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Address for correspondence: Sharon Anderson, Department of Human Ecology, University of Alberta, 302 Human Ecology Building, Edmonton, AB Canada T6 G 2N1 E-mail: [email protected]
Introduction
An important contributor to population ageing has been the long-term survival of persons with chronic illness and disability (Demiray and Bluck 2014; Kinsella, Beard and Suzman 2013). Medical advances have led to the increased life expectancy of people with heart disease, multiple sclerosisand many cancers (Goodin and Reder 2012; Huang et al. 2008). Extension of life across these chronic conditions has been celebrated as a public health triumph (Goldman et al. 2013; Kinsella, Beard and Suzman 2013). Ongoing debates now focus on how to enhance the quality of life in the face of this increased longevity (Jacobs et al. 2009; Mortimer and Segal 2008).
Stroke provides a powerful example of the triumphs and challenges arising from impressive health-care advancements. In developed countries, widespread use of thrombolytic and endovascular clot removal therapies in emergency units and the reduction in early post-stroke complications in dedicated stroke units have reduced mortality rates by over 40 per cent (Feigin et al. 2014). Over 85 per cent of people now survive stroke; and of those, the vast majority (85%) are discharged to their pre-stroke residence (Hall et al. 2015; Krueger et al. 2015). Yet only 15 per cent of stroke survivors recover completely (Feigin et al. 2014; Teasell et al. 2014). Worldwide, stroke remains the leading cause of adult disability (Go et al. 2014).
The personal costs of stroke are high. There is considerable evidence that survivors face a range of physical and cognitive impairments (Salter et al. 2008; Teasell et al. 2014), negative psychological outcomes such as depression (Hackett and Pickles 2014), and difficulty engaging in previously valued roles and activities (Hackett et al. 2012; Mayo et al. 2002). Trygged, Hedlund and Kåreholt (2011) found that compared to the age-matched population, stroke increases the risk of divorce and separation for both men and women of working age.
Chronic conditions also make stringent and complex demands on stroke survivors and their families (Palmer and Glass 2003; Rohrbaugh et al. 2009) who have to reconfigure their responsibilities and roles to meet day-to-day family demands and accommodate the emotional and practical demands of the illness. Stroke...