Objective: Older persons are at a greater risk of functional decline and iatrogenic complications during hospitalization. In the United States, family caregivers often play a minimal role in providing care in the hospital setting despite the fact that they may be actively involved at home. Involving family caregivers in the hospital care of their loved one may result in positive outcomes, both for elderly patients and for their family caregivers. However, few empirical studies have been conducted to evaluate the effectiveness of interventions to enhance family participation in caring for hospitalized elders. The objective of this pilot study was to evaluate the effects of a theoretically-driven, reproducible intervention to empower family caregivers to play an active caregiving role in the hospital for their older relatives.
Design: A prospective, randomized controlled clinical trail was conducted with two groups (treatment group vs. comparison group).
Population, Sample, Setting, Years: The study was conducted in a 750-bed teaching hospital in northeastern United States. Forty-four family members of an equal number of patients that were 65 years old or above were recruited from medical and surgical floors from August of 2001 to January of 2002. The average ages of family caregivers were 75 and 61 years old respectively.
Intervention and Outcome Variables: Family caregivers in the treatment group received audio-tapes containing information about caring for older persons, complications of hospitalization, common emotional reactions and ways that the family caregiver might be able to help in the hospital. Family caregivers were then assisted in developing a specific plan for their loved ones in the hospital care. Family caregivers of the control group listened to audio-tapes that contained general information about the hospital and visited with research assistants who would answer general questions. Family caregivers outcomes included emotional responses (worry, anxiety, and depression), functional outcomes (actual patient care delivered), role outcomes (preparedness for follow-up care, role rewards and role strain, and mutuality). Patient outcomes included length of stay, hospital complications, re-admission after discharge, functional level and depression status.
Methods: Contacts were made with the family caregivers at four time points: 1-2 days after hospital admission (intervention contact); 1-4 days prior to hospital discharge (intervention contact); 2 weeks after discharge (follow-up contact); and 2 months after discharge (follow-up contact). Several validate and reliable instruments were used to measure outcomes of family caregivers and patients.
Findings: Results provide evidence to support the positive effects of the CARE program, in comparison to the control program, in: (a) increasing family caregivers' beliefs about family participation (effect (b) increasing family participation in patients' care (effect (c) increasing preparedness for follow-up care (effect (d) increasing mutuality between family caregiver and care receiver (effect (e) increasing caregiver role rewards (effect sizes=.42-.65), (f) decreasing role strain (effect sizes=.45-.85), (g) decreasing elderly patient's length of stay (effect and (e) reducing the incident rate of acute confusion (effect and some other complications (effect sizes=.12-.53).
Conclusions: These findings provide compelling evidence for the need to develop a full-scale randomized clinical trial to test both the short-and long-term outcomes of the intervention program on family caregiving and hospitalized elders with a larger sample.
Implications: This pilot study demonstrates that family caregivers can be successfully integrated into the hospital care plan. The benefits of this involvement include improved feelings of reward, preparedness for discharge and better understanding between the caregivers and patients. There also was evidence of a reduction in length of stay and delirium. The nursing staff welcomed the increased involvement of the family caregivers and felt that this improved patient care. This intervention has great potential for reproducibility in other hospitals throughout the country.
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