Characteristics of older unpaid carers in England: a study of social patterning from the English Longitudinal Study of Ageing

BACKGROUND

A growing number of older people provide unpaid care, but contemporary research evidence on this group is limited.

AIM

This study aims to describe the characteristics of older people who provide unpaid care and how these vary by socioeconomic position.

METHODS

Using recent information from the English Longitudinal Study of Ageing (ELSA wave 9, 2019), we analysed cross-sectional data on 1,282 unpaid carers aged ≥50. Data on sociodemographics, health, social wellbeing, care intensity and caregiver-recipient relationships were extracted. Total net non-pension wealth quintiles were used as a relative measure of socioeconomic position. Differences between the poorest and richest wealth quintiles were examined through logistic regression.

FINDINGS

Most older carers in ELSA were female and looking after another older person. Poor mental and physical health and social isolation were common, and socially patterned. Compared with carers in the middle wealth group, the poorest group were more likely to be living with the person they cared for (odds ratio (OR) 1.56 [95% confidence interval (CI) 1.03-2.36]) and more likely to experience loneliness (OR 2.29 [95% CI 1.42-3.69]), dependency (i.e. the need for help with activities of daily living) (OR 1.62 [95% CI 1.05-2.51]), chronic pain (OR 1.81 [95% CI 1.23-2.67]), a higher number of diseases (OR 1.75 [95% CI 1.15-2.65]) and fair/poor self-rated health (OR 2.59 [95% CI 1.79-3.76]). The poorest carers were also less likely to have a high quality of life (OR 0.51 [95% CI 0.33-0.80]) or be in work (OR 0.33 [95% CI 0.19-0.59]).

CONCLUSION

Our findings suggest that financially disadvantaged unpaid carers (and their households) may have the greatest needs for intervention and support. Focussing resources on this group has potential to address social inequalities.

Caring for a person living with dementia: identifying and assessing a carer's needs

As the population ages and so do the numbers of people with dementia, there will also be an increase in the number of unpaid family carers. Estimates suggest that one in three of us will become a carer for someone with dementia during our lifetime, some caring for more than one person diagnosed with dementia in their family. There are currently over 700 000 people in the UK acting as primary unpaid carers for people with dementia, all of whom make a substantial contribution, both financially and physically, to their care and support. Carers of people with dementia can experience high levels of carer burden and distress as well poor health and wellbeing due to their caring roles. However, they can sometimes be less than visible to health and social care services as they may not identify themselves as carers or their needs may not be easily recognised which leaves them at risk. Identifying people in caring roles and assessing their needs are the first two steps in supporting them. Community nurses are well placed to do this within their roles.

Informal carer support needs, facilitators and barriers in transitional care for older adults from hospital to home: A scoping review

AIM

To synthesise evidence about informal carers' (carers) experience of their support needs, facilitators and barriers regarding transitional care of older adults with multimorbidity.

BACKGROUND

Carers provide crucial support for older adults during care transitions. Although health practitioners are well positioned to support carers, system factors including limited healthcare resources can compromise the quality of care transitions.

DESIGN

Scoping review.

METHODS

Searches were undertaken of the published literature. Five databases were searched including MEDLINE, CINAHL, EMBASE, PsycINFO and the Cochrane Library. Two reviewers independently screened articles to identify relevant studies. Studies were retrieved from January 2000 to July 2022. Data were extracted and tabulated for study characteristics, support needs, facilitators and barriers. Key themes and patterns were synthesised across the studies.

RESULTS

Eighteen studies including N = 3174 participants were retrieved. Most studies (n = 13) employed qualitative designs. Five studies used surveys. Carers reported their need to: be involved in coordinated discharge planning; advocate and be involved in decision-making; and receive community-based follow-up. Carers described facilitators and barriers in four themes: (1) relationships with the older adult and health practitioners, (2) being involved in coordinated discharge planning; (3) communication and information strategies; and (4) community-based follow-up. Synthesis of themes across all studies resulted in the identification of five areas of research: carers' health literacy; community-based care; carers' involvement in transitional care planning; inpatient and community health practitioners' communication skills; and culturally diverse carers' experiences.

CONCLUSION AND RELEVANCE TO CLINICAL PRACTICE

The review highlights the importance of quality communication and relationships between carers, older adults, health practitioners and health organisations. Although information and education are important there is a need for further research to examine systems that support communication between carers, older adults and health practitioners and health literacy for all carers including culturally diverse carers.

'It was just - everything was normal': outcomes for people living with dementia, their unpaid carers, and paid carers in a Shared Lives day support service

OBJECTIVES

Short breaks support the wellbeing of people living with dementia (PLWD) and their unpaid carers. However, little is known about the benefits of community-based short breaks. The objective of this study was to conduct interviews with stakeholders of a Shared Lives (SL) day support service to explore mechanisms and outcomes for the service. The aim of the study was to refine a logic model for a SL day support service for PLWD, their unpaid carers, and paid carers. This logic model shall form the basis for a Social Return on Investment evaluation to identify the social value contributed by the service.

METHODS

Thirteen interviews were conducted with service stakeholders including PLWD, unpaid carers and paid carers. Framework analysis assisted in the synthesis of the findings into a logic model.

RESULTS

The logic model refined through the interviews, detailed service mechanisms (inputs, activities, outputs) and outcomes. An overarching theme from the interviews concerned the importance of triadic caring relationships, which conferred benefits for those involved in the service.

CONCLUSION

SL day support fosters triadic caring relationships, and interview data suggests that these relationships are associated with meaningful outcomes for PLWD, their unpaid carers, and paid carers. We highlight the implications for policy, practice, and future research.

Interventions that support unpaid carers of adult mental health inpatients: a scoping review

BACKGROUND

Unpaid carers of adult mental health inpatients often lack support for their well-being and feel excluded from decisions about patient care.

AIMS

This scoping review aimed to: synthesise the peer-reviewed literature evaluating the outcomes of brief interventions for unpaid carers of adult mental health inpatients, identify transferable lessons for evidenced-informed practice, and establish future research priorities.

METHODS

PRISMA scoping review guidelines were followed to search 12 databases using predefined search terms. Two reviewers independently screened papers and applied exclusion/inclusion criteria. Studies were included if they evaluated the impact or outcomes of interventions. Two reviewers extracted data and assessed study quality. Data were synthesised to categorise types of interventions and evidence for their outcomes.

RESULTS

16 papers met the inclusion criteria, and five types of interventions were identified: those that aimed to (1) increase carer involvement in inpatient care; (2) facilitate organisational change to increase carer support and involvement; (3) provide carers with support; (4) deliver psychoeducation and offer support; and (5) reduce carer stress and improve coping skills.

CONCLUSIONS

Whilst evidence of intervention effectiveness was promising, the quality of studies was generally weak. More research is needed to develop an evidence-informed approach to supporting carers during inpatient stays.

Stress and well-being of unpaid carers supporting claimants through disability benefit assessments

This study assessed the subjective well-being and perceived stress of unpaid carers of disability benefit claimants. A total of 129 carers from the UK were surveyed between July and September 2017, using a cross-sectional design. Carers, who provided unpaid support to sick or disabled friends, family or neighbours in a non-professional capacity, reported here as unpaid carers, were asked to complete a web-based questionnaire comprising of the Perceived Stress-10-item Scale (PSS-10), the Personal Wellbeing Index-Adult (PWI-A), sociodemographic characteristics, the time they spent caring per day and the number of Personal Independence Payment and Work Capability Assessment interviews prepared for and attended by the person they cared for. Hierarchical regression analyses were performed to assess the effects of the number of benefit assessments on stress and well-being scores, controlling for carers' sociodemographic characteristics and the time they spent caring. Analyses revealed that the number of times that claimants were exposed to benefit assessments significantly and negatively predicted unpaid carers' well-being and was positively related to their stress levels. After controlling for sociodemographic characteristics and hours supporting per day, benefit assessments predicted 8.1% of perceived stress and 4.3% of well-being variance. Being a female unpaid carer of a disability benefit claimant negatively predicted 7.5% of well-being variance. The results offered unique evidence of the negative psychological effects of disability benefit assessments upon unpaid carers, while adding to the evidence of female carers facing increased risks of psychological distress.

Telehealth and Telecare: supporting unpaid carers in Scotland

The Scottish Government Joint Improvement Team (JIT) and the Scottish Centre for Telehealth (SCT), now merged as the Scottish Centre for Telehealth and Telecare (SCTT), published an Education and Training Strategy for Telehealthcare in Scotland in March 2010. In implementing the Strategy’s dedicated Carers Workstream, the SCTT has been working with Carers Scotland and other carer organisations to promote awareness of the benefits of telehealth and telecare in helping to support unpaid carers. Following on from research undertaken by the University of Leeds into the benefits of telecare for carers, developments to date includes the publication of a Training Toolkit for professionals and carer organisations to assist with raising awareness of the benefits of telehealth and telecare specifically for unpaid carers. The toolkit includes outline training programmes, handouts, digital stories and case studies which all adaptable for local use. The presentation will provide an overview of the broader strategic carers’ agenda in relation to telehealth and telecare service delivery, an in-depth look at the Carers and Telehealthcare Training Toolkit and an update on an exciting new technology project to support young carers, being developed in collaboration with Princess Royal Trust for Carers, Glasgow Caledonian and Edinburgh Universities.

Project objectives/deliverables:

Work with local authority, health boards and other partners to raise awareness of telehealth and telecare care amongst carers nationally and locally.

Identify methods and programme for delivery to ensure that carers have access to appropriate information about access to telehealth and telecare services.

Develop core content and supporting materials in carer awareness and telehealth and telecare training to form a Carers and Telehealthcare Training Toolkit.

Evaluate impact of Telehealthcare Training Toolkit on staff and carers to inform future development of Toolkit contents.

Incorporate telehealth and telecare for carers’ content into core curriculum and CPD modules for health and social care staff.

Identify methods and programme for delivery to facilitate the integration of telehealth and telecare needs into carer, community care and health assessment processes.

Work with Glasgow Caledonian University and partners to enhance young carers’ access to information and support via a technology solution.