The stress of caring for a disabled spouse increases the risk of stroke substantially, and the increased risk is greater for husbands than for wives, a new study finds.
“We followed 767 people out of a large study who were caring for a spouse with any disabling condition,” said William E. Haley, a clinical psychologist who is a professor in the School of Aging Studies at the University of South Florida in Tampa. “The spouses who had the highest scores for strain had the highest risk scores for stroke.”
Strain was measured on a standard score by asking the participants how many days during the past week they had felt depressed, lonely, sad or had crying spells. The answers were matched to the Framingham Stroke Risk Score, which measures risk factors such as age, blood pressure, blood cholesterol levels, smoking and diabetes. The study is published in the Jan. 14 online edition of Stroke.
A high score on the measure of strain was associated with an overall 23 percent higher risk of stroke. The association was stronger in husbands than in wives. It was highest in black men with high caregiving strain, with a 26.9 percent increased risk of stroke in the next 10 years.
“We showed that African-American men have the highest risk for stroke of any demographic group,” Haley said. “The risk is nearly doubled for the highest-strain African-American men,” he added.
“For the most part, when men are caregivers they use more paid services,” Haley said. “It’s likely that men who are not getting help, African-American men in particular, experience tremendous strain. Women are more prepared to be caregivers, and show less risk tied to strain.”
It’s not clear whether the high-risk scores will result in an increased incidence of stroke, he noted. “We haven’t followed enough people for long enough to do that analysis,” Haley said. “Over the next several years, we will have the ability to see whether high degrees of strain lead to a higher incidence of stroke and mortality.”
Caregivers who feel the strain can and should seek help, he advised. “We do know already that caregivers can benefit from all sorts of counseling,” Haley said. “We encourage those caregivers to get additional assistance.”
Another study in the same issue of the journal, this one from Sweden, found that only half to three-quarters of people who survived strokes were still taking recommended drugs to prevent a new stroke two years later.
The study of more than 21,000 stroke survivors, average age 75, found that two years later, 26 percent had stopped taking drugs to control high blood pressure, 44 percent had stopped taking cholesterol-lowering statins, 36 percent had stopped taking clot-preventing medications and 55 percent were not taking the blood thinner warfarin.
It’s not clear whether the same pattern of noncompliance is true for the United States, wrote the neurologists from Umea University Hospital, but “it is very much so here,” said Dr. Bruce Ovbiagele, director of the stroke prevention program at the University of California, Los Angeles.
There are several possible explanations for failure to take such basic measures to prevent another stroke, Ovbiagele said. “On the part of the patients, many patients are not clear that they need to be on these medications indefinitely,” he noted.
Physicians can also be at fault, Ovbiagele added. “Some providers are not as insistent about educating patients about how long they need to be on these medications,” he said. “Most evidence of their value comes from relatively short studies, so providers may not think it is evident that they have to be continued.”
Patient compliance with medication instructions after a stroke is best when “there is some structured interventional program to support it,” Ovbiagele said.
SOURCES: William E. Haley, Ph.D., professor, School of Aging Studies, University of South Florida, Tampa; Bruce Ovbiagele, M.D., associate professor, neurology, and director, stroke prevention program, University of California, Los Angeles;