A global measure of quality of life (QOL) has become increasingly important as an adjunctive outcome of health care interventions. Satisfaction with health care and resultant satisfaction with life with a disability or chronic disease have become issues of interest to clinicians and researchers.
Scores on the SWLS in this sample of stroke survivors at 12 months were only slightly below the norms for older community dwelling individuals (24.25) (Pavot, Diener, Colvin, & Sandvik, 1991
). While some studies of long-term stroke survivors have found relatively high rates of life satisfaction (Lindmark & Hamrin, 1995
), most studies have shown that life satisfaction norms are below those of the general population (Ostwald, 2008
). The lack of large differences in this study is consistent with Campbell’s (1981)
assertion that most individuals seek to maximize their sense of well-being and to perceive their life as positively as possible. Using a technique referred to as a “standard gamble,” Hallan and colleagues (1999)
concluded that most stroke survivors did not view stroke as an overwhelming catastrophe.
This study, however, found that between 12 and 24 months, life satisfaction scores declined in the stroke survivors. Post-stroke depression at 12 months was a strong predictor of poor life satisfaction over the ensuing year. This is consistent with other studies that have found a strong relationship between post-stroke depression and life satisfaction up to three years post-stroke (Bays, 2001
; Lofgren, Gustafson & Nyberg, 1999
). Physical function was not a significant predictor of life satisfaction in this study, as has been reported in other studies. However, the survivors may have experienced stagnation in their physical recovery leading to depression and decreased life satisfaction, as was reported by Teasdale and Engberg (2005)
in their 5–15 year follow-up. Being older was associated with a higher level of life satisfaction. Others have reported that younger survivors may have additional social issues, including work and child-care, that may negatively affect their life satisfaction (Teasell, McRae, & Finestone, 2000
). Rehabilitation nurses need to be alert for signs of continuing post-stroke depression and advocate for pharmacological, psychological, and social therapies that may help to relieve the depression and thus increase life satisfaction.
Spousal caregivers’ mean on the SWLS was identical at 12 months (24.25) to the older community-dwelling population mean, and actually surpassed the population mean at 24 months. This is contrary to other studies that have reported significantly lower life satisfaction among caregivers at 12 months, as compared to the general population (Forsberg-Warleby, et al, 2004
). For caregivers, their own health, a perception of their preparedness for the caregiving role, and the stress associated with daily life were significantly related to life satisfaction. This suggests that preparation for the caregiving role is not a one-time event that occurs at the time of the stroke. Over time the needs of the stroke survivor change, both physically and emotionally, and the health status of the caregiver may decline. Nurses encountering spousal caregivers need to continue to assess the caregiver’s current knowledge, skills, and resources, and provide appropriate learning opportunities and referrals. This education may focus on the caregiver’s own health needs, needs of the stroke survivor, and/or stress management techniques and community resources.
The only variable that was a significant predictor of life satisfaction for both stroke survivors and spousal caregivers was their relationship. Couples who expressed a high degree of mutuality (e.g., love, enjoyment of each other) were most satisfied with their lives. This predictor did not change over time and was as strong at 24 months as it was at 12 months. Strokes occur within the context of an existing relationship, which may or may not be mutually rewarding. While nurses cannot change a long-term marital relationship, they do need to be aware of the stresses that a stroke can place on any relationship. Research has demonstrated that physical and cognitive impairments, dysfunctional families, lack of ability to communicate, and/or lack of ability to function socially or sexually, may interfere with a couple’s relationship, interfere with adjustment to the stroke, and interfere with life satisfaction (Clark & Smith, 1999
; Eriksson, Tham & Fugl-Meyer, 2005
, Forsberg-Warleby, et al, 2004
; Korpelainen, Nieminen & Myllyla, 1999
). Rehabilitation nurses need to assist couples to anticipate and cope with changes that the stroke will make in many areas of their lives. While the rehabilitation team focuses on physical, cognitive, occupational, and speech therapy, the nurse must also help the couple to access their strengths and challenges in terms of family support, marital relationship, coping strategies, spiritual resources, lifestyle priorities, and financial and environmental challenges. Working with couples to increase their life satisfaction long term will require making realistic plans to meet short and long-term challenges. Kautz (2007)
provides excellent suggestions for how rehabilitation nurses can intervene to effectively enhance intimacy among couples. Interventions to improve relationships often require an interdisciplinary effort that may include social workers, psychologists, clergy, and peer counselors, as well as referrals to community agencies and support groups.
This study has two major limitations. First, the couples’ satisfaction with life and the quality of their marital relationship were not known prior to the stroke so it is not possible to know how much impact the stroke itself had on either life satisfaction or mutuality scores. Second, since life satisfaction was not measured until 12 months post discharge, it is not known whether life satisfaction changed in a positive or negative direction during the first 12 months post-discharge. However, other studies that have looked at life satisfaction during the first 12 months have reported a negative impact of the stroke on the life satisfaction of the stroke survivor and also the caregiving spouse.
This study has implications for rehabilitation nurses who are concerned about helping stroke survivors and their caregiving spouses to experience long-term life satisfaction. Assessing stroke survivors for post-stroke depression on every encounter and providing continuing treatment may be an important strategy for increasing life satisfaction since depression is a significant predictor of poor life satisfaction. Stroke survivors who perceived that they were doing well emotionally at 12 months had higher levels of life satisfaction at 24 months, a further confirmation of the need to treat depression Spousal caregivers who had good health, felt confident about their caregiving ability, and who reported less stress at 12 months had higher life satisfaction at 24 months. Nurses have an important role in teaching and affirming spouses in their caregiving roles and encouraging them to care for their own health. Finally rehabilitation nurses need to be alert to the impact of the stroke on the relationship between the couple and to assist them in identifying challenges and developing realistic plans to minimize the negative effects of the stroke, and in strengthening their relationship as they face life after a stroke together.