The Psychological Status of Elderly Patients During the Acute Phase of Stroke: A Mixed Methods Analysis.

Objective: This study aims to understand the experiences of elderly patients in the acute phase of stroke, to determine the factors that predict the level of psychological resilience, and to examine the moderating role of rumination between illness perception and psychological resilience.

Methods: A mixed-method of embedded design was employed in this study. In the qualitative study, 13 elderly patients with acute stroke were interviewed based on semi-structured interview guides and recordings. The data were transcribed, and thematic content analysis was conducted. In the quantitative study, a cross-sectional survey was conducted on 240 elderly acute stroke patients using paper-based questionnaires, and data analysis was performed using SPSS25.0 and AMOS24.0.

Results: From the qualitative analysis, we identified risk factors affecting the psychological status of elderly patients with acute stroke, which can be summarised into four major themes and six categories. The content of the four major themes is: lack of disease cognition, facing disease threats and challenges, prominent psychological issues, sense of disease gain. The content of the six categories is: lack of stroke-related disease knowledge and cognitive bias, single source of disease information; significant sequelae, concern about medical expenses; apparent symptoms of anxiety and depression, disease uncertainty and fear. In the Quantitative analysis, results indicated that illness perception had a direct effect on psychological resilience (β = -0.34, p < 0.01) and rumination (β = 0.51, p < 0.01). Also, rumination was directly related to psychological resilience (β = -0.24, p < 0.01). In addition, illness perception was indirectly related to psychological resilience (β = 0.51*-0.24 = -0.12, p < 0.01) mediated through rumination.

Conclusion: Improving the level of rumination in elderly patients with acute stroke can mitigate adverse Illness perception and enhance psychological resilience. This study provides a theoretical basis for developing relevant intervention measures.