The growing homebound population is heavily reliant on informal caregivers, who are increasingly burdened by their roles. This study describes informal caregivers of the homebound who remain caregivers at a 9-month follow-up and examines the impact of a home-based primary care (HBPC) program on caregiver burden and unmet needs using a prospective design with a pre—post intervention assessment. Informal caregivers of the urban homebound are similar to caregivers of other populations and have a broad range of unmet needs. The intervention described is the regular provision of multidisciplinary HBPC. Hundred fourteen caregivers of newly admitted patients complete a baseline interview. For the 56 caregivers who complete a 9-month follow-up interview, participation in HBPC is associated with a statistically significant decrease in overall caregiver burden. At 9 months, caregivers demonstrate an overall decrease in unmet needs, with a statistically significant decrease across two measured domains. These results suggest that the regular provision of multidisciplinary care in the home can mitigate the deleterious impact of informal caregiving.
Adelman, A.M., Fredman, L., & Knight, A.L. (1994). House call practices: A comparison by specialty . Journal of Family Practice, 39, 39-44.
2.
American Academy of Home Care Physicians. ( 2005). AAHCP public policy statement. Retrieved July 21, 2005, from http://www.aahcp.org/public_policy_2005.pdf
3.
American Geriatrics Society. (2006). Interdisciplinary care for older adults with complex needs: American Geriatrics Society position statement. Journal of the American Geriatrics Society, 54, 849-852.
4.
Argimon, J.M., Limon, E., Vila, J., & Cabezas, C. (2004). Health-related quality of life in carers of patient with dementia. Family Practice, 21, 454-457.
5.
Barrocas, A., Bistrian, B.R., Blackburn, G.L., Chernoff, R., Lipschitz, D.A., & Cohen, D. (1995). Appropriate and effective use of the NSI checklist and screens: An update on caring for the elderly by preventing malnutrition . Journal of the American Dietetic Association, 95, 647-648.
6.
Brickner, P.W., Duque, T., Kaufman, A., Sarg, M., Jahre, J.A., Maturlo, S., et al. (1975). The homebound aged-A medically unreached group. Annals of Internal Medicine, 82, 1-6.
7.
Burgener, S., & Twigg, P. (2002). Relationships among caregiver factors and quality of life in care recipients with irreversible dementia. Alzheimer Disease and Associated Disorders, 16(2), 88-102.
8.
Cameron, J.I., Franche, R.L., Cheung, A.M., & Stewart, D.E. (2002). Lifestyle interference and emotional distress in family caregivers of advanced cancer patients. Cancer, 94, 521-527.
9.
Canam, C., & Acorn, S. (1999). Quality of life for family caregivers of people with chronic health problems. Rehabilitation Nursing, 24, 192-196.
10.
Caplan, G.A., Williams, A.J., Daly, B., & Abraham, K. (2004). A randomized, controlled trial of comprehensive geriatric assessment and multidisciplinary intervention after discharge of elderly from the emergency department-The DEED II study. Journal of the American Geriatric Society, 52, 1417-1423.
11.
Clyburn, L., Stones, M., Hadjistavropoulos, T., & Tukko, H. (2000). Predicting caregiver burden and depression in Alzheimer's disease. Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, 55, S2-S13.
12.
Cooke, D.D., McNally, L., Mulligan, K.T., Harrison, M.J., & Newman, S.P. (2001). Psychosocial interventions for caregivers of people with dementia: A systematic review. Aging and Mental Health , 5, 120-135.
13.
Defrances, C.J., Hall, M.J., & Podgornik, M.N. (2003). National Hospital Discharge Survey. Advance data from vital and health statistics; no 359. Hyattsville, MD: National Center for Health Statistics.
14.
Dunkin, J., & Anderson-Hanley, C. (1998). Dementia caregiver burden: A review of the literature and guidelines for assessment and intervention . Neurology, 51, S53-S60.
15.
Ezekiel J.E., Fairclough D.H., Slutsman J., Alper H., DeWitt B., & Emanuel, L.L. (1999). Assistance from family members, friends, paid caregivers, and volunteers in the care of terminally ill patients. New England Journal of Medicine, 341, 956-963.
16.
Feldman, P.H. (1997). Labor market issues in home care. In D. M. Fox & C. Raphael (Eds.), Home based care for a new century (pp. 155-183). Malden, MA: Blackwell.
Fried, L.P., Kronmal, R.A., Newman, A.B., Bild, D.E., Mittelmark, M.B., Polak, J.F., et al. (1998). Risk factors for 5-year mortality in older adults: The Cardiovascular Health Study. Journal of the American Medical Association, 279, 585-592.
19.
Gaugler, J.E., Anderson, K.A., Leach, M.S., Smith, C.D., Schmitt, F.A., & Mendiondo, M. (2004). The emotional ramifications of unmet need in dementia caregiving. American Journal of Alzheimer's Disease and Other Dementias, 19, 369-380
20.
Gaugler, J.E., Kane, R.L., Kane, R.A., & Newcomer, R. (2005). Unmet care needs and key outcomes in dementia . Journal of the American Geriatrics Society, 53, 2098-2105.
21.
Gaugler, J.E., Kane, R.A., & Langlois, J. (2003). Assessment of family caregivers of older adults . In R. L. Kane & R. A. Kane (Eds.), Assessing older persons: Measures, meaning and practical applications (pp. 320-359). New York: Oxford University Press.
22.
Han, B., & Haley, W.E. (1999). Family caregivers for patients with stroke: Review and analysis. Stroke, 30, 1478-1485.
23.
Ho, A., Collins, S.R., Davis, K., & Doty, M.M. (2005). A look at working-age caregivers' roles, health concerns and need for support. New York: The Commonwealth Fund.
Houts, P.S., Yasko, J.M., Kahn, S.B., Schelzel, G.W., & Marconi, K.M. (1986). Unmet psychological, social, and economic needs of persons with cancer in Pennsylvania. Cancer, 58, 2355-2361.
26.
Karnofsky, D.A., & Burchenal, J.H. (1949). The clinical evaluation of chemotherapeutic agents in cancer. In C. M. Macleod (Ed.), Evaluation of chemotherapeutic agents (pp. 199-205). New York: Columbia University Press.
27.
Kasuya, R.T., Polgar-Bailey, P., & Takeuchi, R. (2000). Caregiver burden and burnout. A guide for primary care physicians. Postgraduate Medicine, 108, 119-123.
28.
Katz, S., Ford, A.B., Moskowitz, R.W., Jackson, B.A., & Jaffe, M.W. (1963). Studies of illness in the aged. The index of ADL: A standardized measure of biological and psychological function. Journal of the American Medical Association, 185, 914-919.
29.
Kellogg, F.R., & Brickner, P.W. (2000). Long-term home health care for the impoverished frail homebound aged: A twenty-seven-year experience . Journal of the American Geriatric Society, 48, 1002-1011.
30.
Knight, B.G., Lutzky, S.M., and Macofsky-Urban, F. (1993). A meta-analytic review of interventions for caregiver distress: Recommendations for future research . The Gerontologist, 33, 240-248.
31.
Lawton, M.P., & Brody, E.M. (1969). Assessment of older people: Self-maintaining and instrumental activities of daily living. The Gerontologist , 9, 179-186.
32.
Levine, C., Kuerbis, A., & Gould, D.A. (2000). Survey of family caregivers: Findings and implications for the health care system. New York: United Hospital Fund.
33.
Levine, S.A., Boal, J., & Boling, P.A. (2003). Home care. Journal of the American Medical Association, 290, 1203-1207.
34.
Mangan, P.A., Taylor, K.L., Yabroff, K.R., Fleming, D.A., & Ingham, J.M. (2003). Caregiving near the end of life: Unmet needs and potential solutions. Palliative and Supportive Care, 1, 247-259.
35.
Mittelman, M.S., Ferris, S.H., Shulman, E., Steinberg, G., Ambinder, A., Mackell, J., et al. (1995). A comprehensive support program: Effect on depression in spouse-caregivers of AD patients. The Gerontologist , 35, 792-802.
36.
Montgomery, R.J., & Borgatta. E. F. (1989). The effect of alternative support strategies on family caregiving. The Gerontologist, 29, 457-464.
37.
Mor, V., Allen, S.M., Siegel, K., & Houts, P. (1992). Determinants of need and unmet need among cancer patients residing at home. Health Services Research, 27, 337-360.
38.
Muramatsu, N., & Cornwell, T. (2003). Needs for physician housecalls-Views from health and social service providers. Home Health Care Services Quarterly , 22, 17-29.
39.
National Alliance for Caregiving and American Association for Retired Persons. (1997). Family caregiving in the US: Findings from a national survey. Washington, DC: National Alliance for Caring.
40.
Naylor, M.D., Brooten, D., Campbell, R., Jacobsen, B.S., Mezey, M.D., Pauly, M.V., et al. (1999). Comprehensive discharge planning and home follow-up of hospitalized elders. Journal of the American Medical Association, 281, 613-620.
41.
Noelker, L.S. (2001). The backbone of the long-term care workforce. Generations, 25, 85-91.
42.
Novak, M., & Guest, C. (1989). Application of a multidimensional caregiver burden inventory. The Gerontologist, 29, 798-803.
43.
Novak, M., & Guest, C.I. (1992). A comparison of the impact of institutional institutionalization on spouse and nonspouse caregivers. The Journal of App1ied Gerontology, 11, 379-394.
44.
Partnership for Solutions. (2002). Chronic care: Making the case for ongoing care. Baltimore : Johns Hopkins University Press. Retrieved March 4, 2008, from http://www.partnershipforsolutions.org/DMS/files/chronicbook2002.pdf
45.
Phillips, S.L., Smith, D., Cournoyer, B., & Hillegass, B.E. (2004). Chronic home care: A health plan's experience. Annals of Long Term Care, 12, 41-45.
46.
Pinquart, M., & Sorensen, S. (2003). Differences between caregivers and noncaregivers in psychological health and physical health: A meta-analysis. Psychology and Aging, 18, 250-267.
47.
Pusey, H., & Richards, D. (2001). A systematic review of the effectiveness of psychosocial interventions for carers of people with dementia. Aging and Mental Health, 5, 107-119.
48.
Rees, J., O'Boyle, C., & MacDonagh, R. (2001). Quality of life: Impact of chronic illness on the partner. Journal of the Royal Society of Medicine, 94, 563-566.
49.
Rich, M.W. (1995). A multidisciplinary intervention to prevent the readmission of elderly patients with CHF. New England Journal of Medicine, 333, 1190-1195.
50.
Schulz, R., & Beach, S.R. (1999). Caregiving as a risk factor for mortality. The Caregiver Health Effects Study. Journal of the American Medical Association, 282, 2215-2219.
51.
Schulz, R., Belle, S.H., Czaja, S.J., Gitlin, L.N., Wisniewski, S.R., & Ory, M.G. (2003). Introduction to the special section on Resources for Enhancing Alzheimer's Caregiver Health (REACH). Psychology and Aging, 18, 357-360.
52.
Silliman, R.A., McGarvey, S.T., Raymond, P.M., & Fratwell, M.D. (1990). The Senior Care Study. Does inpatient interdisciplinary geriatric assessment help family caregivers of acutely ill older patients? Journal of the American Geriatric Society, 38, 1163.
53.
Smith, K.L., Ornstein, K., Soriano, T., Muller, D., & Boal, J. (2006). A multidisciplinary program for delivering primary care to the underserved urban homebound: Looking back, moving forward. Journal of the American Geriatric Society, 54, 1283-1289.
54.
Sörensen, S., Pinquart, H.M., & Duberstein, P. (2002). How effective are interventions with caregivers? An updated meta-analysis. The Gerontologist , 42, 356-372.
55.
Steel, K. (1987). Physician-directed long-term home health care for the elderly-A century-long experience. Journal of the American Geriatrics Society, 35, 264-268.
56.
Stolz, P., Uden, G., & Willman, A. (2004). Support for family carers who care for an elderly person at home-A systematic literature review. Scandinavian Journal of Caring Sciences, 18, 111-119.
57.
Szinovacz, M.E., & Davey, A. (2007). Changes in adult child caregiver networks. The Gerontologist, 47, 280-295.
58.
Toseland, R.W., & Rossiter, C.M. (1989). Group interventions to support family caregivers: A review and analysis. The Gerontologist , 29, 438-448.
59.
U.S. Census Bureau. (2004). U.S. interim projections by age, sex, race, and Hispanic origin. Retrieved March 4, 2008, from http://www.census.gov/ipc/www./usinterimproj/
60.
U.S. Department of Health and Human Services, Medicare and Home Health Care. (2003). CMS-10969. Baltimore: Centers for Medicare & Medicaid Services .
61.
U.S. Department of Health and Human Services. ( 2005). Family caregivers: Our heroes on the frontlines of long-term care. Retrieved November 30, 2005, from www.aoa.gov/prof/aoaprog/caregiver/careprof/TownHall/One-page%20factsheet%20(final%20version).doc
62.
U.S. Department of Health and Human Services, Medicare and Home Health Care. (2007). CMS-10969. Baltimore: Centers for Medicare & Medicaid Services .
63.
Vitaliano, P.P., Zhang, J., & Scanlan, J.M. (2003). Is caregiving hazardous to one's physical health? A meta-analysis. Psychological Bulletin, 129, 946-972.
