Psychosocial and Economic Evaluation of Stroke Management in the Elderly: A Prospective Study at the Neurology Department in a Hospital in Dakar, Senegal

Abstract

Stroke is the second leading cause of death worldwide and the leading cause of physical disability in the elderly.The objective of the study was to evaluate the psychosocial and economic aspects of its management. We conducted a crosssectional, descriptive and evaluative study at the neuroscience clinic of FANN National University Hospital from May 8 to August 8, 2019. It involved 60 people aged 60 years and over received in consultation as well as 59 family caregivers who gave their consent. The caregivers' suffering was evaluated using the MINI ZARIT grid consisting of 5 items for a total score ranging from 0 to 7. The psychological impact of the disease was evaluated by the Geriatric Depression Scale in its short version (GDS); composed of 15 items scored from 0 to 1. The direct and indirect financial cost was evaluated on two items: The estimated financial loss associated with the work stoppage estimated by the daily earnings of the primary caregiver. Travel costs related to transportation from home to the neurovascular consultation unit. The mean age of our patients was 71.46 years (standard deviation 7.79 years). Females predominated with a sex ratio of 0.71. Most of our patients were polygamous (38.30%), followed by widowers (35%). Most of the patients had attended Koranic school (38.30%) and 31.70% were illiterate. They were unemployed for 55%. Caregiver burden was absent to mild in 32.20%, mild to moderate in 45.80% and moderate to severe in 22%. Signs of depression were present in 10% of patients, the 30% had a high probability of depression while 60% of patients had no depression. The average length of time the main caregiver was off work was 23.86 days (standard deviation 64.53 days). The average cost of financial losses related to this work stoppage was 200.38 USD (standard deviation 564.72 USD). The average cost of travel was $139.24 (SD $321.03). The average total cost was $339.62 (SD $650.97). The indirect cost of stroke remains quite high and represents a heavy burden for a population where the majority is unemployed, so it is important to propose a psychological support program more adapted to the Senegalese population. The establishment of lowcost home help services and a training program in neuropsychology for clinicians will be useful.