Predictors of caregiver distress among palliative home care clients in Ontario: Evidence based on the interRAI Palliative Care

Hirdes, John P.; Freeman, Shannon; Smith, Trevor F.; Stolee, Paul

doi:10.1017/s1478951511000824

Cited by 48 publications

(49 citation statements)

References 39 publications

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“…We are, however, reasonably certain that all clients in our sample were experiencing significant health instability that would put them at increased risk of dying or they were given a terminal prognosis by a physician. Furthermore, the demographic and clinical/functional characteristics of the clients in this study are quite similar to that of other studies, with home care clients receiving specialized palliative care services, which provides further support that our cohort likely represents a truly palliative group (Hirdes et al, 2012;Fisher et al, 2014).…”

Section: Discussionsupporting

confidence: 84%

“…Additionally, a high proportion (roughly 30%) of the primary caregivers of these clients expressed feelings of distress related to their caregiving role. This rate is similar to that reported for caregivers of older adults with dementia (CIHI, 2010) and is very similar to the rate reported for caregivers of individuals receiving home-based palliative care in Ontario (Hirdes, Freeman, Smith, & Stolee, 2012). The high rate of distress present among these caregivers is concerning because caregivers of seriously ill people are at an increased risk of premature mortality (Abernethy et al, 2008;Bradley et al, 2004).…”

Section: Discussionsupporting

confidence: 82%

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A Comparison Between End-of-Life Home Care Clients With Cancer and Heart Failure in Ontario

Fernandes

Guthrie

2014

Home Health Care Services Quarterly

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Individuals with heart failure experience complex symptoms and have a poor prognosis, comparable to those with cancer. However, people with heart failure are less likely to be recognized as needing palliative care. We compared seriously ill home care clients with cancer versus those with heart failure to explore differences between them using existing data from the Resident Assessment Instrument for Home Care (RAI-HC). The sample included 1,475 older adults (65+) in Ontario who had a prognosis of less than 6 months or severe health instability. Clients with heart failure were significantly older (p < .0001) and experienced significantly higher rates of impairment in activities of daily living (p = .005), cognitive impairment (p < .0001), and severe health instability (p < .0001), but were significantly less likely to have a prognosis of less than 6 months (p < .0001). Home care clients with heart failure have needs similar to those with cancer yet are typically not identified as having a terminal prognosis.

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Section: Discussionsupporting

confidence: 84%

Section: Discussionsupporting

confidence: 82%

A Comparison Between End-of-Life Home Care Clients With Cancer and Heart Failure in Ontario

Fernandes

Guthrie

2014

Home Health Care Services Quarterly

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“…The Changes in Health, End-stage disease, and Signs and Symptoms (CHESS) scale has been shown to predict mortality, health service use, and caregiver distress in the overall populations of persons receiving care in home care, post-acute, nursing home and palliative care settings [9]–[14]. CHESS is a summary measure based on a count of decline in Activities of Daily Living (ADL); decline in cognition; symptoms such as weight loss, shortness of breath, and edema; and clinician ratings of a prognosis of less than six months.…”

Section: Introductionmentioning

confidence: 99%

Use of the interRAI CHESS Scale to Predict Mortality among Persons with Neurological Conditions in Three Care Settings

et al. 2014

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BackgroundPersons with certain neurological conditions have higher mortality rates than the population without neurological conditions, but the risk factors for increased mortality within diagnostic groups are less well understood. The interRAI CHESS scale has been shown to be a strong predictor of mortality in the overall population of persons receiving health care in community and institutional settings. This study examines the performance of CHESS as a predictor of mortality among persons with 11 different neurological conditions.MethodsSurvival analyses were done with interRAI assessments linked to mortality data among persons in home care (n = 359,940), complex continuing care hospitals/units (n = 88,721), and nursing homes (n = 185,309) in seven Canadian provinces/territories.ResultsCHESS was a significant predictor of mortality in all 3 care settings for the 11 neurological diagnostic groups considered after adjusting for age and sex. The distribution of CHESS scores varied between diagnostic groups and within diagnostic groups in different care settings.ConclusionsCHESS is a valid predictor of mortality in neurological populations in community and institutional care. It may prove useful for several clinical, administrative, policy-development, evaluation and research purposes. Because it is routinely gathered as part of normal clinical practice in jurisdictions (like Canada) that have implemented interRAI assessment instruments, CHESS can be derived without additional need for data collection.

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“…Other studies using the DRS as a measure of depression have found the same result [77,78]. The broader research on depression and dementia indicates that patient depression is one of the main causes of caregiver stress [79].…”

Section: Discussionmentioning

confidence: 59%

“…Previous studies that have examined depression in palliative care patients have established associations with certain physical symptoms (e.g., sleep disorders, fatigue, dyspnea, pain, functional disability) [2,4,20,21], psychological symptoms (psychological well-being, spirituality, hopelessness, cognitive loss) [20,22,23], demographic variables (e.g., younger age, gender) [2,21,24,25], prognosis [2], prognostic awareness [26,27], social support [5,21,28,29], and caregiver distress [30,31]. However, prior research has been limited in several ways, notably the lack of sufficient sample sizes [5], samples that do not include people being treated in home settings [32], and the use of assessment tools that have not been validated in a palliative population [3,5].…”

Section: Introductionmentioning

confidence: 99%

Prevalence and risk factors of depressive symptoms in a Canadian palliative home care population: a cross-sectional study

Fisher

Seow

Brazil³

et al. 2014

BMC Palliat Care

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BackgroundDepression in palliative care patients is important because of its intrinsic burden and association with elevated physical symptoms, reduced immunity and increased mortality risk. Identifying risk factors associated with depression can enable clinicians to more readily diagnose it, which is important since depression is treatable. The purpose of this cross-sectional study was to determine the prevalence of depressive symptoms and risk factors associated with them in a large sample of palliative home care patients.MethodsThe data come from interRAI Palliative Care assessments completed between 2006 and 2012. The sample (n = 5144) consists of adults residing in Ontario (Canada), receiving home care services, classified as palliative, and not experiencing significant cognitive impairment. Logistic regression identified the risk factors associated with depressive symptoms. The dependent variable was the Depression Rating Scale (DRS) and the independent variables were functional indicators from the interRAI assessment and other variables identified in the literature. We examined the results of the complete case and multiple imputation analyses, and found them to be similar.ResultsThe prevalence of depressive symptoms was 9.8%. The risk factors associated with depressive symptoms were (pooled estimates, multiple imputation): low life satisfaction (OR = 3.01 [CI = 2.37-3.82]), severe and moderate sleep disorders (2.56 [2.05-3.19] and 1.56 [1.18-2.06]), health instability (2.12 [1.42-3.18]), caregiver distress 2.01 [1.62-2.51]), daily pain (1.73 [1.35-2.22]), cognitive impairment (1.45 [1.13-1.87]), being female (1.37 [1.11-1.68]), and gastrointestinal symptoms (1.27 [1.03-1.55]). Life satisfaction mediated the effect of prognostic awareness on depressive symptoms.ConclusionsThe prevalence of depressive symptoms in our study was close to the median of 10-20% reported in the palliative care literature, suggesting they are present but by no means inevitable in palliative patients. Most of the factors associated with depressive symptoms in our study are amenable to clinical intervention and often targeted in palliative care programs. Designing interventions to address them can be challenging, however, requiring careful attention to patient preferences, the spectrum of comorbid conditions they face, and their social supports. Life satisfaction was one of the strongest factors associated with depressive symptoms in our study, and is likely to be among the most challenging to address.

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Predictors of caregiver distress among palliative home care clients in Ontario: Evidence based on the interRAI Palliative Care

Cited by 48 publications

References 39 publications

A Comparison Between End-of-Life Home Care Clients With Cancer and Heart Failure in Ontario

A Comparison Between End-of-Life Home Care Clients With Cancer and Heart Failure in Ontario

Use of the interRAI CHESS Scale to Predict Mortality among Persons with Neurological Conditions in Three Care Settings

Prevalence and risk factors of depressive symptoms in a Canadian palliative home care population: a cross-sectional study

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