 subjects 3 years post-stroke.
Results: a year after stroke, independent predictors of the worst PHSS were of females (ß coefficient –3.3: 95% CI –5.7 to –0.8), manual workers (–3.2: –5.9 to –0.4), diabetes (–4.2: –7.7 to –0.8), right hemispheric lesions (–4.9: –8.7 to –1.2), urinary incontinence (–7.8: –11.6 to –4.1) and cognitive impairment (–2.7: –5.5 to –0.1); the worst MHSS were associated with being Asian (–11.8: –20.6 to –3.0), ischaemic heart disease (–2.7: –5.4 to –0.03), cognitive impairment (–3.04: –5.8 to –0.3). Subjects aged 65–75 years (5.4: 2.5 to –8.4) had better MHSS than those <65 years. Three years post-stroke, independent predictors of worse PHSS were hypertension (–8.7: –13.5 to –3.9), urinary incontinence (–8.1: –15 to –1.1) and cognitive impairment (–8.3: –13.2 to –3.5).
Conclusions: determinants of HRQOL vary both over time after stroke and whether physical or psychosocial aspects of HRQOL are being considered. This study provides valuable information on factors predicting long-term HRQOL, which can be taken into consideration in audits of clinical practice or in future interventional studies aiming to improve HRQOL after stroke.
Keywords: stroke, long-term outcomes, quality of life, elderly
Received 29 June 2006; accepted in revised form 25 January 2007.