17.7 million family caregivers of older adults in the U.S. today
Family caregivers play a major—and perhaps the most important—role in supporting older adults during hospitalization and especially after discharge. Until recently, however, little attention was paid to family caregivers’ distinctive needs during transitions in care. Consequently, family caregivers consistently rate their level of engagement in decision making about discharge plans and the quality of their preparation for the next stage of care as poor.
Caregiving can be rewarding, but it can also impose burdens on family caregivers. The stress of caregiving is likely to be exacerbated during episodes of acute illness. Nurses and social workers need to attend to the emotional needs of caregivers during transitional care to help minimize their negative experiences and to enhance their ability to support their loved ones.
To inform the development of a TCM intervention, we studied the factors associated with burden that caregivers of cognitively impaired older adults (e.g., deficits in orientation, recall, or executive function or a diagnosed dementia) at the time of hospitalization experienced. Higher burden was associated with younger caregivers, being a spouse, depressive symptoms, caregivers’ lower perceived self-efficacy in managing care recipient symptoms, distress from the older adult’s neuropsychiatric symptoms and reporting limited finances at the end of the month. Caregiver burden was also strongly associated with the patient symptom of delirium and greater functional deficits in basic activities of daily living.
Among caregivers of cognitively impaired older adults who experienced high burden when their relative was hospitalized, the TCM was found to be more effective in reducing burden than similar groups who received other evidence-based interventions. In ongoing studies, the TCM also aims to lessen the burden among family members by reducing the demands of caregiving and improving family functioning.