Neurological disorders have a considerable influence on a significant portion of the
global population, with ∼43% being affected.[1] This burden is particularly pronounced in low- and middle-income countries (LMICs).
Among the top ten conditions that resulted in the greatest nervous system disability-adjusted
life years in 2021, stroke was the primary contributor in most regions across the
world.[1] Moreover, it is crucial to acknowledge that the coronavirus disease 2019 (COVID-19)
pandemic has brought to light an increase in the worldwide prevalence of risk factors
for cardiovascular disease, which has hindered the progress made in reducing the burden
of stroke and cardiovascular diseases.[2]
Brazil, as one of the largest LMICs, has seen an epidemiological shift toward a higher
prevalence of noncommunicable diseases among its aging population. Recent observations
reveal substantial improvements in the management of acute stroke patients in the
country.[3] Despite these achievements, there are still socioeconomic disparities that hinder
the ongoing support for stroke patients in their communities, particularly in post-hospital
care and rehabilitation.[4]
[5]
To maintain the advantages gained in stroke care during the acute phase of stroke
and reduce the stress experienced by stroke patients in their everyday lives, it is
important to consider the preferences of both patients and healthcare providers by
providing equal access to well-staffed, high-quality facilities that offer clear communication
and appropriate information after hospitalization. Therefore, it is important to understand
the severity of the disability faced by stroke survivors.
The occurrence of disability five years after a stroke depends on the severity of
the stroke. Approximately 25% of individuals with minor strokes will have disabilities.
Conversely, ∼50% of those who have had moderate strokes will have a disability. Furthermore,
for those who have experienced a severe stroke, ∼80% will have a disability. Additionally,
it is estimated that around half of the survivors will be disabled ∼10 years after
the stroke.[6]
[7]
These statistics highlight the need for a healthcare system that offers equivalent
levels of care for stroke patients with the aim of providing the highest possible
quality of care to enable stroke survivors to resume their daily activities. This
issue is further compounded in LMICs, where socioeconomic factors can impact the healthcare
support that patients receive.[8]
Caregivers play a critical role in connecting healthcare professionals with stroke
patients after they are released from hospitals, particularly in countries with significant
socioeconomic differences and restricted access to healthcare. As a result, caregivers
often assume primary responsibility for managing the patient's condition once they
have been discharged from hospitals in countries with limited resources for providing
post-acute stroke care. This is particularly true for patients who require similar
rehabilitation care after discharge from the hospital.
Caregivers frequently encounter various barriers and obligations when attempting to
offer post-discharge care to stroke survivors, which often leads to high levels of
stress and risk of burnout. The psychological aspects experienced by caregivers ultimately
affect their ability to provide care. Studies have shown that elevated levels of caregiver
stress can have a detrimental effect on the recovery and successful rehabilitation
of stroke patients.[9] Additionally, the reduced functional capacity of stroke patients can serve as an
indicator for caregivers who are at risk of bearing high levels of burden.[10] Therefore, it is essential to support caregivers to improve their well-being, which
will ultimately benefit stroke survivors' health and quality of life.
Caregivers for stroke patients are primarily family members, with spouses and women
being the most frequent.[11] These individuals are at a higher risk of experiencing burnout and tend to have
a greater chance of developing cardiovascular diseases.[12] Female caregivers, in particular, may be at an increased risk due to the substantial
caregiving burden they face with their sick spouses.[13] Studies have shown that female caregivers have a higher prevalence of unknown or
uncontrolled vascular risk factors compared with stroke patients.[14]
The majority of caregivers are family members, who may have a genetic predisposition
to develop primary conditions such as hypertension, diabetes, and obesity, putting
them at risk of stroke.[15] Research by Marques-Romero and colleagues found a higher prevalence of traditional
stroke-risk factors in a sample of caregivers of stroke patients. Furthermore, the
increased risk in caregivers appears to be unrelated to the level of familial relationship
with the patient under their care.[16]
Further research is required to gain a deeper understanding of stroke risk and its
impact on both stroke survivors and their caregivers. It is crucial to assess the
significance of stress and depressive symptoms as risk factors[17] because not only caregivers for stroke survivors are at a higher risk for cardiovascular
disease, but also caregivers who provide support for individuals with other neurological
conditions, such as dementia.[18]
LMICs are often characterized by additional confounding factors regarding stroke care,
such as ethnic and socioeconomic disparities, limited access to education, and healthcare
systems. These complexities may have had an impact on the findings of Marques-Romero
and colleagues' research.[16]
[19]
The potential usefulness of the stroke riskometer application in helping caregivers
and stroke patients make lifestyle modifications should be considered in the future
to improve stroke-risk awareness among caregivers, ultimately benefiting stroke survivors.[20]
Bibliographical Record
Ayrton Roberto Massaro, Linamara Rizzo Battistella. Stroke patients and their caregivers:
an interdependent relationship crucial for stroke care. Arq Neuropsiquiatr 2024; 82:
s00441787170.
DOI: 10.1055/s-0044-1787170
