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Frailty Does Not Impact Caregiver Burden in Patients with Cirrhosis

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Abstract

Background

Frailty is common and is associated with increased mortality, lower quality of life, and higher readmission rates in cirrhotic patients. Not only are these outcomes important, but further understanding the impact of frailty on a caregiver’s life is crucial to better comprehend caregiver burden in cirrhotic patients and develop strategies to improve care for patients and their caregivers.

Methods

A single-center, prospective study was conducted of cirrhotic patients and their caregivers between 4/1/2019 and 11/1/2019. Frailty testing combined aspects from the Fried Frailty Instrument, Short Physical Performance Battery, and activities of daily living. Caregivers completed questionnaires to evaluate caregiver burden using the Zarit Burden Interview (ZBI-12), and perceived social support, using the Interpersonal Support Evaluation List.

Results

In total, 94 cirrhotic patients were included, 50% males with a median age of 63.1 years. The most common etiology of cirrhosis was nonalcoholic steatohepatitis. Frailty was prevalent (45.1%). In total, 12.8% of caregivers reported a high burden based on ZBI-12. There was no association between frailty and caregiver burden, hospitalization rates, or death. However, frailty was associated with a higher number of outpatient GI visits (p = 0.002). Lower perceived social support among caregivers was associated with a higher caregiver burden (p < 0.0001).

Conclusion

Frailty is prevalent in cirrhotic patients but is not associated with higher rates of caregiver burden. Low perceived social support among caregivers, however, was associated with higher caregiver burden. It is important to recognize the impact of caregiver burden on caregivers of cirrhotic patients and ensure caregivers have the appropriate support to mitigate burden.

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Abbreviations

ADL:

Activities of daily living

BMI:

Body mass index

ESLD:

End-stage liver disease

FFI:

Fried frailty index

GI:

Gastroenterology

HCC:

Hepatocellular carcinoma

HCV:

Hepatitis C

ISEL-12:

The Interpersonal Support Evaluation List-12

IQR:

Interquartile range

MELD-Na:

Model for end-stage liver disease sodium

NASH:

Nonalcoholic steatohepatitis

PCP:

Primary care provider

SPPB:

Short physical performance battery

UCLA:

University of California, Los Angeles Medical Center

ZBI-12:

Zarit Burden Interview-12

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Acknowledgments

We appreciate the contributions made by Dr. Deena Goldwater, Hussein Saleh, Mizna Akbar, Shreya Neogi, Sandra Boutros, Fatima Saleh, and Mohamad Farhat.

Funding

This study had no grant support.

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Authors and Affiliations

  1. Departments of Medicine, University of California at Los Angeles, Los Angeles, CA, USA

    Elizabeth S. Aby, Nguyen V. Pham, Tien S. Dong, Joanna Schaenman & Sammy Saab

  2. Departments of Surgery, University of California at Los Angeles, Los Angeles, CA, USA

    Jung J. Yum, Hussein Ghasham, Fatima Bedier, Claire Malley & Sammy Saab

  3. Pfleger Liver Institute, UCLA Medical Center, 200 Medical Plaza, Suite 214, Los Angeles, CA, 90095, USA

    Sammy Saab

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  1. Elizabeth S. Aby
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Contributions

EA and SS helped in study concept and design, NP, JY, FB, and CM acquired the data, EA, TD, SS analyzed and interpreted the data, EA, NP, TD, JS, SS drafted the manuscript, SS critically revised the manuscript for important intellectual content, TD statistically analyzed, not applicable: obtained funding, SS helped in administrative, technical, or material support, SS supervised the study.

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Correspondence to Sammy Saab.

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Aby, E.S., Pham, N.V., Yum, J.J. et al. Frailty Does Not Impact Caregiver Burden in Patients with Cirrhosis. Dig Dis Sci 66, 3343–3351 (2021). https://doi.org/10.1007/s10620-020-06687-4

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