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We did this study to look at two aspects that are important to the
home care clients. One is their level of frailty.
Frailty is a geriatric syndrome and it's a way to place an older client
on a continuum of health. So there are those that are relatively not frail, or
what we call robust, and then it goes all the way up to those who might be more
frail or very frail. And frailty of course is related to the help that's
required to help support them in the home so that they can perform activities
of daily living, get help with instrumental activities of daily living, and
to do well with a high level of quality of life.
The other aspect that we looked at was caregiver distress, which is also important because
the more frail an older client is, the more likely that their caregiver helping in the home
might have some kind of distress. This is particularly the case when the
caregiver is a spouse who is also older and experiencing their own health issues
but also for a child or a child in-law who might have unique challenges with caring
for their own children, their own health and then also the health of the
parent. So we were interested in the dynamic interplay between the level of
vulnerability or frailty in a client and the level of distress in their caregiver
in predicting important outcomes. And that would be things like placement in
nursing homes, hospitalization, and mortality.
We used linked clinical and administrative health data available to us
through ICES. We had information for seniors - about a quarter of a million seniors -
who were assessed for home care between 2010 and 2013.
With that assessment - it's a very rich clinical assessment tool - we were able to derive a
measure of frailty and so then we could classify home care clients based on how
frail they were. So they might be not very frail, somewhat frail, and have
a higher level, or more severe frailty. And then on the assessment is also a measure
of how distressed their primary caregiver is, whether it's a spouse or a child-in-law,
so we can sort the data in terms of your level of frailty and the presence
or absence of distress in your caregiver, and then try to understand how both
those factors influence outcomes over the one year of follow-up.
In terms of findings, we observed that one in five older home care clients in
Ontario showed frailty. And even though there were significant differences
between male and female clients in their health and their social circumstance,
they showed the same prevalence. So one in five. However, even though the
prevalence was similar in terms of frailty, male clients who were frail
were much more likely to have a distressed caregiver.
So about 50% of male clients who were frail had a distressed caregiver,
compared to about 40% for frail female home care clients. Not surprisingly, the level of frailty -
so the more frail someone was - the higher the risk for all health outcomes
that we looked at, in particular nursing home placement, and death.
And the risks associated with frailty were higher for women than men.
We also found that having a distressed caregiver was an important predictor on its own
for two key outcomes: the likelihood of going into a nursing home, and also the
likelihood for a prolonged hospital stay. And that was true for both male and female clients.
Interestingly, we found that caregiver distress was a very
important predictor of nursing home admission even if the client was not frail,
which is a key finding.
In terms of implications, we are across Canada seeing a tremendous shift with
health care reforms moving from institutional to community-based settings.
And as we witness that, we're worried about the potential stress on
caregivers and the supports that they might need as well as home care clients.
So as we see that shift and the increase in complexity and frailty level among
home care clients, we anticipate that caregiver distress will only increase in
the future. So it's very important to understand the role that caregiver
distress plays, over and above knowing the vulnerability or frailty status of a client,
in predicting important outcomes so that we can better plan and
anticipate health care needs, support needs, and to get those services in
at an earlier stage, and hopefully avoid adverse outcomes.
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