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R. O’Caoimh, N. Cornally, A. Svendrovski, E. Weathers, C. FitzGerald, E. Healy, E. O’Connell, G. O’Keeffe, E. O’Herlihy, Y. Gao, R. O’Donnell, R. O’Sullivan, P. Leahy-Warren, F. Orfila, C. Paúl, R. Clarnette, D.W. Molloy

J Frailty Aging 2016;5(2):104-110

Background: Although caregivers are important in the management of frail, community-dwelling older adults, the influence of different caregiver network types on the risk of adverse healthcare outcomes is unknown. Objective: To examine the association between caregiver type and the caregiver network subtest of The Risk Instrument for Screening in the Community (RISC), a five point Likert scale scored from one (“can manage”) to five (“absent/liability”). To measure the association between caregiver network scores and the one-year incidence of institutionalisation, hospitalisation and death. Design: Observational cohort study. Setting and Participants: Community-dwelling adults, aged >65,attending health centres in Ireland,(n=779). Procedure and Measurements: The caregiver network subtest of the RISC was scored by public health nurses. Caregivers were grouped dichotomously into low-risk (score of one) or high-risk (scores two-five). Results: The majority of patients had a primary caregiver (582/779;75%), most often their child (200/582;34%). Caregiver network scores were highest, indicating greatest risk, when patients had no recognised primary caregiver and lowest when only a spouse or child was available. Despite this, patients with a caregiver were significantly more likely to be institutionalised than those where none was required or identified (11.5% versus 6.5%,p=0.047). The highest one-year incidence of adverse outcomes occurred when state provided care was the sole support; the lowest when private care was the sole support. Significantly more patients whose caregiver networks were scored high-risk required institutionalisation than low-risk networks; this association was strongest for perceived difficulty managing medical domain issues, odds ratio (OR) 3.87:(2.22-6.76). Only perceived difficulty managing ADL was significantly associated with death, OR 1.72:(1.06-2.79). There was no association between caregiver network scores and risk of hospitalisation. Conclusion: This study operationalizes a simple method to evaluate caregiver networks. Networks consisting of close family (spouse/children) and those reflecting greater socioeconomic privilege (private supports) were associated with lower incidence of adverse outcomes. Caregiver network scores better predicted institutionalisation than hospitalisation or death.

R. O’Caoimh ; N. Cornally ; A. Svendrovski ; E. Weathers ; C. FitzGerald ; E. Healy ; E. O’Connell ; G. O’Keeffe ; E. O’Herlihy ; Y. Gao ; R. O’Donnell ; R. O’Sullivan ; P. Leahy-Warren ; F. Orfila ; C. Paúl ; R. Clarnette ; D.W. Molloy (2016): Measuring the effect of carers on patients’ risk of adverse healthcare outcomes using the caregiver network score. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2016.86


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