Caregiver Care

 

Am Fam Physician. 2019 Jun 1;99(11):699-706.

  Patient information: See related handout on caregiver care, written by the authors of this article.

Author disclosure: No relevant financial affiliations.

Eighty percent of adults requiring long-term care currently live at home in the community, and unpaid family caregivers provide 90% of their care. Family caregivers serve as a critical extension of the U.S. health care system, and the demand for family caregivers is expected to increase during the next few decades. Caring for loved ones is associated with several benefits, including personal fulfillment; however, caregiving is also associated with physical, psychological, and financial burdens. Family physicians can aid in the identification, support, and treatment of caregivers by offering caregiver assessments—interviews directed at identifying high levels of burden—as soon as caregivers are identified. Repeat assessments may be considered when there is a change in the status of the caregiver or the care recipient. Caregivers should be directed to appropriate resources for support, including national caregiving organizations, local elder care agencies, websites, and respite care. Psychoeducation, skills training, and therapeutic counseling interventions for caregivers have shown small to moderate success by decreasing caregiver burden and increasing caregiver quality of life. Additional research is needed to further identify strategies to offset caregiver stress, depression, and poor health outcomes. Support and anticipatory guidance for the caregiver is especially helpful during care transitions and at the care recipient's end of life.

A family caregiver is broadly defined as a friend or relative who provides unpaid assistance for a person with a chronic or disabling condition.1 Eighty percent of adults requiring long-term care currently live at home in the community, and unpaid family caregivers provide 90% of their care.2 These caregivers fill an important role for the family and provide a substantial cost savings of an estimated $470 billion nationwide in 2013.3 Family caregivers serve as a critical extension of the U.S. health care system, and supporting this “invisible and isolated army” has emerged as a national public health priority.3,4

WHAT IS NEW ON THIS TOPIC

Caregiver Care

Online interactive programs significantly reduce patient physical symptoms and decrease caregiver burden and depressive symptoms.

In caregivers of people with dementia, a meta-analysis showed that multicomponent interventions (e.g., education, resiliency training, problem solving) can reduce depressive symptoms, improve quality of life, and reduce caregiver burden.

The National Family Caregiver Support Program is the first federally funded program to formally recognize caregivers. However, in 2016, the program received only $150 million in federal funding, approximately one-twentieth of one percent of the estimated value of caregiver contributions to the health system.

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SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferences

All caregivers should be offered assessment to identify high levels of caregiver burden.

C

1, 12, 16

Encouraging caregivers to take a break, take care of their own health, seek preventive health care, join a support group, and seek respite care when needed are key ways that a family physician can provide direct caregiver support.

C

5

Caregivers identified as having unmet educational or informational needs should be directed to appropriate resources for support.

C

1, 6, 13, 16

Psychoeducational, skills training, and therapeutic counseling interventions for caregivers of patients with chronic conditions (e.g., dementia, cancer, stroke, heart failure) have small to moderate success in decreasing caregiver burden and increasing caregiver quality of life.

B

34, 35, 3739

Anticipatory guidance, assistance with advance care planning, and information about appropriate resources should be provided to the care recipient and caregiver during care transitions and at the end of life.

C

36, 37, 43


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferences

All caregivers should be offered assessment to identify high levels of caregiver burden.

C

1, 12, 16

Encouraging caregivers to take a break, take care of their own health, seek preventive health care, join a support group, and seek respite care when needed are key ways that a family physician can provide direct caregiver support.

C

5

Caregivers identified as having unmet educational or informational needs should be directed to appropriate resources for support.

C

1, 6, 13, 16

Psychoeducational, skills training, and therapeutic counseling interventions for caregivers of patients with chronic conditions (e.g., dementia, cancer, stroke,

The Authors

show all author info

KRISTINE SWARTZ, MD, is an assistant professor in the Department of Family and Community Medicine at Thomas Jefferson University, Philadelphia, Pa....

LAUREN G. COLLINS, MD, is a Josiah Macy Jr. Foundation Faculty Scholar and an associate professor in the Department of Family and Community Medicine at Thomas Jefferson University.

Address correspondence to Kristine Swartz, MD, Thomas Jefferson University, 1015 Walnut St., Ste. 401, Philadelphia, PA 19107 (e-mail: kristine.swartz@jefferson.edu). Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.

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show all references

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