Resilience after Stroke: An Intervention to Promote Mental Health and Quality of Life among Older Stroke Survivors

Stroke is the leading cause of adult disability (WHO 2009). The impact of stroke is often sudden, but may have a number of long term physical, mental and social consequences affecting individuals, families and carers. Older people and those from black ethnic groups have a higher risk of having a stroke (Heuschmann et al 2008). Since stroke can often be devastating, it is important to understand how people cope with its long term effects.

Resilience means an ability to ?bounce back? from an adverse event in life (Netuveli et al 2008), such as following a stroke. Being resilient to overcome adversity such as loss or illness in later life is associated with improved mental health and quality of life (Nygren et al 2005, Hildon et al 2009). However, we do not currently know what ?resilience? means to older people in terms of their ability to deal with the adverse consequences of a stroke.

This study aims to understand what ?resilience? means to older stroke survivors and their carers, and how resilience helps some people to recover and adapt to life after a stroke. This information will help us to develop new methods of supporting people with stroke in the long term. We will conduct interviews with older stroke survivors from white and black ethnic groups and their carers. We will also conduct focus groups with workers from health, social care and voluntary services, as well as policy makers in stroke care. We will then bring the results from these together to develop new methods of assisting older stroke survivors and carers to cope with the adverse effects of stroke. The results from the study will be presented at several conferences and published in a report and journal articles.

Stroke is a long term condition affecting a significant proportion of adults in the UK, with the risk of stroke increasing with age and in black ethnic groups (Heuschmann et al 2008). It is the leading cause of adult disability (WHO 2009) and associated with substantially raised risk of depression (Hackett et al 2005). Resilience among older adults, defined as an ability to adapt positively, thrive or ?bounce back? from adversity such as loss and illness (Netuveli et al 2008) is associated with improved mental health and quality of life (Nygren et al 2005, Hildon et al 2009). However, it is currently not known what resilience resources, strategies and contexts may promote or hinder older stroke survivors? ability to cope with the adverse consequences of stroke. This study aims to investigate the meaning and role of resilience after stroke among older stroke survivors and their carers from white and black ethnic groups. The study uses qualitative interviews and focus group discussions to identify user and service providers? understandings of resilience and its relationship to recovery and adaptation after stroke. Using the Medical Research Council?s (MRC) guidance framework for complex interventions (MRC 2008), this information will then be used to develop a culturally appropriate intervention fostering resilience and thereby mental health and quality of life after stroke. We anticipate that this pilot work will lead in the future to the development of a larger randomised controlled trial to promote resilience after stroke for older stroke survivors and their carers.