Creating avenues for relative empowerment (CARE): A pilot test of an intervention to improve outcomes of hospitalized elders and family caregivers

Abstract

The purpose of this pilot study was to evaluate the effectiveness of a family caregiver-focused intervention program (CARE) on the outcomes of hospitalized elders and their family caregivers. A randomized clinical trial was conducted with 49 family caregivers of hospitalized elders in a university medical center in upstate New York. Driven by self-regulation and role theories, the two-phase CARE program consisted of: (a). a mutual agreement consisting of family caregiving activities during hospitalization; and (b). audiotaped information regarding emotional responses and possible complications associated with an elderly patient's hospitalization as well as instructions for effectively participating in the elder's hospital care. The comparison program consisted of information about hospital services and policies. CARE elders had fewer incidents of acute confusion reported by family caregivers during hospitalization and fewer depressive symptoms at 2 weeks and 2 months posthospitalization than did the comparison group. CARE family caregivers participated more in the care of their hospitalized elders and had higher scores on role rewards prior to hospital discharge. Findings from this study support the need for further testing of the CARE intervention with family caregivers to determine its effectiveness on outcomes of hospitalized elders and their family caregivers.

Positive Effects of a Nursing Intervention on Family-Centered Care in Adult Critical Care

“…26 For example, in neonatal transitional care units, parents reported feeling less anxious after the adoption of family-centered care, lengths of hospital stay were shorter, and rehospitalizations were fewer. 27 However, few specific strategies 16,20 to promote family-centered care in adult units have been published. Thus, although family-centered care sounds beneficial in theory, little evidence is available of ways to operationalize this model of care.…”

“…The mean length of stay was similar at both sites: 2.8 days. Both sites were combined surgical and medical units that did pilot study of 49 family caregivers in the United States, Li et al 20 found that when family caregivers of elderly patients actively participated in the care of the patients in an acute care setting, the patients experienced fewer episodes of confusion and depression after hospitalization. Although the results of these 2 studies are promising, the benefits of including patients' family members in the care of critical care patients have yet to be fully determined.…”

Engaging Families to Participate in Care of Older Critical Care Patients

“…5,6,9,11 However, further research is necessary to identify barriers to family participation in care and cost-effective strategies to facilitate and support family participation in care. Although researchers in 1 study 19 did report improved outcomes in older patients, increased understanding is needed to integrate the AACN Synergy Model as a framework to identify nursing competencies that can be used to support the integration of patients' family members into the care of acute and critically ill older adults. CCN…”

“…17,18 The use of a partnership model improves patients' outcomes by emphasizing a nonhierarchical relationship in an environment of trust and respect for the diversity that a patient and his or her family bring to the experience of being critically ill. 16 Creating Avenues for Relative Empowerment (CARE) offers further strategies to facilitate family members' participation in care. 19 The focus of CARE is to educate family members on the common problems (Table 3) seen in hospitalized older adults and the activities that can reduce or prevent these problems, such as fecal incontinence, acute confusion, or urinary incontinence. This program has been used with family caregivers of hospitalized older adults in New York with the outcome of fewer incidents of acute confusion and depressive symptoms.…”

Selecting Control Interventions for Clinical Outcome Studies

“…Examples of studies in which a placebo-type intervention was used include studies by H. Li et al (2003) and Calfas, Sallis, Oldenburg, and French (1997). H. Li et al (2003) tested a caregiver support program's effectiveness on improving outcomes for hospitalized elders and family caregivers. The control group received a treatment in the same form received by the intervention group (i.e., audiotapes); however, the tapes were focused on messages unrelated to caregiving.…”