Health Services Research & Development

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2017 HSR&D/QUERI National Conference Abstract

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1054 — Invisible Partners in Care: Snapshot of Well-Being among Caregivers Receiving Comprehensive Support from the VA

Lead/Presenter: Katherine Miller, COIN - Durham
All Authors: Miller KE (Health Services Research and Development Service, Durham VA Medical Center, Durham, NC) Lindquist J (Health Services Research and Development Service, Durham VA Medical Center, Durham, NC) Olsen MK (Health Services Research and Development Service, Durham VA Medical Center, Durham, NC; Department of Biostatistics and Bioinformatics,Duke University) Shepherd-Banigan M (Health Services Research and Development Service, Durham VA Medical Center, Durham, NC) Campbell-Kotler M (Caregiver Support Program, Department of Veterans Affairs Washington D.C.) Henius J (Caregiver Support Program, Department of Veterans Affairs Washington D.C.) Kabat M (Caregiver Support Program, Department of Veterans Affairs Washington D.C.) Van Houtven CH (Health Services Research and Development Service, Durham VA Medical Center, Durham, NC; Department of Medicine, Duke University Medical Center, NC)

Objectives:
As of May 2016, over 23,000 caregivers of Veterans who served post-September 11, 2001 have enrolled in the Program of Comprehensive Assistance for Family Caregivers (PCAFC), which provides caregivers training, a stipend and access to healthcare. We examined PCAFC caregiver socio-demographics and which caregiver characteristics are associated with caregiver health, well-being and perceived quality of Veterans Health System (VHS) care.

Methods:
A national web survey invitation was sent to 10,000 caregivers of Veterans enrolled in PCAFC for >=90 days by September 2015 (N = 1,407). We describe the respondents' demographic and employment characteristics. Key caregiver outcomes were: perceived financial strain; depressive symptoms (Center for Epidemiologic Studies Depression Scale, CESD-10); perceived quality of VHS care (global CAHPS satisfaction measure); and self-reported health. The association of caregiver characteristics and outcomes were examined with linear and logistic regression models.

Results:
Caregivers reported a mean CESD-10 score = 8.2, above the recommended screening level of 8. Since becoming a caregiver, approximately 50% reported reducing hours worked or stopping working. Reducing hours worked or quitting work was associated with a 0.65 (0.63, 0.66) unit increase in perceived financial strain. Increased length of time as a caregiver was associated with having 0.19 (0.18, 0.19) more depressive symptoms and a 0.08 (0.078, 0.083) unit increase in financial strain. An education level >=high-school was associated with a 0.61 (-0.63, -0.60) unit decrease in perceived quality of VHS care; a 1.50 unit (1.47, 1.54) increase in CESD-10 score, suggesting increased depressive symptoms; and a 1.33 unit (1.31, 1.35) increase in ratings of financial strain. Caregivers reporting Veteran's health as "Fair" or better were associated with fewer depressive symptoms, lower perceived financial strain, higher perceived quality of VHS care and "Good" or better self-reported health. (95% CI)

Implications:
Identifying characteristics of PCAFC caregivers at increased risk for poorer outcomes, for example duration of caregiving, is critical to develop interventions supporting caregivers over the long-term to improve caregiver outcomes.

Impacts:
Higher depressive symptoms among longer duration caregivers, coupled with significant reductions in hours worked in this sample of young family caregivers, suggest interventions are needed to address the long-term emotional and financial needs of these caregivers.