SEED: A Mixed-Methods Study of Stroke-related Experiences and Priorities of Elderly Living with Dementia or Disability, their Family Caregivers, and Physicians.
Date
2024-06-13
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Abstract
Acute ischemic stroke (AIS) results from blood flow loss to part of the brain and is a leading cause of disability worldwide. Pre-stroke dementia is defined as evidence of substantial cognitive decline from a previous performance level, resulting in the person needing help with activities of daily living. This cognitive disorder is associated with higher AIS risk with around 10% of AIS patients have pre-existing dementia. A further 30% of stroke patients have pre-stroke disability. Little is known about the use of stroke therapies in PLWD, as these patients have been conventionally excluded from randomized-controlled trials. We aim to develop a broad picture of the current state of AIS management for PLWD by engaging with the key stake holders–patients, caregivers, and physicians–on the matter. This is accomplished through a systematic review and meta-analysis of reperfusion outcomes in persons with pre-existing dementia, followed by a mixed-methods approach focusing on PLWD. SEED A explores the experiences of PLWD who have a stroke and their primary caregiver. SEED B investigated physician approaches toward the acute stroke management of PLWD. The representative case style survey has been disseminated worldwide to physicians to reveal trends in the stroke management of PLWD, with data collection still ongoing. The use of reperfusion therapies in PLWD has no substantial safety concerns, although there is a need for more robust data, with tailored outcomes. Perspectives shared by patients and caregivers emphasize the importance of preserving independence, and the variety of challenges of navigating dementia and disability in the acute setting and daily life after stroke. Insights from physicians highlight the complexities and nuanced decision-making involved in managing acute stroke in PLWD. These opinions highlight an acute stroke care environment where research evidence, resources and tailored treatment strategies are limited. This thesis underscores the need for including PLWD in future clinical trials and creating tailored stroke treatment strategies. Findings will be used to develop better criteria for stroke therapies and contribute to better definitions of good outcomes after stroke for PLWD. This will inform future study designs, and is relevant to clinicians, researchers, policy makers, patients, and caregivers.
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Keywords
Stroke, Dementia, Disability, Reperfusion
Citation
Betzner, W. (2024). SEED: a mixed-methods study of stroke-related experiences and priorities of elderly living with dementia or disability, their family caregivers, and physicians (Master's thesis, University of Calgary, Calgary, Canada). Retrieved from https://prism.ucalgary.ca.