Impact of Caregiver Burden on Adverse Health Outcomes in Community-Dwelling Dependent Older Care Recipients

Kuzuya, Masafumi; Enoki, Hiromi; Hasegawa, Jun; Izawa, Sachiko; Hirakawa, Yoshihisa; Shimokata, Hiroshi; Iguchi, Akihisa

doi:10.1097/jgp.0b013e3181e9b98d

Cited by 102 publications

(87 citation statements)

References 35 publications

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“…Further study should assess how specific medical illnesses and illness severity impact utilization among the homebound. While direct comparison is difficult, our study population tended to have more dementia and functional dependence than populations described in studies where an association between caregiver burden and utilization was found (Kuzuya et al, 2011). This may be because utilization among healthier patients is less closely tied to medical morbidity.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, in functionally dependent populations like the home-bound, this traditional model should be expanded to include the role that care-giver-related needs play in influencing patients’ health care utilization (Bookwala et al, 2004). Evidence suggests that informal caregiver burden may be associated with various markers of patient health care utilization such as formal homecare service use (Nakagawa & Nasu, 2011), hospitalization (Kuzuya et al, 2011), and nursing home placement (Gaugler, Kane, Kane, Clay, & Newcomer, 2003; Miller, Rosenheck, & Schneider, 2012; Yaffe et al, 2002). To our knowledge, there are no data that evaluate how caregiver burden influences health care utilization at the clinic or practice level.…”

Section: Introductionmentioning

confidence: 99%

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Health Care Utilization Among Homebound Elders

et al. 2013

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Objectives To describe informal caregiver and patient characteristics associated with high caregiver burden in homebound elders and to examine associations between high caregiver burden and patient health care utilization at the practice level. Method We used a cross-sectional and prospective cohort design to study 214 caregiver-patient dyads in a home-based primary care program. Results Informal caregivers with the highest burden were more likely to help with more activities of daily living and instrumental activities of daily living and spend >40 hr/week in caregiving. Patients whose caregivers experienced the highest burden were more likely to be non-White males without 24-hr paid homecare. There were no significant independent associations between high burden and high calls, high visits, or social work involvement. Discussion In this medically complex and highly dependent population, further study of how families and other caregivers impact health care utilization is needed.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Health Care Utilization Among Homebound Elders

et al. 2013

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“…Caregiver burden, a multidimensional response to caregiving consisting of objective burden (the practical aspects of care, such as the amount of time spent caregiving) and subjective burden (a caregiver's perception of the impact of caregiving activities on themselves), has been shown to increase over the course of the disease (1, 3, 9). These negative outcomes in caregivers are consistent predictors of poorer outcomes in PWD, including earlier institutionalization and increased mortality (10, 11). …”

Section: Objectivesmentioning

confidence: 89%

A Randomized Controlled Trial of a Community-Based Dementia Care Coordination Intervention: Effects of MIND at Home on Caregiver Outcomes

Tanner¹,

Black

Johnston

et al. 2015

The American Journal of Geriatric Psychiatry

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Objectives To assess whether MIND at Home, a community-based, multicomponent, care coordination intervention, reduces unmet caregiving needs and burden in informal caregivers of persons with memory disorders. Design 18-month randomized controlled trial of 289 community-living care recipient (CR)/caregiver dyads. Setting 28 postal code areas of Baltimore, MD. Participants Informal caregivers (i.e., an unpaid individual who is regularly relied on by the CR for assistance). Intervention All dyads and the CR's primary care physician received the written needs assessment results and intervention recommendations. Intervention dyads then received an 18-month care coordination intervention delivered by non-clinical community-workers to address unmet care needs through individualized care planning; referral and linkage to dementia services; provision of caregiver dementia education and skill building strategies; and care progress monitoring by an interdisciplinary team. Measurements Primary outcome was total percent of unmet caregiver needs at 18 months. Secondary outcomes included objective and subjective caregiver burden measures, quality of life (QOL), and depression. Results Total percent of unmet caregiver needs declined in both groups from baseline to 18 months, but there was no statistically significant between-group difference. There were no significant group differences in most caregiver burden measures, depression, or QOL. There was a potentially clinically- relevant reduction in self-reported number of hours caregivers spent with the CR for MIND participants compared with controls. Conclusions No statistically significant impacts on caregiver outcomes were found after multiple comparison adjustments. Yet, MIND appeared to have had a modest, and clinically-meaningful, impact on informal caregiver time spent with CRs.

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“…It is known that a high symptom burden is associated with a decreased health-related quality of life (Santos-Eggimann et al 2009, Newcomb 2010), higher health-care costs (Wolff et al 2002, Condelius et al 2007, and it often results in a high caregiver burden (Kuzuya et al 2011). But how living with a high symptom burden is perceived by older people with multimorbidity has not previously been described in qualitative research.…”

Section: Symptom Management Modelmentioning

confidence: 94%

Symptom burden among people with chronic disease

Eckerblad¹

2015

Linköping University Medical Dissertations

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Introduction: Chronic diseases tend to increase with old age. Older people with chronic disease are commonly suffering from conditions which produce a multiplicity of symptoms and a decreased health-related quality of life. Nurses have a responsibility to prevent, ease or delay a negative outcome through symptom management, or assist in achieving an acceptable level of symptom relief. Aim: The overall aim of the thesis was to describe different aspects of symptom burden from the perspective of community-dwelling people with chronic disease. Methods: This thesis is based upon four papers that used both quantitative and qualitative data to describe different aspects of symptom burden, experienced by people with chronic diseases. Paper (I) is a cross-sectional study with 91 participants diagnosed with chronic obstructive pulmonary disease. Papers (II and IV) are based upon secondary outcome data from a randomized controlled trial with 382 community-dwelling older people with multimorbidity. Paper (II) is a cross-sectional study and Paper (IV) has a descriptive and an explorative design reporting on the trajectory of symptom prevalence and symptom burden. Paper (III) is a qualitative study with participants from the AGe-FIT. Results: Among people diagnosed with COPD the most prevalent symptoms with the highest symptom burden scores were shortness of breath, dry mouth, cough, sleep problems, and lack of energy, with just a few differences between participants with moderate and severe airflow limitation (I). For older people with multimorbidity, pain was the symptom with the highest prevalence and burden. Other highly prevalent symptoms were lack of energy and a dry mouth. Poor vision, likelihood of depression, and diagnoses of the digestive system were independently related to the total symptom burden score (II). The symptoms experienced by the older people were persistent and the symptom burden remained high over time (IV). The experience of living with a high symptom burden was described as an endless struggle. The analysis revealed an overall theme, “To adjust and endure” and three sub-themes, “to feel inadequate and limited”, “to feel dependent”, and “to feel dejected” (III). Conclusions: The results of this thesis indicate the importance of early symptom identification. People with chronic diseases have an unmet need for optimized treatment that focuses on the total symptom burden, and not only disease specific symptoms. A large proportion of older people with multimorbidity suffer a high and persistent symptom burden, and the prevalence and trajectory of pain are high. Older people sometimes think their high age is the reason they experience a diversity of symptoms, and they do not always communicate these to their health-care provider

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Impact of Caregiver Burden on Adverse Health Outcomes in Community-Dwelling Dependent Older Care Recipients

Cited by 102 publications

References 35 publications

Health Care Utilization Among Homebound Elders

Health Care Utilization Among Homebound Elders

A Randomized Controlled Trial of a Community-Based Dementia Care Coordination Intervention: Effects of MIND at Home on Caregiver Outcomes

Symptom burden among people with chronic disease

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