الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Stroke is the second leading cause of mortality (13.9% of all deaths in 2013) and first leading cause of disability, particularly in low- and middle-income countries (Chuluunbaatar et al., 2016). Age is one of the strongest determinants of stroke, incidence rises with age, nearly doubling every decade after age 55, and the majority of strokes occur in persons older than 65 (Essa et al., 2011). Unlike other disabling conditions, the onset of stroke is sudden, leaving the individual and the family ill prepared to deal with its sequels. Stroke is often a catastrophic event affecting all aspects of an individual’s life (Kamel et al., 2010).
This disease disables individuals and places considerable burden not only on the family of the individual but on the community as a whole. Caregivers can be considered the second victims of the disease, they often take on this role under sudden and extreme circumstances, with minimal preparation and little guidance and support from healthcare systems (Bartolo et al. 2010).
Caregivers of stroke survivors also experience diminished Quality of Life (QoL) as a result of the physical, emotional, financial and psychological burden of stroke (Onabajo et al., 2013).
Informal caregivers are the backbone of services provided to surviving stroke patients Thus, this study was conducted to develop Home discharge intervention for elderly patients’ caregivers after stroke and to evaluate the effect of the discharge intervention on family caregivers strain and quality of life.
Subjects:
A convenience sample of 60 elderly stroke patients’ caregiver and their stroke survivor were recruited over a period of 6 months atoutpatient clinic of Tala Central Hospital, Shebin- Elkom University Hospital and Shebin- Elkom Teaching Hospital according to the following criteria:-
Inclusion criteria:
Caregivers for newly discharge elderly post stroke patients.
Willing to participate.
Tools of data collection:
Data was collected through the following tools:
1-An interviewing questionnaire (Appendix I):
Socio-demographic data:
a) The caregiver (name, age, sex, level of education, marital status, medical status, working status, kinship to the stroke patient).
b) The stroke patient (name, age, sex, co-morbidities and physical impairment from stroke).
2-SF-12V2 Health Survey for quality of life (Appendix II): SF-12v2 is a set of generic, coherent, well-tested instrument and easily administered quality-of-life measures. Good construct validity and reliability of SF-12 has been reported
3-Barthel Index daily living activities scale (Appendix III):
(BI) was developed by Mahoney & Barthel in 1965 and later modified by Granger and coworkers as a scoring technique that measures the patient’s performance in 10 activities of daily life. Scoring 0-100 and it is considered a reliable disability scale for stroke patients.4- Modified Caregiver Strain Index (MCSI) (Appendix VI):
The Modified Caregiver Strain Index (MCSI) was modified and developed in 2003. This instrument can be used to assess individuals of any age who have assumed the caregiving role for an older adult. Good construct validity and reliability of Modified Caregiver Strain Index has been reported.
The main findings of the study revealed the following:
1- The mean caregivers’ age was 40.4 ±11.3 while the mean studied stroke survivors age was 69.9± 7.6 years.
2- The highest percentage of the study sample caregivers and stroke survivors (75%) were females.
3- Majority of studied caregivers were secondary educated (45%), not working (58.3%) and were son or daughter of the recipient stroke patient (60%).
4- More than 90 % of caregivers mentioned that there is another caregiver for their stroke patients, majority of the studied caregivers (63.3) spend about half a day with the patient, while nearly one third of them spend whole day caring for their patients.
5- The majority (70%) of the studied stroke survivors have Right hemiplegia while 26.7% have Left hemiplegia and only 3.3% have Bilateral.
6- The majority of the studied stroke survivors (93.3) were located at major dependency degree and the main score of the Barthel Index grades of dependency was 31 ± 16.9.
7- The mean score of burden (MCSI) components among the studied caregivers for stroke survivors declined in pre intervention to postintervention and the mean total score decline from 19.2± 2.51 pre intervention to 10.51± 4.46 post interventions which indicated that the intervention was effective in decrease caregiver burden.
8- There was clear Improvement in most QOL subscale, total score and QOL level post intervention.
9- Post intervention assessment revealed a significant improvement (p<0.03) in physical component summary, and a highly significant improvement (P=0.000) in mental component summary, and overall mean score of quality of life (P=0.000).
10- Factors that may associate with caregivers’ burden and quality of life are caregivers’ characteristics (i.e., age, sex, employment of caregivers, caregivers’ health status, and marital status.
11- Male and worked caregivers showed higher significant mean total score of quality of life than females and not worked caregivers. Married caregiver had better quality of life.
12- Male free from chronic disease caregivers showed low level of burden than female, not worked and have chronic disease. More time for care and survivors with high level of dependency had a higher significant burden of their caregivers.
According to the results of the present study, it can be concluded that, home discharge intervention is an effective approach to improve quality of life of elderly stroke caregiver and decrease their strain or burden.Based on the findings of the present study, the following important recommendations are proposed:
Caregiver home discharge intervention needs to be treated as a priority for caregiver support post-stroke.
A comprehensive strain or burden and quality of life assessment must be considered as an essential part of stroke elderly caregiver during regular medical clinic follow up and rehabilitation period.
Activating home discharge intervention to provides long lasting improvements to strain and quality of life and is recommended as a first line and long term strategy of management caregiver burden and improving quality of life. Further researches on large sample size are required.