A Theoretical Exploration of Live Discharge from Hospice for Caregivers of Adults with Dementia

Dementia caregiver burdens predict overnight hospitalization and hospice utilization

OBJECTIVES

To determine sociodemographics and caregiver burdens associated with overnight hospitalization, hospice utilization, and hospitalization frequency among persons with dementia (PWD).

METHODS

Cross-sectional analysis of PWD (n = 899) of the National Health and Aging Trends Study linked to the National Study of Caregiving. Logistic and proportional odds regression determined the effects of caregiver burdens on overnight hospitalization, hospice use, and hospitalization frequency. Differences between PWD alive not-alive groups were compared on overnight hospitalization and frequency.

RESULTS

Alive PWD (n = 804) were 2.36 times more likely to have an overnight hospital stay (p = 0.004) and 1.96 times more likely to have multiple hospitalizations when caregivers found it physically difficult to provide care (p = 0.011). Decedents aged 65-74 (n = 95) were 4.55 times more likely to experience overnight hospitalizations than 85+, hospitalizations were more frequent (odds ratio [OR] = 4.84), and there was a significant difference between PWD alive/not alive groups (p = 0.035). Decedents were 5.60 times more likely to experience an overnight hospitalization when their caregivers had financial difficulty, hospitalizations were more frequent when caregivers had too much to handle (OR = 8.44) and/or no time for themselves (OR = 10.67). When caregivers had no time for themselves, a significant difference between alive/not alive groups (p = 0.018) was detected in hospitalization frequency. PWD whose caregivers had emotional difficulty helping were 5.89 times more likely to utilize hospice than caregivers who did not report emotional difficulty.

SIGNIFICANCE OF RESULTS

Care transitions among PWD at the end of life are impacted by the circumstances and experiences of their caregivers. Subjective caregiver burdens represent potentially modifiable risks for undesired care transitions and opportunities for promoting hospice use. Future work is warranted to identify and address these issues as they occur.

A systematic review of systematic reviews of needs of family caregivers of older adults with dementia

Family caregivers provide vital assistance to older adults living with dementia. An accurate assessment of the needs of caregivers supports the development and provision of appropriate solutions to address these needs. This review of systematic reviews analyzes and synthesizes the needs identified by family caregivers. We conducted a systematic review of systematic reviews using the AMSTAR guideline. Electronic databases were searched for systematic reviews on the needs of caregivers in the context of dementia using a combination of keywords and medical subject headings. Records resulting from the search were screened by two reviewers. Data on the needs of caregivers were extracted from the articles and analyzed using a narrative synthesis approach. Out of the 17 potentially eligible systematic reviews obtained initially, 6 met the inclusion criteria. In total, 20 main needs were identified in the reviews included in this study. The need for information and social support were prominent in this review. Factors such as gender, resources available to the caregiver and the care recipient's health status may influence caregivers' needs. Interventions can be tailored toward addressing the most prominent needs of caregivers such as adequate information and resources and available programs may further accommodate and offer need-tailored support to them.