Horvath KJ (Center for Health Quality, Outcomes, and Economic Research (CHQOER)/GRECC, Bedford VAMC), Trudeau SA
(CHQOER, Bedford VAMC), Harvey RM
As many as 85% of the recommendations from healthcare providers are ignored by elders and their families. This qualitative descriptive study explores the factors that influenced caregiver’s response to recommendations.
As part of the Veterans Home Safety Study, a nurse and occupational therapist completed safety evaluations of 62 participants’ homes. Caregivers were primarily female, average age 69 years, 83% were spouses to care receiver. Care receivers were males with average age 77, with moderate to severe cognitive impairment. We made safety recommendations appropriate to the caregiver, care recipient, and environment, and provided and sometimes installed safety devices. Caregivers were followed monthly by telephone for 6 months. At 6 months, we used a semi structured interview guide to learn what influenced caregivers' implementation of safety modifications and what barriers they perceived. Content analysis of the transcribed interviews was completed and verified through expert panel discussions.
Modifications were most likely to be implemented when they: provided positive outcomes for the veteran and caregiver; were perceived by the caregiver to be important to their safety; did not disrupt existing routines; relieved the caregiver’s worries; or were simple to obtain and install. Barriers to implementation included: lack of tangible resources, caregiver perception as unnecessary at this time; objections from the veteran; or other factors that made it unappealing. Three recurring problems were a lack of understanding of Alzheimer’s disease; a tendency of caregivers to perceive a hierarchical or paternalistic relationship with the professional provider; and a reluctance to change the “normal” appearance of the home.
The negotiation process with the family caregiver to develop a safety plan can be the most challenging part of the home safety visit. Results of this study provide a template for approaches to empower caregivers of persons with AD to implement safety recommendations in the home setting. Future research is needed to evaluate the independent influence of receiving home safety items in addition to home safety recommendations.
Caregivers managing difficult behaviors resulting from Alzheimer’s disease (AD) may be exposing themselves and their loved one to unnecessary risk of harm if they fail to implement recommendations.