Post-stroke Cognition is Associated with Stroke Survivor Quality of Life and Caregiver Outcomes: A Systematic Review and Meta-analysis.

Disability arising from post-stroke cognitive impairment is a likely contributor to the poor quality of life (QoL) stroke survivors and their carers frequently experience, but this has not been summarily quantified. A systematic literature review and meta-analysis was completed examining the association between general and domain-specific post-stroke cognitive functioning and adult stroke survivor QoL, caregiver QoL, and caregiver burden. Five databases were systematically searched, and eligibility for inclusion, data extraction, and study quality were evaluated by two reviewers using a standardised protocol. Effects sizes (r) were estimated using a random effects model. Thirty-eight studies were identified, generating a sample of 7365 stroke survivors (median age 63.02 years, range 25-93) followed for 3 to 132 months post-stroke. Overall cognition (all domains combined) demonstrated a significant small to medium association with QoL, r = 0.23 (95% CI 0.18-0.28), p < 0.001. The cognitive domains of speed, attention, visuospatial, memory, and executive skills, but not language, also demonstrated a significant relationship with QoL. Regarding caregiver outcomes, 15 studies were identified resulting in a sample of 2421 caregivers (median age 58.12 years, range 18-82) followed for 3 to 84 months post-stroke. Stroke survivor overall cognitive ability again demonstrated a significant small to medium association with caregiver outcomes (QoL and burden combined), r = 0.17 (95% CI 0.10-0.24), p < 0.001. In conclusion, lower post-stroke cognitive performance is associated with significant reductions in stroke survivor QoL and poorer caregiver outcomes. Cognitive assessment is recommended early to identify those at risk and implement timely interventions to support both stroke survivors and their caregivers.

Poststroke Cognitive Impairment Negatively Impacts Activity and Participation Outcomes: A Systematic Review and Meta-Analysis.

This systematic review and meta-analysis aimed to investigate whether cognition is associated with activity and participation outcomes in adult stroke survivors. Five databases were systematically searched for studies investigating the relationship between general- and domain-specific cognition and longer-term (>3 months) basic activities of daily living (ADL), instrumental ADLs, and participation outcomes. Eligibility for inclusion, data extraction, and study quality was evaluated by 2 reviewers using a standardized protocol. Effect sizes (r) were estimated using a random-effects model. Sixty-two publications were retained for review, comprising 7817 stroke survivors (median age 63.57 years, range:18-96 years). Median length of follow-up was 12 months (range: 3 months-11 years). Cognition (all domains combined) demonstrated a significant medium association with all 3 functional outcomes combined, r=0.37 (95% CI, 0.33-0.41), P<0.001. Moderator analyses revealed these effects persisted regardless of study quality, order in which outcomes were collected (sequential versus concurrent), age, sample size, or follow-up period. Small to medium associations were also identified between each individual cognitive domain and the separate ADL, instrumental ADL, and participation outcomes. In conclusion, poststroke cognitive impairment is associated with early and enduring activity limitations and participation restrictions, and the association is robust to study design factors, such as sample size, participant age, follow-up period, or study quality. Cognitive assessment early poststroke is recommended to facilitate early detection of disability, prediction of functional outcomes, and to inform tailored rehabilitation therapies.

Comparing memory group training and computerized cognitive training for improving memory function following stroke: A phase II randomized controlled trial.

OBJECTIVES: Memory deficits are common after stroke, yet remain a high unmet need within the community. The aim of this phase II randomized controlled trial was to determine whether group compensatory or computerized cognitive training approaches were effective in rehabilitating memory following stroke. METHODS: A parallel, 3-group, single-blind, randomized controlled trial was used to compare the effectiveness of a compensatory memory skills group with restorative computerized training on functional goal attainment. Secondary outcomes explored change in neuropsychological measures of memory, subjective ratings of prospective and everyday memory failures and ratings of internal and external strategy use. RESULTS: A total of 65 community dwelling survivors of stroke were randomized (24: memory group, 22: computerized cognitive training, and 19: wait-list control). Participants allocated to the memory group reported significantly greater attainment of memory goals and internal strategy use at 6-week follow-up relative to participants in computerized training and wait-list control conditions. However, groups did not differ significantly on any subjective or objective secondary outcomes. CONCLUSION: Preliminary evidence shows that memory skills groups, but not computerized training, may facilitate achievement of functional memory goals for community dwelling survivors of stroke. These findings require further replication, given the modest sample size, subjective nature of the outcomes and the absence of objective eligibility for inclusion.

Investigating the relationship between reduced self-awareness of falls risk, rehabilitation engagement and falls in older adults.

The present study aimed to investigate whether self-awareness of falls risk is associated with rehabilitation engagement, motivation for rehabilitation, and number of falls after hospital discharge. The sample comprised 91 older adults (Mage=77.97, SD=8.04) undergoing inpatient rehabilitation. The Self-Awareness of Falls Risk Measure (SAFRM) was used to measure different aspects of self-awareness. The treating physiotherapist and occupational therapist rated the patient's engagement in rehabilitation and the patient reported his/her motivation for treatment. Falls information was collected from the patient and significant other once a month for three months following hospital discharge. Significant correlations were found between physiotherapist-rated engagement and intellectual (rs=-0.22, p<0.05) and anticipatory awareness (rs=-0.24, p<0.05). Occupational therapist-rated engagement and patient-reported motivation for rehabilitation was correlated with emergent awareness (rs=-0.38 and -0.31, p<0.05, respectively) and overall self-awareness (rs=-0.31 and -0.26, p<0.05, respectively). Regression analyses indicated that overall self-awareness provided a unique contribution to occupational therapist-rated engagement when controlling for age, gender, cognition and functional ability. Falls were reported by 29.9% of participants, however, self-awareness did not differ significantly between fallers and non-fallers. The findings suggest that self-awareness of falls risk is associated with rehabilitation engagement and motivation. Therefore, improving patient self-awareness of falls risk may increase engagement in therapy leading to better patient outcomes.

Self-Awareness of Falls Risk Among Elderly Patients: Characterizing Awareness Deficits and Exploring Associated Factors.

OBJECTIVE: To characterize self-awareness in older adults undergoing inpatient rehabilitation and explore factors associated with reduced awareness of falls risk. DESIGN: Prospective, cross-sectional design. SETTING: Older adult inpatient rehabilitation setting. PARTICIPANTS: Rehabilitation inpatients (N=91; mean age, 77.97±8.04y) and their treating physiotherapist. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Three aspects of self-awareness (intellectual, emergent, anticipatory) were measured using the Self-Awareness of Falls Risk Measure. Demographic, medical, and cognitive (Mini-Mental State Examination) information were collected. Current ability was measured using the FIM and timed Up and Go test. RESULTS: Of the patients in the sample, 31% to 63% underestimated falls risk and 3% to 10% overestimated falls risk depending on the aspect of awareness measured. Different aspects of reduced self-awareness were correlated with being a man, higher educational attainment, neurologic history, lower cognitive ability, and lower functional ability. Regression analysis indicated that sex (ß=-.33, P=.004), education (ß=-.30, P=.006), and neurologic history (ß=-.22, P=.038) were independently associated with overall self-awareness. CONCLUSIONS: The results suggest that a proportion of older adults undergoing inpatient rehabilitation underestimate personal falls risk. Further research is required to investigate the contributors to and effects of reduced self-awareness of falls risk. Greater understanding of these factors will facilitate the development of strategies to increase awareness of falls risk and increase engagement in falls prevention.

Development of a new self-awareness of falls risk measure (SAFRM).

Research suggests that some older individuals may lack awareness of personal falls risk; however, there is no validated scale to measure self-awareness (SA) of falls risk in this population. Therefore, the objective of this study is to describe the development and psychometric evaluation of a new three part (intellectual, emergent, and anticipatory) SAFRM to be used in the older population undergoing inpatient rehabilitation. The SAFRM underwent a comprehensive scale development process. Ninety-one participants aged over 60 years were recruited from rehabilitation wards with their treating physiotherapist and occupational therapist. The results indicated a three factor structure of the scale corresponding to the theoretically developed intellectual, emergent and anticipatory SA sections which explained 50.26% of variance. The SAFRM demonstrated good internal consistency (Cronbach's α=.86-.92), inter-rater reliability between clinicians (ICC=.61-.87), and convergent validity with an SA interview (rs=.31-.50). The SAFRM scores were significantly correlated with clinician-rated SA (rs=-.40 to -.63) providing evidence of ecological validity. The present study provides initial empirical support of the reliability and validity of the SAFRM for assessment of SA of falls risk in the older inpatient population. The availability of this measure will allow further investigation into the causes and consequences of reduced SA in the older population.

Individual and community attitudes toward financial elder abuse.

This study investigated attitudes toward financial elder abuse by sections of the Australian community using three focus groups, including Aged Care Workers, Older Adults, and Younger Adults. Participants were provided discussion cues prior to their focus group (i.e., What is financially abusive behavior? Why does it occur? How can it be prevented?). Two researchers authenticated the transcripts and identified micro- and macro-level themes within and across the groups. The study revealed a range of similar, different, and individual attitudes expressed across the groups, which could be used to develop a survey for a broader investigation of the role of individual attitudes and social/cultural norms in financial elder abuse.