Do Family Caregivers Offset Healthcare Costs for Older Adults? A Mapping Review on the Costs of Care for Older Adults With Versus Without Caregivers

Informal Caregiving: Health System Cost Implications

BACKGROUND

Informal caregiving is seen as a low-cost substitute for care provided by health care professionals. However, caregiving is known to negatively impact caregivers' health and, subsequently, their health care use and costs. This could potentially offset the caregivers' contributions to the health care system.

OBJECTIVE

We examined the impact of caregiving on costs associated with caregivers' use of publicly funded health care services in Ontario, Canada, in comparison with non-caregivers.

METHODS

We included Ontarians who participated in the Canadian Community Health Survey-Healthy Aging Supplement Survey of 2008/09 and linked responses to health care administrative databases. A difference-in-differences design was used to capture differences in caregivers' and non-caregivers' total health care costs 1 and 2 years before and after caregiving start date. Generalized Linear Models were used to model the total health care costs.

RESULTS

The sample size was 4275 with 1265 caregivers and 3010 non-caregivers. We found that while health care utilization increased over time, it increased by a lesser amount for caregivers than non-caregivers. Adjusted total health care costs for caregivers were 11.32% (SE = 0.05, ρ = 0.02) lower than non-caregivers 2 years into caregiving.

CONCLUSIONS

Our study reveals a critical gap in policy, practice, and research driven by a lack of routine data collection and caregiver identification. It also highlights the need for additional longitudinal research focusing on caregivers' objective health.

Changes in Family Structure and Increasing Care Gaps in the United States, 2015-2050

Research on caregiving in the United States has not clearly identified the scope of the gap between care needed and care received and the changes implied by ongoing and anticipated shifts in family structure. This article examines the magnitude of contemporary gaps in care among older adults in the United States and how they are likely to evolve through 2050. We use data from the Health and Retirement Study (1998-2014) to estimate care gaps, operationalized as having difficulties with activities of daily living (ADLs) or instrumental activities of daily living (IADLs) but not receiving care. We also estimate variation in care gaps by family structure. Then, we use data from demographic microsimulation to explore the implications of demographic and family changes for the evolution of care gaps. We establish that care gaps are common, with 13% and 5% of adults aged 50 or older reporting a care gap for ADLs and IADLs, respectively. Next, we find that adults with neither partners nor children have the highest care gap rates. Last, we project that the number of older adults with care gaps will increase by more than 30% between 2015 and 2050-twice the rate of population growth. These results provide a benchmark for understanding the scope of the potential problem and considering how care gaps can be filled.

Palliative care for patients with heart failure and family caregivers in rural Appalachia: a randomized controlled trial

BACKGROUND

Heart failure (HF) is a debilitating disease with worsening symptoms and family caregiving burden. HF affects more than 8 million Americans. West Virginia has the highest HF death rate in the U.S. and limited healthcare services. This study tested whether the family HF palliative and end-of-life care intervention (FamPALcare) improved patient and caregiver outcomes at 3- and 6-month study endpoints.

METHODS

This study used a randomized controlled trial design. Patients with HF and their caregivers were randomly assigned together to the intervention (n = 21) or control (n = 18) group. The intervention included five telephone coaching sessions on the HF home, palliative, and end-of-life care. The outcome data collected at baseline and at 3 and 6 months were from the patients' (a) HF-related health status and depression/anxiety scale scores; and from caregivers' (b) caregiving burden and depression/anxiety scale scores; and (c) anonymous ratings on the 11-item FamPALcare helpfulness scale, completed by the intervention participants.

RESULTS

The mean age of the patients was 65.66 (SD = 13.72) years, and 67% were White males. The mean age of the caregivers was 62.05 (SD = 13.14) years, and 77% were White females. Compared to the controls, patients in the intervention group had significantly greater scores for HF-related health status (p < .05) and lower depression/anxiety scores at 6 months, the study endpoint. The family caregivers in the intervention group had significantly lower scores on caregiving burden (p < .05) and depression/anxiety (p < .01) at 3 months. The mean helpfulness rating was M = 4.46 out of 5 (SD = 0.49).

CONCLUSIONS

The FamPALcare intervention was found to be effective at improving patient HF-related health status and reducing caregiver burden and improving both patient and caregiver depression and anxiety scores. The FamPALcare HF intervention was found feasible and consistently delivered (fidelity). The FamPALcare intervention's cost-effectiveness and helpfulness ratings information will be used to plan for subsequent clinical trials.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04153890, Registered on 4 November 2019, https://clinicaltrials.gov/ct2/show/NCT04153890 .

Factors Affecting Psychological Distress in Family Caregivers of Critically Ill Patients: A Qualitative Study

BACKGROUND

Family caregivers often experience psychological distress during a critical care hospitalization, potentially compromising their ability to function effectively in a supportive role. A better understanding of the sources of family caregiver distress is needed to inform strategies to mitigate its development and impact.

OBJECTIVE

To explore sources of family caregiver psychological distress during a critical care hospitalization and how caregivers' experiences may differ by their anxiety level.

METHODS

Forty adult family members of patients receiving mechanical ventilation for more than 72 hours in 2 intensive care units at an academic medical center were interviewed. A qualitative directed content analysis was done. Experiences were compared by anxiety level group, defined using the Hospital Anxiety and Depression Scale: anxiety (n = 15), borderline anxiety (n = 11), and low anxiety (n=14).

RESULTS

Most family members (32%) were adult children; no major demographic differences were noted across anxiety groups. Among caregivers in the anxiety group, salient factors included early unknowns around critical illness, health care team processes, care decisions made, financial and housing concerns, family dysfunction, and new responsibilities. In general, low-anxiety family caregivers did not express their concerns using language of distress but rather expressed emotion and disappointment and often took action to process their concerns.

CONCLUSIONS

Factors influencing family caregiver distress during the critical care stay were wide-ranging and varied by level of anxiety. The findings highlight several key areas and potential interventions to reduce psychological distress, especially among caregivers with anxiety.

Giving voice to informal caregivers of community-dwelling older adults: A systematic review of empowerment interventions

Taking care for older adults can place informal caregivers at risk for developing health problems. Therefore, interventions aiming to empower informal caregivers have been developed. Empowerment refers to a health promotion process including strategies to improve informal caregivers' self-care behaviours, stress-management and caregiving skills. In literature, empowerment-oriented interventions often target subsamples of informal caregivers defined through the care receiver's condition. These interventions, however, do not adequately capture the complexity of care needs and might even exclude informal caregivers taking care for older people without a specific diagnosis or with a subthreshold condition. Therefore, the aim of this systematic review is to provide an overview of the content and effectiveness of empowerment-oriented interventions directed at informal caregivers of community-dwelling older adults. Following the PRISMA guidelines, a systematic review was performed by searching the following databases: PubMed, PsycINFO, EMBASE and Web of Science. From a total of 6798 unique publications, 13 intervention studies, of which seven randomised controlled trials, were eligible for inclusion. According to the Mixed Methods Appraisal Tool, eight studies scored poor. The intervention studies under review represented different domains of empowerment, with cultivation of positive feelings being the most prevalent one. Social participation and physical health received little attention in interventions. Although no adverse intervention effects were observed, the studies reported mixed results with 57 positive and 47 neutral effects. The limited number and poor quality of studies emphasise the need for future research investigating the effectiveness of empowerment-oriented interventions targeting informal caregivers of older adults.

Family Caregiving during the COVID-19 Pandemic in Canada: A Mediation Analysis

Family caregiving is a public health issue because of caregivers' significant contribution to the health and social care systems, as well as the substantial impact that giving and receiving care has on the health and quality of life of care receivers and caregivers. While there have been many studies that associate caregivers' care work, financial difficulty, navigation, and other caregiving factors with family caregivers' psychological distress, we were interested not only in the factors related to family caregiver anxiety but also in hypothesizing how those effects occur. In this study, we used Andrew Hayes' PROCESS moderation analysis to explore the link between caregiver frailty, weekly care hours, and perceptions of financial difficulty, social support, and anxiety. In this analysis, we included 474 caregivers with relatively complete data on all of the variables. In regression analysis after controlling for gender and age, social loneliness (β = 0.245), frailty (β = 0.199), financial difficulty (β = 0.196), care time (β = 0.143), and navigation confidence (β = 0.131) were all significant. We then used PROCESS Model 6 to determine the significance of the direct, indirect, and total effects through the serial mediation model. The model pathway from frailty to care time to financial difficulty to social loneliness to anxiety was significant. The proportions of family caregivers who were moderately frail, anxious, and experiencing social loneliness after eighteen months of the COVID-19 pandemic found in this survey should be of concern to policymakers and healthcare providers.

Professionals' understanding of their responsibilities in the collaboration with family caregivers of older persons with mental health problems in Norway

Research has highlighted the importance of health and social care professionals' collaboration with family caregivers. In the field of mental healthcare, involvement of family members is perceived as beneficial to the recovery process of the care recipient. Furthermore, family care-giving is an essential part of elderly care. It is well documented that family members need support to prevent negative consequences of care-giving. Nevertheless, involvement of and support for family caregivers have not developed into a common practice, and research has identified professional barriers to collaboration with family caregivers in several areas. The aim of this study was to explore professionals' experiences of collaboration with family caregivers of older persons with mental health problems, and how they understood their responsibility towards families. We conducted three focus group interviews with 18 health and social care professionals working in community-based services, in three rural municipalities in Western Norway. The thematic analysis by Braun and Clarke guided the analysis. The findings in relation to the professionals' role and responsibility towards family caregivers are presented in three themes: family caregivers - a resource that needs support; a responsibility with unclear boundaries; and balancing different needs. Professionals recognised family caregivers' need for support and acknowledged the importance of family relationships. However, they experienced dilemmas in performing their dual responsibility of caring for the older care recipient as well as the family member, which they described as having unclear guidelines. They also experienced that they had insufficient knowledge to take on this responsibility. We argue that the exercising of discretion is essential for the professionals' responsibility, and that clarification of their responsibility is needed. We recommend a stronger focus in education on developing competence in the family perspective. Furthermore, the apportionment of professionals' responsibility needs to be formalised, especially when several services are involved in providing care.

Co-residence beliefs 1973-2018: Older adults feel differently than younger adults

Objective

This brief study examines support for co-residence (i.e. aging parents living with their adult children), and how age predicts support for this belief considering the rapidly aging U.S. population.

Background

Co-residence, a form of intergenerational transfer between family members, can help facilitate care for aging parents as well as help older adults age in the community. Support for this type of co-residence was on the rise in the 1970s and 1980s.

Method

Support for co-residence of older adults living with their adult children is estimated using 36,843 responses from the U.S. General Social Survey from 1973 to 2018. Descriptive analyses, logistic regression, and decomposition analyzes are used to test explanatory factors in trends, focusing on differences for older (age 65 and older) vs. younger (under 65) respondents.

Results

Older adults are less supportive than younger adults of co-residence even as support has generally increased across time. Decomposition results show that a little over half of the difference between younger and older adults is explained by cohort replacement, with two-fifths of the difference unexplained by social or demographic factors.

Conclusion

Findings suggest that although cohort replacement has contributed to an attitude shift over time, important age differences in attitudes remain. Older adults are less supportive of co-residence than younger adults.

Reasons for the Place of Care of the Elders: A Systematic Review

BACKGROUND

Relocation is a very important event in people's lives in general, but really significant in old age. However, some predictors of relocation still need to be improved. The objective of this review was to synthesize qualitative evidence to understand the reasons of the participants to decide on the place of care of the older people.

METHODS

Systematic review of qualitative studies was conducted in six databases: Scopus, SciELO, PubMed, PsycINFO, Web of Science and CINAHL, from its beginning until 29 November 2017. Qualitative or mixed studies, written in English or Spanish and addressing the decision-making process (already experienced by participants) on the place of care of older persons (65 years or older), were included in the review. PROSPERO (registration number: CRD42018084826).

RESULTS

A total of 46 articles were finally included in the analysis. Our main result is the distinction of multiple reasons for each population group involved in the decision-making process, ranking these reasons into three factors: Retention, pull and push.

CONCLUSION

This differentiation allows for a more detailed and in-depth analysis of the motivations of the different groups involved in this process.