Objective: Limitations in activities of daily living are major components of most stroke outcome scales. We examined whether activity limitations or other factors predicted self-reported well-being among stroke survivors in a large nationally representative survey.
Methods: Individuals with a self-reported history of stroke were identified from the National Health and Aging Tends Study (NHATS wave 1, year 2011). Self-reported well-being (primary outcome) was defined based on a previously validated 7-item measure (higher=greater well-being) assessing emotions (feeling cheerful, bored, full of life, or upset) and self-realization (purpose in life, self-acceptance, and environmental mastery). Activity limitations were defined by the need for assistance in any of 11 activities of daily living/instrumental activities of daily living (ADLS/IADLS). Multivariable linear regression was used to identify factors associated with well-being.
Results: 738 stroke survivors 65 or older were included (57% female, 9% African American, 6% Hispanic). The final multivariable model (see Table) only modestly explained the total variability in well-being (R-squared=0.28). Number of ADL/IADL limitations was not associated with well being. Notable predictors of lower well being included depressive symptoms, chewing problems, pain that limited activity, and restricted ability to participate in valued life activities. Income was modestly associated with improved well-being, while social network support and access to communication technology were not associated.
Conclusions: Limitations in ADLs/IADLs were not predictive of well-being in this population of stroke survivors, which raises the question of whether existing outcome scales adequately measure the most important patient-centered outcomes. Much of what determines well-being among stroke survivors remains unexplained.