Study Focuses on Caregivers of Veterans with Chronic Illness
BACKGROUND:
As the healthcare system shifts from inpatient to outpatient treatment, more caregiving has been required of families. The care provided by informal caregivers extends the capacities of the formal healthcare system, and can be a source of stress for the caregiver. Caregivers who are appropriately supported are less likely to experience strain and, in turn, may be better equipped to care for their loved ones, preventing crises that can result in unnecessary hospital admission or nursing home placement. This study sought to identify predictors of caregiver strain and satisfaction associated with caring for Veterans with chronic illness. The majority of caregivers in this study were spouses who lived with Veterans enrolled in VA’s Care Coordination and Home Telehealth (CCHT) program. The CCHT program was created to help manage Veterans’ chronic illness in their preferred site of care – their homes. Using data collected via telephone interviews, investigators focused on 120 Veteran/caregiver dyads who completed the survey from May through September 2008. Survey variables included: demographics, health characteristics (e.g., physical health status and depression), resources (e.g., self-efficacy, social support, outside help), and outcomes of caregiving strain (e.g., financial, physical, social, time) and caregiving satisfaction.
FINDINGS:
- Although 76% of caregivers reported feeling very self-confident in their caregiving role, more than one-third (37%) reported high strain. Overall, the mean caregiving satisfaction score indicated a moderate level of satisfaction.
- Caregiver characteristics that predicted strain included having less support, having depressive symptoms, and using paid help. Veteran characteristics that predicted caregiver strain included greater need for caregiving assistance in IADL (instrumental activities of daily living), and greater levels of depression.
- Predictors of lower caregiver satisfaction included less social support, older age, depression, and poor Veteran health status. Predictors of higher caregiver satisfaction included helping the Veteran with medical equipment and the coping style of "taking medication."
- Both caregivers and Veterans reported similar levels of assistance provided, which were relatively low for ADL (activities of daily living) and IADL. However, caregivers reported providing a mean of 43 hours per week in assistance. Investigators suggest this may be due to the higher percentage of spouse caregivers in this sample, who are available for caregiving around the clock. A majority of caregivers expressed a need to know more about the Veteran’s medication.
LIMITATIONS:
- The cross-sectional survey design prevented evaluation of temporal effects of caregiving on caregivers and Veterans over time.
- Because caregivers and Veterans who lived together were typically interviewed during the same telephone contact, there was the potential for one to ‘listen in’ on the other, which may have affected the information provided by participants.
- This study focused only on Veterans enrolled in the CCHT.
AUTHOR/FUNDING INFORMATION:
This study was funded by HSR&D (RRP 07-308). Dr. Wakefield is part of HSR&D’s Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City, IA.
Wakefield B, Hayes J, Boren S, Pak Y, and Davis J. Strain and Satisfaction in Caregivers of Veterans with Chronic Illness. Research in Nursing & Health November 22, 2011;e-pub ahead of print.
