Two million stroke survivors utilize medical visit companions

Over one-third of older adults are accompanied by a companion to routine medical visits.¹ Little is known about these companions for stroke survivors, a population who encounter short- and long-term disability and may benefit from medical care companions.

Methods

We performed a retrospective cross-sectional analysis of community-dwelling Medicare beneficiaries who participated in the 2011 National Health and Aging Trends Study. We included older adults who reported that they “saw a regular doctor” in the past year (n = 7,115, 86% of the round 1 sample). Study participants with missing data regarding reported stroke (n = 7), use of a medical companion (n = 7), or physical capacity (n = 83) were excluded. Our final study cohort was 7,018, representing 32.5 million community-dwelling Medicare beneficiaries aged 65 years and older, after applying sample weights.

Participants were categorized as having a medical visit companion if they affirmed that someone “sat with you at the doctor” at least 1 time in the past year. The roles of identified companions were defined relative to 4 activities: helping the participant onto the examination table; reminding the participant about questions for their doctor; talking to the doctor; and helping to understand the doctor. Physical impairment was defined as difficulty in 12 self-reported physical capacities.² Individuals with probable dementia were identified.³ After application of survey weights, descriptive analyses assessed the proportion of stroke survivors with a medical visit companion compared with nonstroke survivors. Next, we compared the characteristics of stroke survivors with and without a medical visit companion and then conducted a logistic regression analysis to explore predictors of having a medical visit companion. Finally, we described the role of the medical visit companions among stroke survivors. Analyses were performed in STATA 14 (StataCorp LLC, College Station, TX), and the study was approved by the Institutional Review Board from the University of Michigan.

Data availability

Data are publicly available (nhats.org/).

Results

Stroke survivors were more likely to have a medical visit companion than older adults who had not had a stroke (59% vs 35%, p < 0.001), representing approximately 2 million stroke survivors who attended at least 1 medical visit with a companion. Among stroke survivors, being 80 years of age or older (OR: 1.70, 95% CI: 1.25–2.31, p = 0.001), being married (OR: 2.26, 95% CI: 1.49–3.42, p < 0.001), greater physical impairment (OR: 1.19, 95% CI: 1.13–1.25, p < 0.001), and probable dementia (OR: 2.88, 95% CI: 1.54–5.39, p = 0.001) were associated with greater likelihood of having a companion. Of stroke survivors with probable dementia, 17.1% did not have a medical companion (table).

Table.

Predictors of having medical visit companions among stroke survivors (unweighted N = 847; survey weighted N = 3,345,463)

Among stroke survivors, medical visit companions performed activities to assist with patient-doctor communication. Of companions identified, 69.6% talked to the doctor, 64.4% helped the stroke survivor to understand the doctor, and 63.1% reminded the stroke survivors of questions to ask the doctor. In addition, 27.8% of companions reported helping the stroke survivor up to the examination table. Of these 4 tasks, companions performed an average of 2.2 (SD = 1.5) activities.

Discussion

Stroke survivors are about 1.7 times more likely to have a medical visit companion than older adults without stroke. The reliance on medical visit companions among older stroke survivors is likely a function of supply and demand. For example, on the supply side, married stroke survivors were more likely to have a medical visit companion. Regarding demand, stroke survivors with greater physical impairment and with dementia were more likely to have a care companion. However, there may be missed opportunities to improve care, particularly among the 17% of stroke survivors with dementia who did not have a companion. Among those with dementia, attending medical visits alone has been associated with higher likelihood of being undiagnosed or being unaware of a dementia diagnosis,⁴ suggesting the importance of medical care companions in facilitating patient-doctor communication and providing contextual information.⁵ No differences in companion utilization were found by sex, race, primary language, or educational attainment.

More information is required to determine how best to leverage medical visit companions' efforts to assist stroke survivors in engaging with the health care system and achieving improved health outcomes. Further research is also needed to determine the most important roles for companions and to what extent medical visit companions can catalyze changes in health-promoting behaviors among stroke survivors. With almost 2 million stroke survivors accompanied to medical visits by a companion, optimizing this resource may have a positive public health impact.

Appendix. Authors

Study funding

Supported by NIH/NIMHD R01MD008879 and NIH/NIA R01AG059733.

Disclosure

R. Price, A. Brenner, and C. Chieh Lin report no disclosures relevant to the manuscript. J. Burke has received compensation from Astra Zeneca for his role on the adjudication committee of the SOCRATES trial. L. Skolarus has consulted for Bracket Global regarding poststroke disability. Go to Neurology.org/N for full disclosures.