What are the consequences of caring for older people and what interventions are effective for supporting unpaid carers? A rapid review of systematic reviews

Abstract

ObjectivesTo identify and map evidence about the consequences of unpaid caring for all carers of older people, and effective interventions to support this carer population.DesignA rapid review of systematic reviews, focused on the consequences for carers of unpaid caring for older people, and interventions to support this heterogeneous group of carers. Reviews of carers of all ages were eligible, with any outcome measures relating to carers’ health, and social and financial well-being. Searches were conducted in MEDLINE, PsycInfo and Epistemonikos (January 2000 to January 2020). Records were screened, and included systematic reviews were quality appraised. Summary data were extracted and a narrative synthesis produced.ResultsTwelve systematic reviews reporting evidence about the consequences of caring for carers (n=6) and assessing the effectiveness of carer interventions (n=6) were included. The review evidence typically focused on mental health outcomes, with little information identified about carers’ physical, social and financial well-being. Clear estimates of the prevalence and severity of carer outcomes, and how these differ between carers and non-carers, were absent. A range of interventions were identified, but there was no strong evidence of effectiveness. In some studies, the choice of outcome measure may underestimate the full impact of an intervention.ConclusionsCurrent evidence fails to fully quantify the impacts that caring for older people has on carers’ health and well-being. Information on social patterning of the consequences of caring is absent. Systematic measurement of a broad range of outcomes, with comparison to the general population, is needed to better understand the true consequences of caring. Classification of unpaid caring as a social determinant of health could be an effective lever to bring greater focus and support to this population. Further work is needed to develop and identify suitable interventions in order to support evidence-based policymaking and practice.

Patients’ experiences of being treated for acute illness at home as an alternative to hospital admission: a qualitative study in Denmark

“…As the treatment took place in the home environment of both patients and families, it was quite natural that family members became involved either as observers or active partners in solving practical tasks related to the treatment. Several studies on chronic diseases describe how long-term caregiving can be a burden for the caregiver and how hospital admission can be a ‘break’ for the caregivers 14. Our study showed that from a patient’s perspective, family involvement was perceived as something positive and not a burden.…”

“…Several studies on chronic diseases describe how long-term caregiving can be a burden for the caregiver and how hospital admission can be a ‘break’ for the caregivers. 14 Our study showed that from a patient’s perspective, family involvement was perceived as something positive and not a burden. However, little is known about the caregivers’ perspective on short-term and temporary caregiving during home treatment, which should be explored in future research.…”

Three Perspectives on the Experience of Support for Family Caregivers in First Nations Communities

“…Although we did not assess these aboriginal FCGs’ health and wellbeing, worldwide, FCGs are at increased risk of deteriorating health [ 42 , 43 ] and financial insecurity [ 44 ] which makes the FCG role itself a public health issue and social determinant of health [ 42 , 45 ]. Both Public Health England [ 42 ] and the American National Caregiving Alliance [ 45 ] point to a greater proportion of FCGs than noncarers with chronic conditions and had difficulty taking care of their own health. Framing family caregiving from the public health perspective positions issues related FCGs’ work and role as a lifecourse population health concern.…”

A Qualitative Study to Understand the Impact of Caring for Traumatic Injury Survivors

“…Despite this, research exploring the social impact of caregiving in other injury types is lacking (e.g., for orthopaedic injuries). The challenges and demands of caring for older people are well documented; however, a recent review of systematic reviews by Spiers et al [ 14 ] stated that current evidence fails to quantify the impact of caregiving on wellbeing. Authors suggested the need for a comprehensive review to explore the impact of caring for older people on outcomes in terms of social and financial well-being.…”

“…Research typically investigates shorter term impacts following injury, despite evidence of financial burden continuing over many years [ 18 ]. It is well known that unpaid caring for older people can lead to a loss of employment or reduction in working hours [ 14 ], with many carers having to manage employment alongside caring responsibilities. However, there is limited evidence to describe the impact of this dual role on financial and social wellbeing not only in the widely studied older person carer population [ 14 ], but also in the traumatic injury carer population.…”