Understanding Caregiver Burden and Hospital Use Among Older Home Care Recipients in Nova Scotia
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Background and rationale: There has been a shift in health care resource allocation from long-term care (LTC) facilities to home care, aiming to provide better care for older adults with multi-morbidities and alleviate burdens on health care systems. Home care is often fragmented and requires support from family and friend caregivers. Caregivers’ experiences and situations can vary resulting in differing levels of caregiver burden. Caregivers who experience burden are sometimes unable to continue caregiving, and care recipients are prematurely admitted to institutions. Previous literature primarily focuses on associations between caregiver burden and older care recipients’ LTC use, and it is unclear whether or not caregiver burden influences utilization of acute care services, such as hospitals. Hospital use could indicate problems in primary health care that are essential to coordinate complex needs of older care recipients and are costly to the health care system. Research questions: (1) Do older home care recipients who have caregivers experiencing distress, burnout, or dissatisfaction have higher hospital use than those who have a caregiver with none of these experiences? (2) If not, what other factors explain higher hospital use of the older home care recipient? Methods: This is a secondary analysis of the Nova Scotia Residential Assessment Instrument-Home Care (RAI-HC) collected from 2009 to 2012. Data were collected to assess the health of home care recipients and their caregivers as well as the quality of home care services provided by Nova Scotia Continuing Care. Hospitalization was measured in a follow-up RAI-HC. Caregiver burden was measured by three indicators available in the RAI-HC: (1) caregiver distress, (2) caregiver burnout, and (3) caregiver dissatisfaction. The study used logistic regression to investigate the relationships between older care recipient hospitalization and each indicator of caregiver burden, controlling for older home care recipient predisposing, enabling, and need characteristics variables using the Andersen model of health service utilization. Findings: Out of the 4,235 older home care recipients who received home support services from Nova Scotia Continuing Care, 21.75% were hospitalized. In the unadjusted analyses, out of the three indicators of caregiver burden, only caregiver burnout was statistically significantly associated with hospitalization (odds ratio: 1.31; 95% confidence intervals: 1.03-1.67). After adjusting for older home care recipient predisposing, enabling, and need characteristics, none of the three indicators of caregiver burden were associated with hospitalization at the 95% confidence level. However, two older home care recipient factors were statistically significantly associated with an increased likelihood of hospitalization across all three models, including requiring assistance with Activities of Daily Living (ADL) and being diagnosed with a respiratory disorder. Older home care recipients diagnosed with Alzheimer’s disease were statistically significantly less likely to be hospitalized across all three models. Conclusions: While caregiver burden was not statistically significantly associated with hospitalization, it should not undermine the burden that caregivers experience. These results should be understood with caution as caregiver burden is difficult to measure. The RAI-HC has a promise to contribute to the caregiver burden literature with its focus on a general population, as opposed to clinical population. Future research should validate further the three indicators of caregiver burden in the RAI-HC.