Training Informal Caregivers of Frail Older Veterans Before Hospital Discharge

Durham Va Medical Center, Durham NC

Investigators

Abstract

In 2003, over 13.2 million persons aged 65 years and older were discharged from hospitals, accounting for nearly 50% of all hospital discharges. The current healthcare system allows only the sickest patients admitted to hospitals, and then discharged as quickly as possible.Shorter hospital stays and expansion of home care technology have transferred the responsibility for the care of patients onto their informal caregivers. Thus, the success of care plans - from hospital discharge to care in the home - often rests on the shoulders of the informal caregivers. Understandably, therefore, acquisition of adequate teaching prior to hospital discharge has been consistently identified as a major unmet need of informal caregivers. The VA, through the passage of the Millennium Healthcare and Benefits Act, is committed to providing high quality long-term care in the least restrictive setting possible - the patient's home. To achieve this, the VA recognizes the important role that caregivers play by including long-term care and caregiving as a priority research area. Specifically, the VA emphasizes the need to enhance caregiver support by providing caregiver education and training. The specific aims of the study are to (1) determine the feasibility of conducting an individualized, tailored training program for informal caregivers of frail older veterans prior to their hospital discharge and (2) determine the impact of this training program on self-efficacy and caregiving preparedness on informal caregivers of frail older veterans. As a secondary aim, data will be collected on patients': physical symptom intensity and distress and use of emergency services (ED) or rehospitalization within 14 and 30 days of hospital discharge. The study will use a prospective cohort design with data collection before and after training, and at 1, 2, and 4 weeks after hospital discharge of patients. The setting will be a medical unit at the Durham VAMC. Sample size will be 50 caregiver-patient dyads. Patient's inclusion criteria include 65 years or older and will be discharged home, plus (a) with 3 or more chronic medical diagnoses, (b) with 5 or more prescribed medications, and (c) requires assistance in activities of daily living and home care. An informal caregiver is a person who provides most of the "hands-on" care to the patient at home. Caregivers will receive individualized and tailored training on medication management, identification of red flags, identification of VA health care resources, and interventions specific to patient's condition. For caregiver self-efficacy and preparedness as well as patient outcomes, descriptive statistics and multivariate analysis including mixed models will be used. Twelve caregivers will be interviewed to learn how the training has (or has not) assisted them, and identify those components that were best or worst received. Interview data will be analyzed qualitatively.