Home Care NetWork
Home Care Literature Reviews 2004
Caregiver Issues:
Porter EJ, Ganong LH, Drew N, Lanes TI. A new typology of home-care helpers. Gerontologist. 2004;44:750-9.
This structured a survey of 25 women aged 80-94 years was used to create a new typology of homecare helpers the basis of the nature of the help. The authors delineated home-care helpers as regular helpers, on-call helpers, can-will doers, and mainstays. The authors make the case that this categorization makes the potential value of homecare efforts more quantifiable compared to the standard association of formal care with paid help and informal care with unpaid help.Hellstrom Y, Hallberg IR. Determinants and characteristics of help provision for elderly people living at home and in relation to quality of life. Scand J Caring Sci. 2004;18:387-95. This Swedish survey of 448 elderly people, aged 75-99 years, living at home and receiving help with instrumental and/or personal activities for daily living found that age, number of children, number of complaints, the ability to stay alone at home and living alone were associated with receiving help from different kinds of caregivers. Recipients receiving help from informal caregivers were younger, more often married and living with someone. Those receiving help from both informal and formal caregivers had more help with instrumental and personal activities for daily living and were not able to stay alone at home as much as those receiving help from other kinds of caregivers. Those receiving help from formal caregivers had fewer children, were more often single and were living alone more often than the other recipients. The critical role of informal caregivers is once more affirmed in this study. There is no reason to believe that the outcomes would have been different and a North American cohort.
Home Care Literature Reviews 2003
Caregiver Issues:
Coon DW, Thompson L, Steffen A, Sorocco K, Gallagher-Thompson D. Anger and depression management: psychoeducational skill training interventions for women caregivers of a relative with dementia. Gerontologist. 2003;43:678-89.
This cohort study of 169 women aged 50 and older who were caring for a community-dwelling relative with a dementing illness randomly assigned participants to one of three treatment interventions: anger management, depression management, or a wait-list control group. Participants in both anger management and depression management groups had significant reductions in their levels of anger or hostility and depression. Self-sufficiancy was also significantly increased in both intervention groups. These small group skills training sessions had a beneficial impact on stresses caregivers.
Covinsky KE, Newcomer R, Fox P, Wood J, Sands L, Dane K, Yaffe K. Patient and caregiver characteristics associated with depression in caregivers of patients with dementia. J Gen Intern Med. 2003;18: 1006-14.
This cross-sectional study of 5624 patients with moderate to advanced dementia and their primary caregivers upon enrollment in the Medicare Alzheimer's Disease Demonstration found that 32% were depressed. Independent patient predictors of caregiver depression were younger age,(odds ratio = 1.91; 95% confidence interval [1.33 to 2.76] in patients less than 65 years compared to patients over 85 years), white (1.53; [1.18 to 1.99]) and Hispanic ethnicity (2.50 [1.69 to 3.70]) compared to black ethnicity, education (1.16; [1.01 to 1.33] for those with less than a high school education), ADL dependence (1.55; [1.26 to 1.90] for patients dependent in 2 or more ADL compared to patients dependent in no ADL), and behavioral disturbance, particularly angry or aggressive behavior (1.47; [1.27 to 1.69] for patients with angry or aggressive behavior). Independent caregiver predictors of depression included low income (1.45; [1.18 to 1.77] for less than $10,000/per year, compared to >$20,000 per year), the relationship to the patient (2.73; [1.31 to 5.72] for wife, compared to son of male patient), hours spent caregiving (1.89; [1.51 to 2.38] for 40 to 79 hours/week compared to less than 40 hours/week), and functional dependence (2.53; [2.13 to 3.01] for ADL dependent compared to IADL independent). This article gives a good profile of those caregivers at risk for depression.
Schulz R, Mendelsohn AB, Haley WE, Mahoney D, Allen RS, Zhang S, Thompson L, Belle SH; Resources for Enhancing Alzheimer's Caregiver Health Investigators. End-of-life care and the effects of bereavement on family caregivers of persons with dementia. N Engl J Med. 2003;349:1936-42.
This survey of 217 family caregivers to individuals dying with dementia found that half the caregivers reported spending at least 46 hours per week assisting patients with activities of daily living and instrumental activities of daily living. The majority felt they were on duty 24 hours a day, that the patient had frequent pain, and that they had had to end or reduce employment due to the demands of caregiving. Caregivers had depressive symptoms while providing care but these symptoms receded in the year the patient's death. Seventy-two percent of caregivers reported that the death was a relief to them, and more than 90 percent reported belief that it was a relief to the patient. This confirms the findings in other studies of caregivers of patients with dementia. The data on follow up of depression symptoms is new and reassuring.
Ingleton C, Payne S, Nolan M, Carey I. Respite in palliative care: a review and discussion of the literature. Palliat Med. 2003;17:567-75.
This systemic review of the literature for evidence supporting the provision or utility of respite in palliative care context and its impact on caregivers'' physical, psychological and social outcomes. Two hundred sixty papers were reviewed. Of these papers 28 related directly to adult respite care in specialist palliative care. The relevant papers included either a description of the program, guidance on referral criteria to respite services or evaluated the effects of respite on the patient. There were no empirical studies assessing the effects of respite provided by specialist palliative care services on caregiver outcomes. This article is included primarily to illustrate the sorry state of the art and as a call for research in this area.
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