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PPO 09-272 – HSR&D Study

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PPO 09-272
Training Informal Caregivers of Frail Older Veterans Before Hospital Discharge
Cristina C Hendrix DNSc MSN BSN
Durham VA Medical Center, Durham, NC
Durham, NC
Funding Period: April 2010 - March 2011

BACKGROUND/RATIONALE:
Hospital discharge represents a critical period that challenges the ability of frail older veterans to remain at home. Family or informal caregivers are their major source of assistance for home care; yet, these caregivers often receive limited discharge training before hospital discharge of their loved ones.

OBJECTIVE(S):
The primary aim of this pilot was to examine the feasibility of conducting an individualized caregiver training program before hospital discharge of older veterans. As an exploratory aim, we determined the training's impact on caregiver self-efficacy and preparedness. We also conducted semi-structured interviews to determine benefits (if any) of the caregiver training program.

METHODS:
Sample consisted of 50 caregiver-patient dyads. The training was approximately for an hour and included teachings on medication management; identification of medical red flags; and discussion of community-based resources. To tailor the training on dyadic needs, each caregiver identified two home care issues for inclusion in the training. Within 48-72 hours of discharge, medication reconciliation was performed by phone. Program feasibility was determined whether caregivers can be recruited and can complete the training before hospital discharge of patients. Caregiver self-efficacy and preparedness in home care were assessed before and after the training, and at 1 and 4 weeks of discharge of patients. Phone interviews were conducted at either the 1st or 4th week of hospital discharge.

FINDINGS/RESULTS:
A total of 1,690 inpatients were screened and 252 (15%) met the study eligibility criteria. Of these, 112 were approached and 50 (44.6%) agreed to participate. Of the 50 consented dyads, 40 (80%) caregivers received the training. Of the 40 caregivers who received the training, 33 (82.5%) completed the 4th week data collection. Analysis of the
response profiles on self-efficacy and preparedness scales was conducted using SAS Proc Mixed with an unstructured covariance matrix. The mean self-efficacy improved after the training and the improvement was sustained up to 4 weeks after hospital discharge (baseline:783.86; post-training:903.64; 1 week of hospital discharge:867.85; 4 weeks of hospital discharge:877.02). The same trend was seen on the impact of the training on caregiving preparedness, but the changes were on a smaller scale (T1:26. 95; T2:30.55; T3:28.88; T4:28.91). The interview responses verified the importance of receiving individualized training for home care before hospital discharge. Suggested areas for future training were information about diet and nutrition for patients, how to access VA community-based resources, and how to manage caregiving burden.

IMPACT:
This study has the potential to assist caregivers in their home care of older veterans after hospital discharge. Findings of this pilot will serve as the foundation to rigorously test the effects of the training on caregiver and patient outcomes.

PUBLICATIONS:

Journal Articles

  1. Hendrix C, Tepfer S, Forest S, Ziegler K, Fox V, Stein J, McConnell ES, Hastings SN, Schmader K, Colon-Emeric C. Transitional Care Partners: a hospital-to-home support for older adults and their caregivers. Journal of the American Association of Nurse Practitioners. 2013 Aug 1; 25(8):407-14.
  2. Hendrix CC, Landerman R, Abernethy AP. Effects of an individualized caregiver training intervention on self-efficacy of cancer caregivers. Western Journal of Nursing Research. 2013 May 1; 35(5):590-610.
  3. Hendrix CC, Hastings SN, Van Houtven C, Steinhauser K, Chapman J, Ervin T, Sanders L, Weinberger M. Pilot study: individualized training for caregivers of hospitalized older veterans. Nursing Research. 2011 Nov 1; 60(6):436-41.
  4. Bailey DE, Steinhauser K, Hendrix C, Tulsky JA. Pairing Self-Management with Palliative Care: Intervening in Life-Limiting Illness. Journal of nursing and healthcare of chronic illness. 2011 Mar 1; 3(1):1-3.


DRA: Aging, Older Veterans' Health and Care, Health Systems
DRE: Prevention
Keywords: none
MeSH Terms: none

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