Caregivers and Families of Critically Ill Patients

Advocating for a Loved One in the Setting of Uncertainty: A Mixed-Methods Study Among Caregivers of Sepsis Survivors at the Point of a Sepsis Readmission

BACKGROUND

The trajectory of recovery after sepsis varies. Survivors may have considerable ongoing limitations, requiring a caregiver for a prolonged period.

OBJECTIVES

To learn about experiences, quality of life, coping, resilience, and social support of caregiver caring for survivors of sepsis.

METHODS

We conducted a convergent mixed-methods study, recruiting informal caregivers of patients who had survived sepsis in the past year and were readmitted to the intensive care unit with sepsis. Individual face-to-face, semistructured interviews and validated surveys on quality of life, coping, caregiver burden, resilience, and social support were administered to caregivers. Interview transcripts were analyzed using content analysis. Surveys were scored and summarized using descriptive statistics.

RESULTS

Caregivers were primarily middle-aged, White, and female. Half were spouses of their care recipient. Caregivers reported some deficits in mobility, pain, and anxiety/depression. Coping styles varied, with engaged coping being more prevalent. Most caregivers reported mild to moderate burden, all reported either normal or high resilience levels, and types of social support were similar. However, interviews and survey findings were not always consistent. Major themes that emerged from the analysis included (1) advocating for and protecting their loved one, (2) coping with caregiving, (3) uncertain future, (4) rewards of caregiving, and (5) need to optimize communication with family.

DISCUSSION

Caregivers of sepsis survivors are protective of their care recipient and use a variety of strategies to advocate for their loved one and to cope with the uncertainty involved in a new intensive care unit admission. More advocacy and support are needed for this population.

Rationale and study design for decision making & implementation of aging-in-place/long term care plans among older adults

Background

Remaining in one's own home and community is a priority for many older adults as they age. Decision-making and planning is critical to ensure successful aging-in-place (AIP), especially when individuals experience age-related changes such as cognitive decline. Objectives: We are testing how decision-making and planning for AIP is impacted by changes in older adults' cognition and function, chronic conditions, social influences, environmental factors and identifying the mediating/moderating interactions between factors. We will also assess whether decision-making and planning for AIP translates into timely adoption of plans and goal concordance between older adults and their surrogate/caregiver decision makers.

Methods

We will conduct a longitudinal single-group interventional clinical trial of community-dwelling older adults who are enrolled in LitCog, (R01AG03611) and expose them to an online intervention, PlanYourLifespan.org, which facilitates decision-making and planning for AIP. Enrolled participants (n = 398) will complete interviews at baseline, one month, and every six months up to 42 months in conjunction with the LitCog study, where cognitive, social, functional, and health literacy data is collected. Additionally, we will collect data on decision-making, resource use, communication of plans, timing of plan implementation, and goal concordance.

Projected outcomes

Findings from this study may generate evidence on how age-related changes in older adults may affect decision-making and implementation in relation to AIP as well as the impact of social relationships and support. Ultimately these findings may help shape the design of programs and practices that may improve the lives of older adults and the capacity of institutions to adapt to societal aging and AIP.