Measuring the Effect of Carers on Patients’ Risk of Adverse Healthcare Outcomes Using the Caregiver Network Score

Abstract

Background: Although caregivers are important in the management of frail, community-dwelling older adults, the influence of different caregiver network types on the risk of adverse healthcare outcomes is unknown. Objective: To examine the association between caregiver type and the caregiver network subtest of The Risk Instrument for Screening in the Community (RISC), a five point Likert scale scored from one (“can manage”) to five (“absent/liability”). To measure the association between caregiver network scores and the one-year incidence of institutionalisation, hospitalisation and death. Design: Observational cohort study. Setting and Participants: Community-dwelling adults, aged >65,attending health centres in Ireland,(n=779). Procedure and Measurements: The caregiver network subtest of the RISC was scored by public health nurses. Caregivers were grouped dichotomously into low-risk (score of one) or high-risk (scores two-five). Results: The majority of patients had a primary caregiver (582/779;75%), most often their child (200/582;34%). Caregiver network scores were highest, indicating greatest risk, when patients had no recognised primary caregiver and lowest when only a spouse or child was available. Despite this, patients with a caregiver were significantly more likely to be institutionalised than those where none was required or identified (11.5% versus 6.5%,p=0.047). The highest one-year incidence of adverse outcomes occurred when state provided care was the sole support; the lowest when private care was the sole support. Significantly more patients whose caregiver networks were scored high-risk required institutionalisation than low-risk networks; this association was strongest for perceived difficulty managing medical domain issues, odds ratio (OR) 3.87:(2.22-6.76). Only perceived difficulty managing ADL was significantly associated with death, OR 1.72:(1.06-2.79). There was no association between caregiver network scores and risk of hospitalisation. Conclusion: This study operationalizes a simple method to evaluate caregiver networks. Networks consisting of close family (spouse/children) and those reflecting greater socioeconomic privilege (private supports) were associated with lower incidence of adverse outcomes. Caregiver network scores better predicted institutionalisation than hospitalisation or death.

Differences in healthcare service utilization in patients with polypharmacy according to their risk level by adjusted morbidity groups: a population-based cross-sectional study

“…Younger patients and males showed higher levels of risk and complexity, probably because their severe conditions shortened their life expectancy and men have a shorter lifespan [ 21 ]. High-risk individuals generally presented increased ratios of functional impairment, consistent with previous studies [ 17 ]; however, the demand for a primary caregiver grew with the reduction in risk level, since the lack of this service could contribute to the increase in risk level, as observed in other studies [ 31 ].…”

Prevalence and Predictors of Caregiver Burden in a Memory Clinic Population

“…These conditions may lead to an increased burden of care (providing additional supervision and hands on care) and compound changes in cognition. Further as insufficient data were available on the characteristics of caregivers themselves, particularly no data were available on their own co-morbidities, mood, functional and cognitive status, these variables should also be examined in future research as well as the effect of different care networks (e.g., formal versus informal) and support structures available to mitigate carer burden [ 48 ]. Finally, no standardized approach to diagnosing caregiver burden was used, potentially over or underestimating prevalence.…”

Validation of the Portuguese Version of the Risk Instrument for Screening in the Community (RISC) Among Older Patients in Primary Care in Northern Portugal

“…In this study we showed that the caregiver network's ability to cope with mental health problems can also predict institutionalization [AUC of 0.77 (95% CI:0.61-0.94)]. Again, this has been shown when the caregiver network score, a component of the RISC, has been studied alone (42). A study conducted in two French communities over 22 years concluded that the presence of informal caregivers, especially a partner, has a strong protective effect, reducing the risk of institutionalization by 40% for a person aged ≥80 (43).…”

“…older people who live with other family members and have poor social networks (few interactions with other people) are more likely to have health problems than other adults with good social networks who live alone (44). These data reinforce that a "good" social network is a protective factor for adverse events (42). The RISC also had fair predictive validity for death [AUC of 0.77 (95% CI: 0.65-0.88)].…”