Carer engagement in the hospital care of older people: an integrative literature review

Understanding family carer experiences and perceptions of engagement in delirium prevention and care for adults in hospital: Qualitative systematic review

AIM

To identify, describe and synthesise what is known about family carers' experiences and perspectives of engagement in delirium prevention and care for adults in hospital.

DESIGN

Systematic review and synthesis of qualitative evidence.

DATA SOURCES

Comprehensive literature search within PubMed, CINAHL, EMBASE, Scopus, Cochrane Central and PsycInfo databases to August 2022. Peer reviewed original qualitative research published in English.

METHODS

Data were extracted using Covidence systematic review software. Methodological quality was reviewed against the Critical Appraisal Skills Program (CASP) Qualitative Checklist. Thematic synthesis was used to develop analytical themes. Confidence in the Evidence from Reviews of Qualitative Research (GRADE-CERQual) framework was applied to findings.

RESULTS

Of 3429 records identified, 29 met criteria for final inclusion. Studies included a range of settings (intensive care, medical and surgical wards) and family carer types (spouse, daughter, parent and friend). Three primary themes Shared Caregiving, Partnership and Support, Communication for Shared Understanding and three cross-cutting contextual themes Care Transitions, Family Carer Context and Hospital Context were identified. Family carers have mixed experiences of involvement in delirium care and prevention. Family carer engagement in care impacted perceptions of care quality and their own self-efficacy. Where person-centred care expectations were not met, some family carers adopted compensatory or care contingency strategies. Information sharing and timely support from hospital staff who understood the carer context supported carer involvement. Supportive physical environments and addressing power imbalances allowed greater engagement.

CONCLUSION

Family carers often wish to be involved in delirium prevention and care, but need to be recognised as individuals, listened to, informed and supported to optimise their contribution.

IMPACT

The review findings can guide health professional and decision makers to optimise family carer involvement in delirium care programs.

PROTOCOL REGISTRATION

PROSPERO [CRD42020221854].

REPORTING

ENTREQ. No Patient or Public Contribution.

Family Support During Hospitalization Buffers Depressive Symptoms Among Independent Older Adults

OBJECTIVES

Hospitalization is a stressful event that may lead to deterioration in older adults' mental health. Drawing on the stress-buffering hypothesis, we examined whether family support during hospitalization would moderate the relations between level of independence and in-hospital depressive symptoms.

METHOD

This research was a secondary analysis of a cohort study conducted with a sample of 370 hospitalized older adults. Acutely ill older adults reported their level of independence at time of hospitalization and their level of depressive symptoms three days into the hospital stay. Family support was estimated by a daily report of hours family members stayed with the hospitalized older adult.

RESULTS

Independent older adults whose family members stayed longer hours in the hospital had fewer depressive symptoms than independent older adults with shorter family visits. Relations between depressive symptoms and family support were not apparent for dependent older adults, even though their family members stayed more hours.

CONCLUSIONS

This study partially supports the stress-buffering hypothesis, in that social support ameliorated depressive symptoms among hospitalized independent older adults.

CLINICAL IMPLICATIONS

Assessing depressive symptoms and functional ability and creating an environment conducive to family support for older adults may be beneficial to hospitalized older adults' mental health.

Readmission is experienced as inevitable among older adults receiving homecare: A qualitative interview study

BACKGROUND

Older adults receiving homecare have an increased risk of readmission. The transition from hospital to home can be experienced as unsafe, and older adults describe themselves as vulnerable during the post-discharge period. Thus, the objective was to explore the experiences of unplanned readmissions among older adults who receive homecare.

METHODS

We conducted qualitative individual semi-structured interviews with older adults, 65 years or above, receiving homecare and being readmitted to an emergency department (ED) between August and October 2020. Data were analysed by systematic text condensation as described by Malterud.

FINDINGS

We included 12 adults aged 67-95 years, seven were male, and eight lived alone. The analysis derived three themes: (1) Responsibility and security at home, (2) the role of family, friends and homecare and (3) the importance of trust. The older adults felt that the hospital strived for too-early discharge, as they still did not feel well. They worried about how to manage their daily life. Active involvement of their family increased their sense of security, but those living alone described feeling anxious being at home by themselves after discharge. Although older adults did not wish to go to the hospital, inadequate treatment at home and the feeling of responsibility for their illness made them feel insecure. They expressed that earlier negative experiences affected their trust in the system and their inclination to ask for help.

CONCLUSIONS

The older adults were discharged from the hospital despite feeling ill. They described inadequate competencies from healthcare professionals in the home as a contributing factor to their readmission. The readmission increased a sense of security. Support from the family in the process was essential and provided a sense of security, whereas older adults living alone experienced feelings of insecurity in the home environment.

Influencing factors of the treatment level of elderly care workers and their career development prospects

BACKGROUND

The increasingly aging population in current China has encouraged the emergence of the diversified and multi-level elderly care service industry, and the demand for high-quality elderly life with the help of elderly caregivers continues to grow.

METHODS

Based on the existing questionnaire data, this article explores the influencing factors of the treatment level of care staff, and explores their future development prospects.

RESULTS

The results show that whether they have participated in relevant vocational skills competitions, whether they have worked overtime, whether they have overtime wages, and their monthly income have significant effects on their satisfaction of treatment levels. Elderly care workers who have participated in skills competitions are more satisfied about their salary. In addition, workers who rarely and occasionally work overtime are more satisfied compared with those who have never worked overtime; Caregivers with a monthly income of 5,000-6,999 yuan are more satisfied with their salary and treatment than those with below 3,000 yuan.

CONCLUSION

Therefore, in order to better match the supply and demand of care workers, we should provide formal training and skill competitions for them, appropriately increase their salary level and reasonably arrange their working hours, so as to attract more professional talents into elderly care industry.

Factors Predicting Older Patients' Family Involvement by Nursing Staff in Hospitals: The View of Hospital Nurses in Israel

According to the family-centered approach, the involvement of family in the care of hospitalized older patients is a crucial element of quality care. Active involvement of family in care by the nursing staff depends on different factors, including attitudes towards the importance of family in the care and perception of the interactions with the family. This study aims to identify the factors predicting staff behavior of involving the family in the care process. A cross-sectional study was conducted among 179 nursing staff at a hospital, using a self-report questionnaire examining staff attitudes towards the importance of family in care, the perception of the interactions with the family (family behavior, communication and conflicts), and staff behavior toward family involvement. The findings point out the importance that staff attitudes have on their behavior in the active involvement of family in the care of older patients. Staff behavior of family involvement was predicted by their perceptions of the family (as conversational partners and having their own resources), less conflicts with the family, and staff academic education. Staff behavior toward family is influenced by their attitude and staff–family relationships. Educational programs should emphasize the importance of family, as well as dealing with conflicts.

Family Caregiver and Provider Perspectives on Inclusive Care: Aligning Needs and Expectations

BACKGROUND

Home-based and community-based health care for individuals with complex medical conditions is often provided by family caregivers. Yet caregivers often are not meaningfully included in interactions with clinical health care teams. Inclusive care means inviting the caregiver to participate in shared decision-making and treatment planning. For aging or medically vulnerable adults, caregiver inclusion is an important facet of patient-centered care.

METHODS

We apply a mixed-methods approach using a survey (n=50) and semistructured interview data (n=13) from a national sample of caregivers of veterans and semistructured interview data from (n=24) providers from 3 Veterans Affairs regional networks. We elicited data from caregivers about their experiences with inclusive care and how providers communicate with them and assess their capacity. We juxtaposed these data with provider perspectives to see where there was alignment.

FINDINGS

We determined that caregivers play important roles in trust-building, communications management, implementation of care plans at home or in the community, and improving the care of care recipients-while maintaining a balance between competing tensions.

CONCLUSIONS

Our findings suggest that expanding inclusive care could improve care quality and health outcomes of individuals with complex health care needs. Further, our findings bolster recent policy efforts at the federal and state levels to increase recognition of caregivers as key members of the health care team.

Perceptions of staff and family responsibility to provide hospitalized older adults with basic activities care and emotional support

Many older adults need help with Activities of Daily Living (ADL) and emotional support during hospitalization. Hospital staff is officially responsible for care, but most older adults are accompanied by family members who provide at least some of the support. In this study, we asked physicians, nurses, nursing assistants, and relatives about hospital staff versus family responsibility for providing ADL care and emotional support, and about actual levels of help provision by the hospital staff in Israel.  Staff members (except physicians) tended to see staff as more responsible for ADL care than family, while emotional support was a shared responsibility. Nursing assistants were the most likely to report that staff provided high levels of support, and all participants reported that staff provided more ADL care than emotional support. It is important for family members and hospital staff to have open discussions of their expectations and responsibilities when older adults are hospitalized.

Relatives' negotiation power in relation to older people's acute hospital admission: A qualitative interview study

BACKGROUND

Acutely admitted older people are potentially vulnerable and dependent on relatives to negotiate and navigate on their behalf.

AIM

This study aimed to explore relatives' experiences of their interactions with healthcare professionals during acute hospital admission of older people to derive themes of importance for relatives' negotiations with these professionals.

METHOD

A qualitative design was applied. Relatives of acutely admitted older people at two emergency departments in Denmark were interviewed (n = 17). The qualitative content analysis was guided by Graneheim and Lundman's concepts.

RESULTS

The analysis derived four themes: (a) Mandate, (b) Incentive, (c) Capability and (d) Attitude to taking action. These four sources of relatives' negotiation power can be illustrated in the MICA model.

CONCLUSION

Four themes were identified as important sources of relatives' negotiation power. Since the four sources of power potentially change according to the situation, relatives' negotiation power seems to be context dependent.

Effectiveness of an Acute Care for Elders unit at a long-term care facility for frail older patients with COVID-19

The Acute Care for Elders (ACE) is a model of care addressed to reduce the incidence of loss of self-care abilities of older adults occurring during hospitalization for acute illness.

This observational study aimed to describe the effectiveness of an ACE unit at a long-term care facility to prevent functional decline (decrease in the Barthel Index score of >5 points from admission to discharge) in older adults with frailty (Clinical Frailty Scale score ≥5) and symptomatic COVID-19.

Fifty-one patients (mean age: 80.2 + 9.1 years) were included. Twenty-eight (54.9%) were women, with a median Barthel index of 50 (IQR:30–60) and Charlson of 6(IQR: 5–7), and 33 (64.7%) had cognitive impairment.

At discharge, 36(70.6%) patients had no functional decline, 6 (11.7%) were transferred to hospital and 4(7.8%) died.

An ACE unit at a long-term care facility constitutes an alternative to hospital care to prevent hospital-associated disability for frail older patients with COVID-19.

Transitional 'hospital to home' care of older patients: healthcare professionals' perspectives

BACKGROUND

Transitional care is a key area of care provision to older people with chronic and complex health conditions and is associated with the quality of care delivered in the healthcare system.

AIMS

This study aimed to explore the perspectives of healthcare providers, including nurses and physicians, regarding transitional care from hospital to home in an urban area of Turkey.

METHODS

A qualitative study using a thematic analysis method was carried out. In-depth semi-structured interviews were held with eight clinical nurses and five general physicians involved in the provision of healthcare services to older patients in the transitional care process from hospital to home.

FINDINGS

The thematic analysis of in-depth semi-structured interviews with 13 healthcare professionals led to the development of the following themes: 'uninterrupted chain of care transfer', 'commitment to meet patient's needs' and 'support and removing ambiguities'.

CONCLUSIONS

Key factors impacting on the quality and safety of transitional care and continuity of healthcare are communication and collaboration between healthcare staff and settings, and older patients' as well as family caregivers' awareness and their feelings of responsibility towards the continuity of care at home.

The impacts of family involvement on general hospital care experiences for people living with dementia: An ethnographic study

BACKGROUND

A quarter of people in general hospitals have dementia. Limited existing studies suggest that hospital care experiences of people living with dementia, and the involvement of their families in care, may be suboptimal.

OBJECTIVES

The objectives of this study were to explore how family involvement impacts upon experiences of hospital care for people living with dementia.

DESIGN

A qualitative ethnographic study.

METHODS

Ethnographic data were collected from two care of older people general hospital wards. Data were collected via observations, conversations and interviews with people living with dementia, families and staff. In total, 400 hours of observation and 46 interviews were conducted across two 7-9 month periods.

RESULTS

People living with dementia could experience a lack of connection on multiple levels - from pre-hospital life as well as life on the wards - where they could spend long periods of time without interacting with anyone. There was great variation in the degree to which staff used opportunities to involve families in improving connections and care. When used, the knowledge and expertise of families played a crucial role in facilitating more meaningful interactions, demonstrating how person-centred connections and care are possible in busy hospital settings. Despite such benefits, the involvement of families and their knowledge was not routine. Care was required to ensure that family involvement did not override the needs and wishes of people living with dementia.

CONCLUSIONS

This study demonstrates the benefits of involving families and their knowledge in care, advocating for family involvement, alongside the involvement of people living with dementia, to become a more routine component of hospital care.

The Components of Nursing Competence in Caring for Older People in Iranian Hospitals: A Qualitative Study

Background:

There is limited research on gerontological nursing competence in hospitals. However, there is no comprehensive and integrated description of the gerontological nursing competence requirements in hospitals. The purpose of this study was to explain the components of nursing competence in caring for older people in Iranian hospitals.

Materials and Methods:

This is a qualitative descriptive-exploratory study. The data were collected through a semi-structured interview with nurses, nurse managers, and clinical educators in teaching hospitals and nursing schools affiliated to Arak, Isfahan, and Tehran Universities of Medical Sciences in Iran from September 2015 to July 2016. Participants included 25 people who were selected by purposive and snowball sampling method. Sampling continued until data saturation. Data were analyzed using conventional content analysis method.

Results:

Data analysis generated three main categories including (1) Patient and family centered care; (2) Process-oriented care; and (3) Self-care and continuing professional development.

Conclusions:

Nurses should have competencies such as participation and empowerment of the patient and family; ease of comfort in the elderly; comprehensive geriatric assessment; development, implementation and evaluation of care plan; development of knowledge and clinical proficiency; and coaching so that they can work effectively during the care of the elderly. The results of this study can be used by nursing educators, nursing students, and nurses to develop their individual and professional skills in the field of gerontological nursing.

The built environment and older adults: A literature review and an applied approach to engaging older adults in built environment improvements for health

AIMS AND OBJECTIVES

This paper presents a review of the literature about the built environment as it impacts the health of older people. It then introduces the gerontological nurse and researcher to the Our Voice framework for engaging older people as citizen scientists in order to empower them as agents of change in improving their local built environment and ultimately advancing community health.

BACKGROUND

Community-level strategies to promote successful ageing in place are critical both to optimising health outcomes and containing healthcare costs. Such strategies must take into account the influence of the built environment both on individual health behaviours and on overall community health. At the same time, the perspectives and experiences of older people themselves ought to inform policies and practices in a systematic way.

DESIGN

Integrative literature review.

METHOD

A wide scan of English language articles published in the EMBASE, PubMed and CINAHL bibliographic databases was conducted. Additional articles were sourced by mining relevant reference lists (i.e., snowball sampling). Papers included were published between 2005 and 2016.

RESULTS

Three distinct components emerged from the review: the impact of the built environment on health-in particular the health of older persons; citizen science and its applicability for older people research; and the promise of the Our Voice citizen science framework to activate changes in the built environment that improve older peoples' health.

CONCLUSION

The ageing of the world's population brings with it an increased population-level risk of chronic disease and disability. We present the Our Voice framework, developed by researchers at Stanford University, as a promising strategy for engaging and empowering older people as citizen scientists, as a framework to apply to gerontological nursing and improving community health.

IMPLICATIONS FOR PRACTICE

Gerontology nurses are encouraged to: (i) Recognise the impact of the built environment and other community-level factors on the health of their patients. (ii) Encourage older adults to take an active role in documenting features of their environments that promote or hinder healthy living. (iii) Support policies and programmes that promote healthy environments.

Few opportunities to influence decisions regarding the care and treatment of an older hospitalized family member: a qualitative study among family members

BACKGROUND

The drive towards patient involvement in health services has been increasingly promoted. The World Health Organisation emphasizes the family's perspective in comprehensive care. Internationally there is an increased emphasis on what patients and their family tell about the hospital experiences. However, current literature does not adequately address the question of participation experiences among relatives of older hospitalized family members. There is a paucity of research with a generational perspective on relatives' opportunities to exert influence. The aim of the study was to explore relatives' experiences of opportunities to participate in decisions about the care and treatment of older hospitalized family members and whether there are different experiences of influence to the relatives' age.

METHODS

This was an explorative study applying individual qualitative interviews. The interviews were analysed following hermeneutic methodological principles. Two Norwegian geriatric wards participated: one at a university hospital and one at a local hospital. Twelve participants, six women and six men, were purposively selected. The relatives were aged from 36 to 88 (mean age 62) and were spouses, children and/or children-in-law of patients.

RESULTS

The relatives' experienced opportunities to exert influence were distributed along a continuum ranging from older relatives being reactive waiting for an initiative from health professionals, to younger adults being proactive securing influence. Older "invisible" carers appeared to go unnoticed by the health professionals, establishing few opportunities to influence decisions. The middle-aged relatives also experienced limited influence, but participated when the hospital needed it. However, limited participation seemed to have less impact on their lives than in the older relatives. Middle-aged relatives and younger adults identified strategies in which visibility was the key to increasing the odds of gaining participation. The exceptional case seemed to be some older carers' experiences of influencing decisions with the help of professionals.

CONCLUSIONS

Our findings suggest that experiences of influence were limited regardless of age. However, the results indicated that participation among relatives decrease with age while vulnerability for not having influence seemed to increase with age. The problem of patient choice most clearly manifested among the older carers, which might indicate that the relatives' age sets terms for opportunities to participate.

Extending "Continuity of Care" to include the Contribution of Family Carers

BACKGROUND

Family carers, as a "shadow workforce", are foundational to the day-to-day integration of health service delivery for older family members living with complex health needs. This paper utilises Haggerty's model of continuity of care to explore the contribution of family carers' to the provision of care and support for an older family member's chronic condition within the context of health service delivery.

METHODS

We analysed data from interviews of 13 family carers in a case study of primary health care in New Zealand - a Maori Provider Organisation - to determine the alignment of family caregiving with the three levels of continuity of care (relational continuity, informational continuity, and management continuity).

RESULTS

We found alignment of family caregiving tasks, responsibilities, and relationships with the three levels of continuity of care. Family carers 1) partnered with providers to extend chronic care to the home; 2) transferred and contributed information from one provider/service to another; 3) supported consistent and flexible management of care.

DISCUSSION

The Maori Provider Organisation supported family carer-provider partnership enabled by shared Maori cultural values and social mandate of building family-centred wellbeing. Relational continuity was the most important level of continuity of care; it sets precedence for family carers and providers to establish the other levels - informational and management - continuity of care for their family member cared for. Family carers need to be considered as active partners working alongside responsive primary health care providers and organisation in the implementation of chronic care.

Patients' and providers' perceptions of the preventability of hospital readmission: a prospective, observational study in four European countries

OBJECTIVES

Because of fundamental differences in healthcare systems, US readmission data cannot be extrapolated to the European setting: To investigate the opinions of readmitted patients, their carers, nurses and physicians on predictability and preventability of readmissions and using majority consensus to determine contributing factors that could potentially foresee (preventable) readmissions.

DESIGN

Prospective observational study. Readmitted patients, their carers, and treating professionals were surveyed during readmission to assess the discharge process and the predictability and preventability of the readmission. Cohen's Kappa measured pairwise agreement of considering readmission as predictable/preventable by patients, carers and professionals. Subsequently, multivariable logistic regressionidentified factors associated with predictability/preventability.

SETTING

15 hospitals in four European countries PARTICIPANTS: 1398 medical patients readmitted unscheduled within 30 days MAIN OUTCOMES AND MEASURES: (1) Agreement between the interviewed groups on considering readmissions likely predictable or preventable;(2) Factors distinguishing predictable from non-predictable and preventable from non-preventable readmissions.

RESULTS

The majority deemed 27.8% readmissions potentially predictable and 14.4% potentially preventable. The consensus on predictability and preventability was poor, especially between patients and professionals (kappas ranged from 0.105 to 0.173). The interviewed selected different factors as potentially associated with predictability and preventability. When a patient reported that he was ready for discharge during index admission, the readmission was deemed less likely by the majority (predictability: OR 0.55; 95% CI 0.40 to 0.75; preventability: OR 0.35; 95% CI 0.24 to 0.49).

CONCLUSIONS

There is no consensus between readmitted patients, their carers and treating professionals about predictability and preventability of readmissions, nor associated risk factors. A readmitted patient reporting not feeling ready for discharge at index admission was strongly associated with preventability/predictability. Therefore, healthcare workers should question patients' readiness to go home timely before discharge.

Understanding informal carers' experiences of caring for older people with a hip fracture: a systematic review of qualitative studies

PURPOSE

This systematic review aimed to reconceptualize experiences from a variety of papers to provide direction for research, policy and practice.

METHOD

Meta-ethnography was used to inform the review, and 21 studies were included.

FINDINGS

The analysis identified a core theme of "engaging in care: struggling through", as carers, who wanted to be involved in caring, learnt to live with the intense and stressful impact of caring and changes to their life. The core theme is represented through three themes (1) Helping another to live, (2) Adapting ways of living and (3) Negotiating the unknown.

CONCLUSIONS

The discussion identified a focus on carers of people suffering from a hip fracture, the willingness of informal carers to engage in caring and the intense experience of adapting to changes in relationships and dependency alongside a steep experiential learning curve. Tensions exist in negotiations with complex health care systems as carers do not feel their expertise is valued and struggle to find and understand information. Implications for Rehabilitation Including relatives/carers in the umbrella of care within a family-centred approach. Involving relatives/carers within shared decision-making about care requirements and rehabilitation goals. Utilizing forms of experiential learning to help the development of relatives/carers skills in relation to their role as carer. Providing opportunities for carers to explore ways of sustaining their own health through self-compassion.

Supportive care for older people with frailty in hospital: An integrative review

BACKGROUND

Growing numbers of older people living with frailty and chronic health conditions are being referred to hospitals with acute care needs. Supportive care is a potentially highly relevant and clinically important approach which could bridge the practice gap between curative models of care and palliative care. However, future interventions need to be informed and underpinned by existing knowledge of supportive care.

AIM

To identify and build upon existing theories and evidence about supportive care, specifically in relation to the hospital care of older people with frailty, to inform future interventions and their evaluation.

DESIGN

An integrative review was used to identify and integrate theory and evidence. Electronic databases (Cochrane Medline, EMBASE and CIHAHL) were searched using the key term 'supportive care'. Screening identified studies employing qualitative and/or quantitative methods published between January 1990 and December 2015. Citation searches, reference checking and searches of the grey literature were also undertaken.

DATA SOURCES

Literature searches identified 2733 articles. After screening, and applying eligibility criteria based on relevance to the research question, studies were subject to methodological quality appraisal. Findings from included articles (n=52) were integrated using synthesis of themes.

RESULTS

Relevant evidence was identified across different research literatures, on clinical conditions and contexts. Seven distinct themes of the synthesis were identified, these were: Ensuring fundamental aspects of care are met, Communicating and connecting with the patient, Carer and family engagement, Building up a picture of the person and their circumstances, Decisions and advice about best care for the person, Enabling self-help and connection to wider support, and Supporting patients through transitions in care. A tentative integrative model of supportive care for frail older people is developed from the findings.

CONCLUSION

The findings and model developed here will inform future interventions and can help staff and hospital managers to develop appropriate strategies, staff training and resource allocation models to improve the quality of health care for older people.

Outcomes for family carers of a nurse-delivered hospital discharge intervention for older people (the Further Enabling Care at Home Program): Single blind randomised controlled trial

BACKGROUND

Hospital discharge of older people receiving care at home offers a salient opportunity to identify and address their family caregivers' self-identified support needs.

OBJECTIVES

This study tested the hypothesis that the extent to which family caregivers of older people discharged home from hospital felt prepared to provide care at home would be positively influenced by their inclusion in the new Further Enabling Care at Home program.

DESIGN

This single-blind randomised controlled trial compared outcomes from usual care alone with those from usual care plus the new program. The program, delivered by a specially trained nurse over the telephone, included: support to facilitate understanding of the patient's discharge letter; caregiver support needs assessment; caregiver prioritisation of urgent needs; and collaborative guidance, from the nurse, regarding accessing supports.

SETTING AND PARTICIPANTS

Dyads were recruited from the medical assessment unit of a Western Australian metropolitan public hospital. Each dyad comprised a patient aged 70 years or older plus an English speaking family caregiver.

METHODS

The primary outcome was the caregiver's self-reported preparedness to provide care for the patient. Data collection time points were designated as: Time 1, within four days of discharge; Time 2, 15-21days after discharge; Time 3, six weeks after discharge. Other measures included caregivers' ratings of: their health, patients' symptoms and independence, caregiver strain, family well-being, caregiver stress, and positive appraisals of caregiving. Data were collected by telephone.

RESULTS

Complete data sets were obtained from 62 intervention group caregivers and 79 controls. Groups were equivalent at baseline. Needs prioritised most often by caregivers were: to know whom to contact and what to expect in the future and to access practical help at home. Support guidance included how to: access help, information, and resources; develop crisis plans; obtain referrals and services; and organise legal requirements. Compared to controls, preparedness to care improved in the intervention group from Time 1 to Time 2 (effect size=0.52; p=0.006) and from Time 1 to Time 3 (effect size=0.43; p=0.019). These improvements corresponded to a change of approximately 2 points on the Preparedness for Caregiving instrument. Small but significant positive impacts were also observed in other outcomes, including caregiver strain.

CONCLUSIONS

These unequivocal findings provide a basis for considering the Furthering Enabling Care at Home program's implementation in this and other similar settings. Further testing is required to determine the generalisability of results.