Hostname: page-component-586b7cd67f-dsjbd Total loading time: 0 Render date: 2024-11-27T21:18:48.720Z Has data issue: false hasContentIssue false
  • English
  • Français

Reconciling Marriage and Care after Stroke

Published online by Cambridge University Press:  03 July 2017

Sharon Anderson ,
Norah Keating  and
Donna Wilson
Sharon Anderson*
Affiliation:
Department of Human Ecology, University of Alberta
Norah Keating
Affiliation:
College of Human Sciences & Health Sciences, Swansea University, Wales, and Optentia Research Focus Area, North-West University, South Africa
Donna Wilson
Affiliation:
Faculty of Nursing, University of Alberta
*
*Correspondence and requests for reprints should be sent to / La correspondance et les demandes de tirés-à-part doivent être adresées à : Sharon Anderson, MEd., MSc., Ph.D. Department of Human Ecology 302 Human Ecology Building University of Alberta Edmonton, AB T6G 2R3 <[email protected]>
Get access Rights & Permissions [Opens in a new window]

Abstract

Most research on stroke’s impact on couples has focused on the transition to caregiving/receiving. Despite considerable evidence that marriage is the primary source of support in the face of chronic conditions, little is known about what happens to marriage in the context of care after stroke. To address this gap, we undertook a qualitative grounded-theory study of 18 couples in which one partner had experienced a stroke. Findings revealed two interrelated themes of the couple processes: working out care, which involved discovering and addressing disruptions in day-to-day activities; and rethinking marriage, which involved determining the meaning of their relationship within the new context of care and disability. Three distinct types of marriages evolved from these processes: reconfirmed around their pre-stroke marriage; recalibrated around care; and a parallel relationship, “his” and “her” marriage. Our findings highlight the need to consider relationship dynamics in addition to knowledge about stroke and care.

Résumé

La plupart des recherches concernant les impacts des accidents vasculaires cérébraux (AVC) sur les couples ont été centrées sur la transition vers le rôle de soignant ou de bénéficiaire de soins. Même s’il est bien établi que la source principale du soutien dans les cas de maladies chroniques soit le mariage, il n’existe que peu de données sur les effets de ces soins, après un AVC, sur la relation maritale. Afin de combler cette lacune, nous avons réalisé une étude qualitative fondée sur une théorie à base empirique impliquant 18 couples dans lesquels l’un des époux avait subi un AVC. Les résultats ont mis en évidence deux thèmes étroitement liés en ce qui concerne la dynamique de couple : organiser les soins, un thème qui implique la découverte des problèmes dans la vie de tous les jours et leur prise en charge ; et repenser le mariage, un aspect qui nécessite la détermination du sens rattaché à la relation de couple dans un nouveau contexte caractérisé par des soins et des incapacités. Trois types du mariage se sont ressortis à partir de ces processus : la « reconfirmation » du mariage tel qu’il existait avant l’AVC ; la recalibration » du mariage autour des nouveaux soins ; et la « relation parallèle » — considérée comme « son mariage » à chacun des deux prtenaires. Ces résultats mettent en évidence la nécessité de considérer les dynamiques des relations, en plus des connaissances associées à l’AVC et aux soins.

Keywords

agingmarriagerelationshipsolder adultsstrokevieillissementmariagerelationsadultes plus âgésaccident vasculaire cérébral
Type
Articles
Information
Canadian Journal on Aging / La Revue canadienne du vieillissement , Volume 36 , Issue 3 , September 2017 , pp. 386 - 401
Check for updates
Copyright
Copyright © Canadian Association on Gerontology 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Achten, D., Visser-Meily, J. M. A., Post, M. W. M., & Schepers, V. P. M. (2012). Life satisfaction of couples 3 years after stroke. Disability and Rehabilitation, 34(17), 1468–1472.Google Scholar
Adamit, T., Maeir, A., Ben Assayag, E., Bornstein, N. M., Korczyn, A. D., & Katz, N. (2015). Impact of first-ever mild stroke on participation at 3 and 6 month post-event: The TABASCO study. Disability and Rehabilitation, 37(8), 667–673.Google Scholar
Agard, A. S., Egerod, I., Tonnesen, E., & Lomborg, K. (2015). From spouse to caregiver and back: A grounded theory study of post-intensive care unit spousal caregiving. Journal of Advanced Nursing, 71(8), 1892–1903. doi:10.1111/jan.12657 Google Scholar
Alwin, D.F. (2012). Integrating varieties of life course concepts. The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences, 67(2), 206–220. doi:10.1093/geronb/gbr146.CrossRefGoogle ScholarPubMed
Backstrom, B., Asplund, K., & Sundin, K. (2010). The meaning of middle-aged female spouses’ lived experience of the relationship with a partner who has suffered a stroke, during the first year postdischarge. Nursing Inquiry, 17(3), 257–268. doi:10.1111/j.1440-1800.2010.00490.x Google Scholar
Badr, H., & Krebs, P. (2013). A systematic review and meta-analysis of psychosocial interventions for couples coping with cancer. Psycho-Oncology, 22(8), 1688–1704. doi:10.1002/pon.3200 CrossRefGoogle ScholarPubMed
Bakas, T., Clark, P. C., Kelly-Hayes, M., King, R. B., Lutz, B. J., Miller, E. L., … Stroke Nursing and the Stroke Council (2014). Evidence for stroke family caregiver and dyad interventions: A statement for healthcare professionals from the American Heart Association and American Stroke Association. Stroke, 45(9), 2836–2852. doi:10.1161/STR.0000000000000033 Google Scholar
Banks, P., & Pearson, C. (2004). Parallel lives: Younger stroke survivors and their partners coping with crisis. Sexual and Relationship Therapy, 19(4), 413–429.Google Scholar
Bates, B. E., Kwong, P. L., Xie, D., Valimahomed, A., Ripley, D. C., Kurichi, J. E., & Stineman, M. G. (2013). Factors influencing receipt of early rehabilitation after stroke. Archives of Physical Medicine and Rehabilitation, 94(12), 2349–2356. doi:10.1016/j.apmr.2013.07.021 Google Scholar
Berg, C. A., & Upchurch, R. (2007). A developmental-contextual model of couples coping with chronic illness across the adult life span. Psychological Bulletin, 133(6), 920–954. doi:10.1037/0033-2909.133.6.920 CrossRefGoogle ScholarPubMed
Buck, H. G., Harkness, K., Wion, R., Carroll, S. L., Cosman, T., Kaasalainen, S., Arthur, H. M. (2015). Caregivers’ contributions to heart failure self-care: A systematic review. European Journal of Cardiovascular Nursing, 14(1), 79–89. doi:10.1177/1474515113518434 CrossRefGoogle ScholarPubMed
Buehlman, K. T., Gottman, J. M., & Katz, L. F. (1992). How a couple views their past predicts their future: Predicting divorce from an oral history interview. Journal of Family Psychology, 5(3–4), 295–318.CrossRefGoogle Scholar
Buschenfeld, K., Morris, R., & Lockwood, S. (2009). The experience of partners of young stroke survivors. Disability and Rehabilitation, 31(20), 1643–1651. doi:10.1080/09638280902736338 Google Scholar
Calasanti, T., & King, N. (2015). Intersectionality and age. In Twigg, J. & Martin, W. (Eds.), Routledge handbook of cultural gerontology (pp. 193–200). London, ENG: Routledge.Google Scholar
Cameron, J. I., Naglie, G., Gignac, M. A. M., Bayley, M., Warner, G., Green, T., ... Cheung, A. M. (2014). Randomized clinical trial of the Timing it Right Stroke Family Support Program: Research protocol. BMC Health Services Research, 14.Google Scholar
Carlsson, G. E., Forsberg-Warleby, G., Moller, A., & Blomstrand, C. (2007). Comparison of life satisfaction within couples one year after a partner’s stroke. Journal of Rehabilitation Medicine, 39(3), 219–224. doi:10.2340/16501977-0048 Google Scholar
Charmaz, K. (1991). Good days, bad days: The self in chronic illness and time. New Brunswick, NJ: Rutgers University Press.Google Scholar
Charmaz, K. (2006). Constructing grounded theory: A practical guide through qualitative analysis. Thousand Oaks, CA: Sage.Google Scholar
Charon, J.M. (2010). Symbolic interactionism: An introduction, an interpretation, an integration (10th ed.). New York, NY: Prentice Hall.Google Scholar
Daniel, K., Wolfe, C. D. A., Busch, M. A., & McKevitt, C. (2009). What are the social consequences of stroke for working-aged adults?: A systematic review. Stroke, 40(6), e431–e440. doi:10.1161/STROKEAHA.108.534487 Google Scholar
Dowswell, G., Lawler, J., Dowswell, T., Young, J., Forster, A. & Hearn, J. (2000). Investigating recovery from stroke: A qualitative study. Journal of Clinical Nursing, 9(4), 507–515.Google Scholar
Eisikovits, Z., & Koren, C. (2010). Approaches to and outcomes of dyadic interview analysis. Qualitative Health Research, 20(12), 1642–1655. doi:10.1177/1049732310376520 CrossRefGoogle ScholarPubMed
Elder, G. H. Jr. (Ed.). (1985). Life course dynamics: Trajectories and transitions, 1968–1980 (Project of SSRC committee on the life course.). Ithaca, NY: Cornell University Press.Google Scholar
Falconier, M. K., Jackson, J. B., Hilpert, P., & Bodenmann, G. (2015). Dyadic coping and relationship satisfaction: A meta-analysis. Clinical Psychology Review, 42, 28–46. doi:10.1016/j.cpr.2015.07.002 Google Scholar
Feigin, V. L., Forouzanfar, M. H., Krishnamurthi, R., Mensah, G. A., Connor, M., Bennett, D. A., Moran, A. E., … GBD Stroke Experts Group. (2014). Global and regional burden of stroke during 1990–2010: Findings from the Global Burden of Disease Study 2010. Lancet, 383(9913), 245–255. doi:10.1016/S0140-6736(13)61953-4 Google Scholar
Forsberg-Warleby, G., Moller, A., & Blomstrand, C. (2004). Life satisfaction in spouses of patients with stroke during the first year after stroke. Journal of Rehabilitation Medicine, 36(1), 4–11. doi:10.1080/16501970310015191 Google Scholar
Gaugler, J. E. (2010). The longitudinal ramifications of stroke caregiving: A systematic review. Rehabilitation Psychology, 55(2), 108–125. doi:10.1037/a0019023 Google Scholar
Glaser, B.G., & Strauss, A. (1967). The discovery of grounded theory. Hawthorne, NY: Aldine Press.Google Scholar
Godwin, K. M., Ostwald, S. K., Cron, S. G., & Wasserman, J. (2013). Long-term health-related quality of life of stroke survivors and their spousal caregivers. Journal of Neuroscience Nursing, 45(3), 147–154. doi:10.1097/JNN.0b013e31828a410b Google Scholar
Gottman, J. M., & Notarius, C. I. (2002). Marital research in the 20th century and a research agenda for the 21st century. Family Process, 41(2), 159–197. doi:10.1111/j.1545-5300.2002.41203.x CrossRefGoogle Scholar
Green, T. L., & King, K. M. (2010). Functional and psychosocial outcomes 1 year after mild stroke. Journal of Stroke & Cerebrovascular Diseases, 19(1), 10–16.Google Scholar
Grigorovich, A., Forde, S., Levinson, D., Bastawrous, M., Cheung, A. M., & Cameron, J. I. (2015). Restricted participation in stroke caregivers: Who is at risk? Archives of Physical Medicine and Rehabilitation, 96(7), 1284–1290.Google Scholar
Hall, R., Khan, F., O’Callaghan, C., Kapral, M.K., Cullen, A., Levi, J., Wu, J., … Bayley, M. (2014). Ontario stroke evaluation report 2014: On target for stroke prevention and care. Retrieved from http://www.ices.on.ca/Publications/Atlases-and-Reports/2014/Ontario-Stroke-Evaluation-Report-2014 Google Scholar
Holt-Lunstad, J., Smith, T. B., & Layton, J. B. (2010). Social relationships and mortality risk: A meta-analytic review. PLoS Medicine, 7(7). doi:10.1371/journal.pmed.1000316 Google Scholar
King, K. B., & Reis, H. T. (2012). Marriage and long-term survival after coronary artery bypass grafting. Health Psychology, 31(1), 55–62. doi:10.1037/a0025061 Google Scholar
Krueger, H., Koot, J., Hall, R. E., O’Callaghan, C., Bayley, M., & Corbett, D. (2015). Prevalence of individuals experiencing the effects of stroke in Canada: Trends and projections. Stroke, 46(8), 2226–2231. doi:10.1161/strokeaha.115.009616 Google Scholar
Kurichi, J. E., Xie, D., Bates, B. E., Ripley, D. C., Vogel, W. B., Kwong, P., & Stineman, M. G. (2014). Factors associated with home discharge among veterans with stroke. Archives of Physical Medicine and Rehabilitation, 95(7), 1277–1282.e1273. doi:10.1016/j.apmr.2014.03.008 Google Scholar
Mancini, A. D., & Bonanno, G. A. (2006). Marital closeness, functional disability, and adjustment in late life. Psychology and Aging, 21(3), 600–610. doi:10.1037/0882-7974.21.3.600 Google Scholar
Manne, S., & Badr, H. (2008). Intimacy and relationship processes in couples’ psychosocial adaptation to cancer. Cancer, 112(11 Suppl.), 2541–2555. doi:10.1002/cncr.23450 CrossRefGoogle ScholarPubMed
Martin, S. C. (2016). Relational issues within couples coping with Parkinson’s disease: Implications and ideas for family-focused care. Journal of Family Nursing, 22(2), 224–251.Google Scholar
Martire, L. M., Schulz, R., Helgeson, V. S., Small, B. J., & Saghafi, E. M. (2010). Review and meta-analysis of couple-oriented interventions for chronic illness. Annals of Behavioral Medicine, 40(3), 325–342. doi:10.1007/s12160-010-9216-2 Google Scholar
Mayo, N. E., Wood-Dauphinee, S., Carlton, R., Durcan, L., & Carlton, J. (2002). Activity, participation, and quality of life 6 months poststroke. Archives of Physical Medicine and Rehabilitation, 83(8), 1035–1042.Google Scholar
McCarthy, M. J., Lyons, K. S., & Powers, L. E. (2011). Expanding poststroke depression research: Movement toward a dyadic perspective. Topics in Stroke Rehabilitation, 18(5), 450–460.Google Scholar
Mees, M., Klein, J., Yperzeele, L., Vanacker, P., & Cras, P. (2016). Predicting discharge destination after stroke: A systematic review. Clinical Neurology and Neurosurgery, 142, 15–21.CrossRefGoogle ScholarPubMed
Mellor, R. M., Slaymaker, E., & Cleland, J. (2013). Recognizing and overcoming challenges of couple interview research. Qualitative Health Research, 23(10), 1399–1407. doi:10.1177/1049732313506963 CrossRefGoogle ScholarPubMed
Miller, L. E., & Caughlin, J. P. (2013). “We’re going to be survivors”: Couples’ identity challenges during and after cancer treatment. Communication Monographs, 80(1), 63–82. doi:10.1080/03637751.2012.739703 Google Scholar
Murray, S. L., & Holmes, J. G. (2011). Interdependent minds: The dynamics of close relationships. New York, NY: Guilford Press.Google Scholar
Neff, L. A., & Karney, B. R. (2016). Acknowledging the elephant in the room: How stressful environmental contexts shape relationship dynamics. Current Opinion in Psychology, 13, 107–110.Google Scholar
Ostwald, S. K., Godwin, K. M., & Cron, S. G. (2009). Predictors of life satisfaction in stroke survivors and spousal caregivers after inpatient rehabilitation. Rehabilitation Nursing, 34(4), 160–167+174.Google Scholar
Pallesen, H. (2014). Body, coping and self-identity. A qualitative 5-year follow-up study of stroke. Disability and Rehabilitation, 36(3), 232–241. doi:10.3109/09638288.2013.788217 Google Scholar
Park, E. O., & Schumacher, K. L. (2014). The state of the science of family caregiver-care receiver mutuality: A systematic review. Nursing Inquiry, 21(2), 140–152. doi:10.1111/nin.12032 Google Scholar
Pinquart, M., & Sörensen, S. (2006). Gender differences in caregiver stressors, social resources, and health: An updated meta-analysis. Journals of Gerontology - Series B Psychological Sciences and Social Sciences, 61(1), P33–P45.Google Scholar
Pretter, S., Raveis, V. H., Carrero, M., & Maurer, M. S. (2014). Couples living with cardiovascular disease: Effects on the marital relationship. Journal of Family Social Work, 17(1), 21–36. doi:10.1080/10522158.2013.865288 Google Scholar
Quinn, K., Murray, C. D., & Malone, C. (2014a). The experience of couples when one partner has a stroke at a young age: An interpretative phenomenological analysis. Disability and Rehabilitation, 36(20), 1670–1678. doi:10.3109/09638288.2013.866699 Google Scholar
Quinn, K., Murray, C.D., & Malone, C. (2014b). Spousal experiences of coping with and adapting to caregiving for a partner who has a stroke: A meta-synthesis of qualitative research. Disability and Rehabilitation, 36(3), 185–198.Google Scholar
Robles, T. F., Slatcher, R. B., Trombello, J. M., & McGinn, M. M. (2014). Marital quality and health: A meta-analytic review. Psychological Bulletin, 140(1), 140–187. doi:10.1037/a0031859 Google Scholar
Robles, T. F. (2014). Marital quality and health: Implications for marriage in the 21st century. Current Directions in Psychological Science, 23(6), 427–432. doi:10.1177/0963721414549043 Google Scholar
Rochette, A., Bravo, G., Desrosiers, J., St-Cyr Tribble, D., & Bourget, A. (2007). Adaptation process, participation and depression over six months in first-stroke individuals and spouses. Clinical Rehabilitation, 21(6), 554–562. doi:10.1177/0269215507073490 CrossRefGoogle ScholarPubMed
Rohrbaugh, M. J., & Shoham, V. (2012). Family consultation for couples coping with health problems: A social cybernetic approach in Friedman, H.S. (Ed.), The Oxford Handbook of Health Psychology (pp. 477–498), Oxford, ENG: Oxford University Press.Google Scholar
Rottmann, N., Hansen, D. G., Larsen, P. V., Nicolaisen, A., Flyger, H., Johansen, C., & Hagedoorn, M. (2015). Dyadic coping within couples dealing with breast cancer: A longitudinal, population-based study. Health Psychology, 34(5), 486–495. doi:10.1037/hea0000218 Google Scholar
Shields, C. G., Finley, M. A., Chawla, N., & Meadors, P. (2012). Couple and family interventions in health problems. Journal of Marital and Family Therapy, 38(1), 265–280. doi:10.1111/j.1752-0606.2011.00269.Google Scholar
Smurawska, L. T., Alexandrov, A. V., Blandin, C. F., & Norris, J. W. (1994). Cost of acute stroke care in Toronto, Canada. Stroke, 25, 1628–1631.Google Scholar
Tanwir, S., Montgomery, K., Chari, V., & Nesathurai, S. (2014). Stroke rehabilitation: Availability of a family member as caregiver and discharge destination. European Journal of Physical and Rehabilitation Medicine, 50(3), 355–362.Google Scholar
Taule, T., & Råheim, M. (2014). Life changed existentially: A qualitative study of experiences at 6-8 months after mild stroke. Disability and Rehabilitation, 36, 2107–2119.Google Scholar
Teasell, R. W., Fernandez, M. M., McIntyre, A., & Mehta, S. (2014). Rethinking the continuum of stroke rehabilitation. Archives of Physical Medicine and Rehabilitation, 95(4), 595–596. doi:10.1016/j.apmr.2013.11.014.Google Scholar
Thompson, H. S., & Ryan, A. (2009). The impact of stroke consequences on spousal relationships from the perspective of the person with stroke. Journal of Clinical Nursing, 18(12), 1803–1811. doi:10.1111/j.1365-2702.2008.02694.x Google Scholar
Traa, M. J., De Vries, J., Bodenmann, G., & Den Oudsten, B. L. (2015). Dyadic coping and relationship functioning in couples coping with cancer: A systematic review. British Journal of Health Psychology, 20(1), 85–114. doi:10.1111/bjhp.12094 Google Scholar
Trygged, S., Hedlund, E., & Kåreholt, I. (2011). Education and poststroke separation among couples with mutual children. Journal of Divorce and Remarriage, 52(6), 401–414. doi:10.1080/10502556.2011.592423 Google Scholar
Turner, J. H. (2011). Extending the symbolic interactionist theory of interaction processes: A conceptual outline. Symbolic Interaction, 34(3), 330–339. doi:10.1525/si.2011.34.3.330 Google Scholar
Uchino, B. N., Cawthon, R. M., Smith, T. W., Light, K. C., McKenzie, J., Carlisle, M., & Bowen, K. (2012). Social relationships and health: Is feeling positive, negative, or both (ambivalent) about your social ties related to telomeres? Health Psychology, 31(6), 789–796. doi:10.1037/a0026836 Google Scholar
Umberson, D., & Montez, J. K. (2010). Social relationships and health: A flashpoint for health policy. Journal of Health and Social Behavior, 51, S54–S66. doi:10.1177/0022146510383501 Google Scholar
Visser-Meily, A., Post, M., Gorter, J. W., Berlekom, S. B. V., Van Den Bos, T., & Lindeman, E. (2006). Rehabilitation of stroke patients needs a family-centred approach. Disability and Rehabilitation, 28(24), 1557–1561.Google Scholar