Stress in caregivers of hospitalized oldest-old patients

The Effect of Coffee Aromatherapy on Reducing Fatigue and Stress Levels of Female Caregivers Caring for the Elderly in Hospitals

Background. The exploration of coffee as an aromatherapy in the health service has not been widely carried out. In many cases, aromatherapy has been shown to reduce stress and fatigue. Purpose.   To analyzes the effect of coffee aromatherapy on the fatigue and stress levels of female caregivers caring for the elderly at the University of Sumatera Utara Hospital (USU Hospital), in Medan. Methods. This is a quasi-experiment one group pretest posttest design.  The research involved 16 caregivers were given a treatment of coffee oil by inhalation for 15 minutes for three consecutive days, without coffee oil inhalation and 10% of coffee oil concentration on the first day, 20% on the second day, and 30% on the third day. Each sample received a pretest and posttest in the form of stress and fatigue instruments.  The data analysis performed was univariate in order to describe the properties of each variable examined and analyze the mean score. Similarly, bivariate analysis with the Analysis of Variance (ANOVA) statistical test was used to determine the effect of coffee aromatherapy on reducing the fatigue and stress level. Results. The result showed that most caregivers were elderly children with an average age of 38 years, 81.3% assisted in caring for the elderly, and actively working outside the home. Based on the ANOVA test, the data showed that the administration of coffee aromatherapy for three consecutive days has no effect on female caregivers’ fatigue and stress level.  However, the mean score showed a decrease in fatique and stress level before and after coffee oil inhalation in three days.  Conclusion. It is necessary to provide coffee oil aromatherapy intervention with a longer duration to have an effect on reducing caregiver fatique and stress in the future, so the results are expected to form the basic data for the design of nursing interventions based on complementary therapies in order to reduce the fatigue and stress of caregivers while providing care to the hospitalized elderly.

Redundancy within hospital-related harm prediction tools

The predictive ability and efficiency of inpatient harm screening tools is unclear. We performed a retrospective analysis of approximately 25 000 people admitted to our hospital in 2019. We found that the discriminatory ability of the harm screening tools was at best moderate and could be attributed to one or two questions that overlapped with each other in the harm they predicted.

Examination of risk scores to better predict hospital-related harms

BACKGROUND

Many hospitals use predictive scores to identify a person's risk of inpatient falls, pressure injury and malnutrition despite evidence of limited predictive accuracy.

AIM

To examine whether we could improve predictive accuracy by generating a score combining all components of currently used tools.

METHODS

We performed a retrospective, cross-validation study in a single sub-acute (geriatrics and rehabilitation) hospital, extracting data regarding hospital risk scores, and incidence of falls, pressure injury and malnutrition from January 2014 to June 2016. The sample was randomly halved into training and testing data sets. For each harm outcome, model fit was examined using area under receiver operating characteristic curves (AUC) and proportions of people reclassified based on a combined score were calculated. Secondary analyses explored the predictive performance of individual question-responses.

RESULTS

Data were available for 4487 admissions (median age 83.0 years). A total of 667 (15%) people had at least one fall, 499 (11%) had at least one pressure injury and 20 (0.4%) malnutrition. The currently used tools had, at best, moderate ability to predict risk of harm outcomes (AUC 0.56-0.73). Testing of the combined score models resulted in minimal change in AUC (<5.1%) and did not add value to risk category reclassification. Most of the predictive ability of the currently used tools relied on the performance of two individual question-responses.

CONCLUSION

Combining scores or reducing to two-item question-responses did little to change predictive accuracy. This study highlights the limitations of hospital harm predictive scores and emphasises the importance of rigorous testing of predictive scores.

The Effect of Transitions in Caregiving Status and Intensity on Perceived Stress Among 992 Female Caregivers and Noncaregivers

BACKGROUND

Informal caregiving, a chronic stressor, is also a dynamic experience, as caregivers may repeatedly enter and exit the role and alter the amount of care they provide. Changes in caregiving status and intensity influence stress, but few studies have evaluated the simultaneous impact of these changes on perceived stress.

METHODS

A total of 1,027 female caregivers and noncaregivers (mean age = 81.7), of which 992 were included in the final sample, were followed for at least two consecutive annual interviews (ie, one interval) and up to five interviews over a 9-year period. Caregiving status was measured by self-report of whether the respondent assisted someone with at least one basic or instrumental activity of daily living; caregiving intensity was dichotomized at the median number of basic or instrumental activity of daily living tasks caregivers performed. The associations between changes in caregiving status and intensity level with Perceived Stress Scale (PSS) score at the end of an interval were estimated using mixed-effects regression models.

RESULTS

Respondents contributed 2,832 intervals. High-intensity caregivers reported the highest stress at the end of an interval, whereas noncaregivers reported the lowest (mean PSS = 18.97 vs 15.73, p < .01). Low-intensity caregivers, whose intensity increased, had higher stress than continuing high-intensity caregivers. Those who stopped caregiving, regardless of intensity level, reported the same amount of stress as noncaregivers.

CONCLUSIONS

Transitions in caregiving status and intensity affect caregiver perceived stress. Continuing high-intensity caregivers and those who transition from low- to high-intensity caregiving report the highest stress of all transition groups, suggesting that stress-reduction interventions should target high-intensity caregivers.

The effect of a virtual ward program on emergency services utilization and quality of life in frail elderly patients after discharge: a pilot study

Introduction

Attendance at emergency departments and unplanned hospital readmissions are common for frail older patients after discharge from hospitals. A virtual ward service was piloted to deliver “hospital-at-home” services by community nurses and geriatricians to frail older patients immediately after their discharge from hospital to reduce emergency services utilization.

Objectives

This study examined the impacts of the virtual ward service on changes in the patients’ emergency attendance and medical readmissions, and their quality of life (QOL).

Methods

A matched-control quasi-experimental study was conducted at four hospitals, with three providing the virtual ward service (intervention) and one providing the usual community nursing care (control). Subjects in the intervention group were those who are at high risk of readmission and who are supported by home carers recruited from the three hospitals providing the virtual ward service. Matched control patients were those recruited from the hospital providing usual care. Outcome measures include emergency attendance and medical readmission in the past 90 days as identified from medical records, and patient-reported QOL as measured by the modified Quality-of-Life Concerns in the End of Life Questionnaire (Chinese version). Wilcoxon signed-rank tests compared the changes in the outcome variables between groups.

Results

A total of 39 patients in each of the two groups were recruited. The virtual ward group showed a greater significant reduction in the number of unplanned emergency hospital readmissions (−1.41±1.23 versus −0.77±1.31; P=0.049) and a significant improvement in their overall QOL (n=18; 0.60±0.56 versus 0.07±0.56; P=0.02), but there was no significant difference in the number of emergency attendances (−1.51±1.25 versus −1.08±1.48; P=0.29).

Conclusion

The study results support the effectiveness of the virtual ward service in reducing unplanned emergency medical readmissions and in improving the QOL in frail older patients after discharge.

Informal caregiving and the risk for coronary heart disease: the Whitehall II study

BACKGROUND

The stress associated with informal caregiving has been shown to be associated with poor health, including coronary heart disease (CHD). However, it is unclear if the risk of CHD is attributable to caregiving or prior poor health of the caregiver.

METHODS

We used data from the Whitehall II cohort study. Caregiving and caregiver's health (using 3 measures: self-rated health, mental health using the General Health Questionnaire, and physical component score of the SF-36) were assessed in 1991-1993 among 5,468 men and 2,457 women aged 39-63 years. CHD (fatal CHD, clinically verified nonfatal myocardial infarction, and definite angina) incidence was recorded for a mean 17 years; sociodemographic variables, health behaviors, and cardiovascular risk factors were included as covariates.

RESULTS

Cox regression showed the risk of CHD in caregivers not to be higher (hazard ratio = 1.18; 95% CI: 0.96, 1.45) compared with noncaregivers. Analyses stratified by health status showed that compared with noncaregivers in good health, caregivers with poor self-rated (hazard ratio = 2.00; 95% CI: 1.44, 2.78), mental (hazard ratio = 1.63; 95% CI: 1.16, 2.30), or physical (hazard ratio =1.87; 95% CI: 1.34, 2.62) health had greater risk of CHD. A similar elevated risk was observed in noncaregivers with poor health; no excess risk was observed among caregivers reporting good health, and the combined effect of poor health and caregiving did not exceed their independent effects.

CONCLUSIONS

Caregiving in midlife is not in itself associated with greater risk of CHD, but it is associated with increased risk for CHD among caregivers who report being in poor health.

Hearing loss and depressive symptoms in elderly patients

AIMS

Hearing loss is a common disability that has a profound impact on communication and daily functioning in the elderly. The present study assesses the effects of hearing aids on mood, quality of life and caregiver burden when hearing loss, comorbidity and depressive symptoms coexist in the elderly.

METHODS

A total of 15 patients aged older than 70 years suffering from hearing loss and depressive mood were recruited. Comorbidity was evaluated by the Cumulative Illness Rating Scale, functional ability by the Activities of Daily Living scale and the Lawton Instrumental Activities of Daily Living scale, cognitive capacity by the Mini-mental State Examination and the Clock Drawing Test, psychological status by the Center for Epidemiological Studies-Depression scale, and quality of life by the Short Form (36) Health Survey. Caregiver burden was appraised by the Caregiver Burden Inventory. Testing was carried out at baseline and at 1-, 3- and 6-month intervals, assessing the use of binaural digital and programmable hearing aids.

RESULTS

Reduction in depressive symptoms and improved quality of life at statistically significant levels were observed early on with the use of hearing aids. In particular, general health (P < 0.02), vitality (P < 0.03), social functioning (P < 0.05), emotional stability (P < 0.05) and mental health (P < 0.03) all changed for the better, and were maintained for the study duration. The degree of caregiver burden also declined, remaining low throughout the study.

CONCLUSIONS

The benefits of digital hearing aids in relation to depressive symptoms, general health and social interactivity, but also in the caregiver - patient relationship, were clearly shown in the study. The elderly without cognitive decline and no substantial functional deficits should be encouraged to use hearing aids to improve their quality of life.

The effect of comorbidity burden on health care utilization for patients with cancer using hospice

BACKGROUND

The treatment of patients with advanced cancer with multiple comorbid illnesses is complex. Although an increasing number of such patients are being referred to hospice, the comorbidity burden of this patient population is largely unknown but has implications for the complexity of care provided by hospices. This study reports the comorbidity burden in a national sample of hospice users with cancer and estimates the effect of higher comorbidity on health care use and site of death.

METHODS

Cross-sectional study using Surveillance, Epidemiology and End Results-Medicare data for hospice users who died of cancer in 2002 (N = 27,166). We measured comorbidity burden using the Charlson comorbidity index and used multivariable generalized estimating equations to estimate the association between comorbidity burden and the following outcomes: emergency department and intensive care unit (ICU) admission, hospitalization, hospice disenrollment, and hospital death.

RESULTS

Patients with cancer who used hospice had an average Charlson comorbidity index value of 1.24, including 18.8% who suffered from comorbid dementia. In analyses adjusted for patient demographics, site of primary cancer, and number of days with hospice, higher comorbidity burden was associated with higher likelihood of emergency department admission (odds ratio [OR] = 1.69, 95% confidence interval [CI] 1.52, 1.87), ICU admission (OR = 3.28, 95% CI 2.45, 4.38), inpatient hospitalization (OR = 2.14, 95% CI 1.90, 2.42), hospice disenrollment (OR = 1.41, 95% CI 1.29, 1.56) and hospital death (OR = 2.51, 95% CI 2.08, 3.02).

CONCLUSION

These findings underscore the complexity of the hospice patient population and highlight a potential need to risk adjust the per diem hospice reimbursement rates to account for increased resource requirements for hospices serving patients with higher comorbidity burden.

Self-ratings of health and change in walking speed over 2 years: results from the caregiver-study of osteoporotic fractures

Although poorer self-rated health (SRH) is associated with increased mortality, less is known about its impact on functioning. This study evaluated whether poorer SRH was associated with decline in walking speed and whether caregiving, often considered an indicator of chronic stress, modified this relation. The sample included 891 older US women from the Caregiver-Study of Osteoporotic Fractures. SRH was assessed at the baseline Caregiver-Study of Osteoporotic Fractures interview, conducted in 1999-2001, and was categorized as fair/poor or excellent/good. Rapid walking speed over 2, 3, or 6 m was measured at baseline and 2 annual follow-up interviews. Respondents with fair/poor SRH walked significantly slower at baseline than those with excellent/good health (mean = 0.8 (standard deviation, 0.3) vs. 1.0 (standard deviation, 0.3) m/second, P < 0.001). In adjusted linear mixed models of percentage change in walking speed, respondents with fair/poor SRH experienced a greater decline in walking speed than those with excellent/good SRH (-5.66% vs. -0.60%, P = 0.01). Caregivers with fair/poor SRH declined more than noncaregivers (-9.26% vs. -4.09%). High-intensity caregivers had the largest decline (-12.88%), whereas low-intensity caregivers in excellent/good SRH had no decline (2.61%). In summary, poorer SRH was associated with decline in walking speed in older women, and the stress of caregiving may have exacerbated its impact.

Hospital-based palliative care consultation: effects on hospital cost

CONTEXT

Palliative care consultation teams in hospitals are becoming increasingly more common. Palliative care improves the quality of hospital care for patients with advanced disease. Less is known about its effects on hospital costs.

OBJECTIVE

To evaluate the relationship between palliative care consultation and hospital costs in patients with advanced disease.

DESIGN, SETTING, AND PATIENTS

An observational study of 3321 veterans hospitalized with advanced disease between October 1, 2004 and September 30, 2006. The sample includes 606 (18%) veterans who received palliative care and 2715 (82%) who received usual hospital care. October 1, 2004 and September 30, 2006.

MAIN OUTCOME MEASURES

We studied the costs and intensive care unit (ICU) use of palliative versus usual care for patients in five Veterans Affairs hospitals over a 2-year period. We used an instrumental variable approach to control for unmeasured characteristics that affect both treatment and outcome.

RESULTS

The average daily total direct hospital costs were $464 a day lower for the 606 patients receiving palliative compared to the 2715 receiving usual care (p < 0.001). Palliative care patients were 43.7 percentage points less likely to be admitted to ICU during the hospitalization than usual care patients (p < 0.001).

COMMENTS

Palliative care for patients hospitalized with advanced disease results in lower costs of care and less utilization of intensive care compared to similar patients receiving usual care. Selection on unobserved characteristics plays an important role in the determination of costs of care.

The relationship between hearing impairment and cognitive function: a 5-year longitudinal study

Maximizing patients' cognitive functioning and quality of life is a key concern for nurses. Some data suggest that hearing loss may be associated with cognitive decline. To further assess this association, a 5-year longitudinal study was conducted using a community sample of 2,002 men and women ages 50 to 94. A relatively strong relationship between baseline hearing impairment and subsequent poorer cognitive function was found in both existing and new cases of cognitive impairment. These findings raise questions for nursing practice and support the need for increased dialogue and collaborative studies across specialties to both refine the understanding of the factors involved and develop clinical strategies to minimize sensory and cognitive loss.

Caregiving intensity and change in physical functioning over a 2-year period: results of the caregiver-study of osteoporotic fractures

It is unknown whether caregivers who perform more caregiving tasks have a greater decline in health from higher stress or less decline because of better health, staying active, or psychological factors. This 1999-2004 US study examined caregiving intensity and 2-year change in performance-based functioning among 901 elderly women from the Caregiver-Study of Osteoporotic Fractures sample. Caregivers were categorized as high (n = 167) or low (n = 166) intensity based on how many activities of daily living they performed for the care recipient. Caregiving intensity status and physical performance score (sum of quartiles of walking pace, grip strength, and chair-stand speed; range, 0-9) were assessed at baseline and at 2 annual follow-up interviews. At baseline, high-intensity caregivers reported the most stress but had the best physical functioning; noncaregivers (n = 568) had the poorest physical functioning (adjusted scores = 5.09 vs. 4.54, P = 0.03). Low-intensity caregivers declined more than noncaregivers over 2 years, but high-intensity caregivers did not (adjusted difference = -0.33, P = 0.07 vs. 0.03, P = 0.89). Among respondents with the same caregiving status at baseline and 1-year interviews, high-intensity caregivers maintained the highest physical performance throughout follow-up. Higher levels of physical performance persisted over 2 years among high-intensity caregivers, which did not support the traditional stress hypothesis.

Are all caregivers created equal? Stress in caregivers to adults with and without dementia

OBJECTIVE

Caregiving for older adults is stressful; however, by treating caregivers as a homogenous group, it is possible that stress-related factors are misrepresented for some. This study of 349 elderly caregivers explored mediators of the caregiving / stress relationship for caregivers to adults with (n = 106), and without (n = 243) dementia.

METHODS

The sample was from the Caregiver Study of Osteoporotic Fractures (CG-SOF), ancillary to SOF, a four-site cohort of 9,704 women.

RESULTS

Stress was higher (p < .001) in dementia than nondementia caregivers (m = 19.85; 16.45). For caregivers overall, intensity and recipient problems were associated with stress but mediated through role captivity. However, relationships differed when stratified by recipient dementia status. Only recipient problems among nondementia caregivers was mediated through captivity.

DISCUSSION

Results confirm previous findings of lower stress among nondementia caregivers and suggest that different factors influence caregivers' appraisal of the situation, including their perception of stress, based on recipients' dementia status.

Palliative care in hospitals

Palliative care is medical care focused on the relief of suffering and support for the best possible quality of life for patients facing serious, life-threatening illness and their families. It aims to identify and address the physical, psychological, and practical burdens of illness. Palliative care may be delivered simultaneously with all appropriate curative and life-prolonging interventions. In practice, palliative care practitioners provide assessment and treatment of pain and other symptom distress; employ communication skills with patients, families, and colleagues; support complex medical decision making and goal setting based on identifying and respecting patient wishes and goals; and promote medically informed care coordination, continuity, and practical support for patients, family caregivers, and professional colleagues across healthcare settings and through the trajectory of an illness. The field of hospital palliative care has grown rapidly in recent years in response to patient need and clinician interest in effective approaches to managing chronic life-threatening illness. The growth in the number and needs of seriously and chronically ill patients who are not clearly terminally ill has led to the development of palliative care services outside the hospice benefit provided by Medicare (and other insurers). This article reviews the clinical, educational, demographic, and financial imperatives driving this growth, describes the clinical components of palliative care and the range of service models available, defines the relation of hospital-based palliative care to hospice, summarizes the literature on palliative care outcomes, and presents practical resources for clinicians seeking knowledge and skills in the field.

Life course transitions and depressive symptoms among women in midlife

This study examined the relationship between three midlife transitions and depressive symptoms among 952 women 50 to 59 years of age. Using longitudinal data from women interviewed for the 1992 and 2000 Health and Retirement Study, the study described changes in marital status, change to a parental caregiving role, and changes in perceived health across the eight years. Further, it examined the impact of these changes on mental health. The findings indicate that becoming widowed, becoming a caregiver, and perceiving health declines significantly increased depressive symptoms in the year 2000, even when controlling for pre-transition levels of depressive symptoms. The findings are consistent with the lifecourse perspective that individual development occurs in context and across the lifespan. The findings confirm and add to current midlife research literature.

End-of-life care in geriatric psychiatry

Depression, anxiety and delirium are relatively common during the final stages of terminal disease, and each can profoundly impact the quality of those last days for both patient and involved family. In this article the authors review the assessment and treatment of each syndrome in the context of palliative care for older adults. Treatment of mental disorders at the end of life warrants special consideration due to the need to balance the benefits of treatment against the potential burden of the intervention, especially those that might worsen quality of life. Dementia and the complications of depression and behavioral disturbance within dementia are also discussed. Finally, caregivers of dying patients are vulnerable to stress, depression, grief, and complicated bereavement. Interventions for caregivers who are debilitated by these states are briefly summarized.