Activity of Daily Living (ADL) and Stress among Elderly with Stroke by Gender –Inspection of Mediation Effect for Social Participation-

Background and Purpose: Despite the improvement of the standard of living and advancement of medicine, the number of disabled elderly caused by chronic diseases is increasing rapidly. Especially the number of elderly with stroke continuously rises. And for elderly with stroke related disabilities, loss of independence, decrease of social participation, and increase in stress cause serious problems both physically and psychologically. However, despite the increase of disabled elderly, there is not enough research on elderly with stroke related disability. Therefore, this research will examine the relationship between ADL and stress for elderly with stroke, and inspect the mediation effect of social participation on stress.

Methods: This research uses survey from 2006 with matched random sampling of elderly who are 55 years or older that uses the social service agency for elderly. The subjects for analysis were 201 elderly with stroke related disabilities. The dependent variable is stress: stress from family conflict and stress from concerns regarding their health. The independent variable is ADL: changing positions, regulating bowels, walking, eating, bathing, dressing and undressing, using the bathroom, personal hygiene and etc, total of 10 categories. Mediating variable is social participation, measured by the degree of activity in social participation. The control variables were age, education, economic status, and grade of disability. The SPSS 15.0 Package and Amos7.0 was used for statistical analysis and multi-regression and SEM were executed.

Results: First, social participation was proved to have mediation effect between stress and ADL among elderly with stroke(p<.05). Gender differences were examined for this pattern. For women, the higher the ADL, the greater the social participation (p<.001), and higher social participation reduced stress (p<.05). For elderly women, social participation showed full mediation effect between ADL and stress (p<.05). In reverse, for elderly men, although higher ADL showed higher social participation (p<.01), ADL or social participation did not affect stress.

Conclusions and Implications: First, community based program that improves social participation among elderly with stroke would effectively reduce stress among elderly with stroke living at home. Second, the stress level of elderly women with stroke was higher than their male counterpart, and the factors that affect stress was different between the two genders. Therefore, intervention for elderly women with stroke is urgent and emotional support and social participation encouragement specialized for elderly women are necessary.