Journal of General Internal Medicine

, Volume 27, Issue 1, pp 37–44

Difficulty Assisting with Health Care Tasks Among Caregivers of Multimorbid Older Adults

  • Erin R. Giovannetti
  • Jennifer L. Wolff
  • Qian-Li Xue
  • Carlos O. Weiss
  • Bruce Leff
  • Chad Boult
  • Travonia Hughes
  • Cynthia M. Boyd
Original Research

Abstract

BACKGROUND

Family caregivers provide assistance with health care tasks for many older adults with chronic illnesses. The difficulty they experience in providing this assistance, and related implications for their well-being, have not been well described.

OBJECTIVE

The objectives of this study are: (1) to describe caregiver’s health care task difficulty (HCTD), (2) determine the characteristics associated with HCTD, and (3) explore the association between HCTD and caregiver well-being.

DESIGN

This is a cross-sectional study.

PARTICIPANTS

Baseline sample of caregivers to older (aged 65+ years) multimorbid adults enrolled in an ongoing cluster-randomized controlled trial (N = 308).

MAIN MEASURES

The HCTD scale (0–16) is comprised of questions measuring self-reported difficulty in assisting older adults with eight health care tasks, including taking medication, visiting health care providers, and managing medical bills. Caregivers were categorized using this scale into no, low, medium, and high HCTD groups. We used ordinal logistic regression and multivariate linear regression analyses to examine the relationships between HCTD, caregiver self-efficacy, caregiver strain (Caregiver Strain Index), and depression (Center for Epidemiological Studies Depression Scale), controlling for patient and caregiver socio-demographic and health factors.

KEY RESULTS

Caregiver age and number of health care tasks performed were positively associated with increased HCTD. The quality of the caregiver’s relationship with the patient, and self-efficacy were inversely associated with increased HCTD. A one-point increase in self-efficacy was associated with a significant lower odds of reporting high HCTD (OR, 0.64; 95% CI, 0.54, 0.77).Adjusted linear regression models indicated that high HCTD was independently associated with significantly greater caregiver strain (B, 2.7; 95% CI, 1.12, 4.29) and depression (B, 3.01; 95% CI, 1.06, 4.96).

CONCLUSIONS

This study demonstrates that greater HCTD is associated with increased strain and depression among caregivers of multimorbid older adults. That caregiver self-efficacy was strongly associated with HCTD suggests health-system-based educational and empowering interventions might improve caregiver well-being.

KEY WORDS

caregiver chronic disease self efficacy psychology 

References

  1. 1.
    Boyd CM, Darer J, Boult C, Fried LP, Boult L, Wu AW. Clinical practice guidelines and quality of care for older patients with multiple comorbid diseases: implications for pay for performance. JAMA. 2005;294(6):716–24.PubMedCrossRefGoogle Scholar
  2. 2.
    Gijsen R, Hoeymans N, Schellevis FG, Ruwaard D, Satariano WA, van den Bos GA. Causes and consequences of comorbidity: a review. J Clin Epidemiol. 2001;54(7):661–74.PubMedCrossRefGoogle Scholar
  3. 3.
    Hoffman C, Rice D, Sung HY. Persons with chronic conditions. Their prevalence and costs. JAMA. 1996;276(18):1473–9.PubMedCrossRefGoogle Scholar
  4. 4.
    May C, Montori VM, Mair FS. We need minimally disruptive medicine. BMJ. 2009;339:b2803.PubMedCrossRefGoogle Scholar
  5. 5.
    Bookman A, Harrington M. Family caregivers: a shadow workforce in the geriatric health care system? Journal of Health Politics, Policy and Law. 2007;23(6):1005–41.Google Scholar
  6. 6.
    Kapp MB. Health care decision making by the elderly: I get by with a little help from my family. Gerontologist. 1991;31(5):619–23.PubMedCrossRefGoogle Scholar
  7. 7.
    Deimling GT, Smerglia VL, Barresi CM. Health care professionals and family involvement in care-related decisions concerning older patients. J Aging Health. 1990;2(3):310–25.PubMedCrossRefGoogle Scholar
  8. 8.
    Wu H, Wang J, Cacioppo JT, Glaser R, Kiecolt-Glaser JK, Malarkey WB. Chronic stress associated with spousal caregiving of patients with Alzheimer’s dementia is associated with downregulation of B-lymphocyte GH mRNA. J Gerontol A Biol Sci Med Sci. 1999;54(4):M212–5.PubMedCrossRefGoogle Scholar
  9. 9.
    Kiecolt-Glaser JK, Preacher KJ, MacCallum RC, Atkinson C, Malarkey WB, Glaser R. Chronic stress and age-related increases in the proinflammatory cytokine IL-6. Proc Natl Acad Sci U S A. 2003;100(15):9090–5.PubMedCrossRefGoogle Scholar
  10. 10.
    Burton LC, Newsom JT, Schulz R, Hirsch CH, German PS. Preventive health behaviors among spousal caregivers. Prev Med. 1997;26(2):162–9.PubMedCrossRefGoogle Scholar
  11. 11.
    Pinquart M, Sorensen S. Correlates of physical health of informal caregivers: a meta-analysis. Journal of Gerontology: Psychological Sciences. 2007;62B(2):P126–P37.CrossRefGoogle Scholar
  12. 12.
    Schulz R, Newsom J, Mittelmark M, Burton L, Hirsch C, Jackson S. Health effects of caregiving: the caregiver health effects study: an ancillary study of the Cardiovascular Health Study. Ann Behav Med. 1997;19(2):110–6.PubMedCrossRefGoogle Scholar
  13. 13.
    Albert SM. Beyond ADL-IALD: recognizing the full scope of family caregiving. In: Levine C, ed. Family caregivers on the job: moving beyond ADLs and IADLs. New York: United Hospital Fund; 2004.Google Scholar
  14. 14.
    Oberst MT, Thomas SE, Gass KA, Ward SE. Caregiving demands and appraisal of stress among family caregivers. Cancer Nursing. 1989;12(4):209–15.PubMedCrossRefGoogle Scholar
  15. 15.
    Bakas T, Burgener SC. Predictors of emotional distress, general health and caregiving outcomes in family caregiving of stroke survivors. Topics in Stroke Rehabilitation. 2002;9(1):34–45.PubMedCrossRefGoogle Scholar
  16. 16.
    Carey PJ, Oberst MT, McCubbin MA, Hughes SH. Appraisal and caregiving burden in family members caring for patients receiving chemotherapy. Oncology Nursing Forum. 1991;18(8):1341–8.PubMedGoogle Scholar
  17. 17.
    Bakas T, Austin JK, Jessup SL, Williams LS, Oberst MT. Time and difficulty of tasks provided by family caregivers of stroke survivors. Journal of Neuroscience Nursing. 2004;36(2):95–106.PubMedCrossRefGoogle Scholar
  18. 18.
    Bakas T, Pressler SJ, Johnson EA, Nauser JA, Shaneyfelt T. Family caregiving in heart failure. Nursing Research. 2006;55(3):180–88.PubMedCrossRefGoogle Scholar
  19. 19.
    Halm MA, Bakas T. Factors associated with caregiver depressive symptoms, outcomes and perceived physical health after coronary artery bypass surgery. Journal of Cardiovascular Nursing. 2007;22(6):508–15.PubMedGoogle Scholar
  20. 20.
    Travis S, McAuley WJ, Kmochowski J, Bernard MA, Kao HS, Greene R. Factors associated with medication hassles experienced by family caregivers of older adults. Patient Education and Counseling. 2007;66:51–7.PubMedCrossRefGoogle Scholar
  21. 21.
    Travis S, Bernard MA, McAuley WJ, Thornton M, Kole T. Development of the Family caregiver medication administration hassles scale. Gerontologist. 2003;43(3):360–8.PubMedCrossRefGoogle Scholar
  22. 22.
    Lazarus RS, Folkman S. Stress, appraisal, and coping. New York: Springer; 1984.Google Scholar
  23. 23.
    Wolff JL, Rand-Giovannetti E, Palmer S, Wegener S, Reider L, Frey K, et al. Caregiving and chronic care: the guided care program for families and friends. J Gerontol A Biol Sci Med Sci. 2009;64(7):785–91.PubMedCrossRefGoogle Scholar
  24. 24.
    Pope G, Kautter J, Ellis R, Ash A, Ayanian J, Lezzoni L, et al. Risk adjustment of Medicare capitation payments using the CMS-HCC model. Health Care Financ Rev. 2004;25:119–41.PubMedGoogle Scholar
  25. 25.
    Robinson B. Validation of a caregiver strain index. J Gerontol. 1983;38(3):344–8.PubMedGoogle Scholar
  26. 26.
    Boyd C, Wolff JL, Giovannetti ER, Reider L, Weiss CO, Xue Q, et al. Difficulty with health care management tasks among multimorbid older adults. JAGS. 2010. 58(s1). Presented at the annual research meeting in Orlando, FL.Google Scholar
  27. 27.
    Lorig K, Stewart A, Ritter P, Gonzalez V, Laurent D, Lynch J. Outcome measures for health education and other health care interventions. Thousand Oaks: Sage; 1996.Google Scholar
  28. 28.
    Thornton M, Travis S. Analysis of the reliability of the modified caregiver strain index. J Gerontol B Psychol Sci Soc Sci. 2003;58B(2):S127–S32.CrossRefGoogle Scholar
  29. 29.
    Weissman MM, Sholomskas D, Pottenger M, Prusoff BA, Locke BZ. Assessing depressive symptoms in five psychiatric populations: a validation study. Am J Epidemiol. 1977;106(3):203–14.PubMedGoogle Scholar
  30. 30.
    Ware J, Kosinski M. SF-36 Physical and Mental Health summary scales: a manual for users of version I. 2nd ed. Lincoln: Quality Metric Inc.; 2001.Google Scholar
  31. 31.
    Weiss CO, Boyd CM, Yu Q, Wolff JL, Leff B. Patterns of prevalent major chronic disease among older adults in the United States. JAMA. 2007;298(10):1160–2.PubMedCrossRefGoogle Scholar
  32. 32.
    Fortinsky RH, Kercher K, Burant CJ. Measurement and correlates of family caregiver self-efficacy for managing dementia. Aging Ment Health. 2002;6(2):153–60.PubMedCrossRefGoogle Scholar
  33. 33.
    Nakagawa S, Cuthill I. Effect size, confidence interval and statistical significance: a practical guide for biologists. Biol Rev. 2007;82:591–605.PubMedCrossRefGoogle Scholar
  34. 34.
    Gilliam CM, Steffen AM. The relationship between caregiving self-efficacy and depressive symptoms in dementia family caregivers. Aging Ment Health. 2006;10(2):79–86.PubMedCrossRefGoogle Scholar
  35. 35.
    Schulz R, O’Brien AT, Bookwala J, Fleissner K. Psychiatric and physical morbidity effects of dementia caregiving: prevalence, correlates, and causes. Gerontologist. 1995;35(6):771–91.PubMedCrossRefGoogle Scholar
  36. 36.
    Ory MG, Hoffman RR, Yee JL, Tennstedt S, Schulz R. Prevalence and impact of caregiving: A detailed comparison between dementia and nondementia caregivers. Gerontologist. 1999;39(2):177–85.PubMedCrossRefGoogle Scholar
  37. 37.
    Sorensen S, Pinquart M, Duberstein P. How effective are interventions with caregivers? An updated meta-analysis. Gerontologist. 2002;42(3):356–72.PubMedCrossRefGoogle Scholar
  38. 38.
    Keller ML, Leventhal H, Prohaska TR, Leventhal EA. Beliefs about aging and illness in a community sample. Research in Nursing & Health. 1989;12(4):247–55.CrossRefGoogle Scholar
  39. 39.
    Schulz R, Hebert RS, Dew MA, Brown SL, Scheier MF, Beach SR, et al. Patient suffering and caregiver compassion: new opportunities for research, practice, and policy. Gerontologist. 2007;47(1):4–13.PubMedCrossRefGoogle Scholar
  40. 40.
    Rabow MW, Hauser JM, Adams J. Supporting family caregivers at the end of life:“they don’t know what they don’t know.”. JAMA. 2004;291(4):483–91.PubMedCrossRefGoogle Scholar
  41. 41.
    Council on Scientific Affairs, American Medical Association. Physicians and family caregivers: a model for partnership. JAMA. 1993;269(10):1282–4.Google Scholar
  42. 42.
    Tulner LR, Frankfort SV, Wesselius F, van Campen JP, Koks CH, Beijnen JH. Do geriatric outpatients adhere to medication changes advised after assessment? An exploratory pilot study. Curr Clin Pharmacol. 2009;4(2):154–8.PubMedCrossRefGoogle Scholar
  43. 43.
    DiMatteo MR. Social support and patient adherence to medical treatment: a meta-analysis. Health Psychol. 2004;23(2):207–18.PubMedCrossRefGoogle Scholar
  44. 44.
    Miller EA, Weissert WG. Predicting elderly people’s risk for nursing home placement, hospitalization, functional impairment, and mortality: a synthesis. Med Care Res Rev. 2000;57(3):259–97.PubMedCrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine 2011

Authors and Affiliations

  • Erin R. Giovannetti
    • 1
    • 3
  • Jennifer L. Wolff
    • 1
    • 2
  • Qian-Li Xue
    • 1
    • 2
  • Carlos O. Weiss
    • 1
  • Bruce Leff
    • 1
    • 2
  • Chad Boult
    • 1
    • 2
  • Travonia Hughes
    • 1
  • Cynthia M. Boyd
    • 1
    • 2
  1. 1.Division of GeriatricsJohns Hopkins School of MedicineBaltimoreUSA
  2. 2.Department of Health Policy and ManagementJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  3. 3.Johns Hopkins University School of MedicineBaltimoreUSA

Personalised recommendations