The effect of respite care on elderly patients and their carers

Age and Ageing, July, 1994 by A.C. Homer, C.J. Gilleard

Summary

Fifty-eight carers and their dependants who received inpatient respite care were studied before and during the admission period. Although there was no observable improvement in the carers' emotional well-being the majority of the patients showed an improvement in functioning, particularly those who were being looked after by highly stressed carers. Many carers expressed a wish for more respite than they were currently offered, and some would have preferred a more flexible type of service.

Introduction

Inpatient respite care--whether in the form of holiday breaks or regular relief admissions--is provided to offer a break to carers and reduce their sense of burden(1). Although some research has suggested that elderly patients' health might be adversely affected by respite admissions(2), subsequent reports have not observed any increase in patients' mortality(3) nor any functional deterioration(4). Clear evidence of substantial benefits to carers or patients has also been lacking(5)(6). Research on the impact of respite admission on carer well-being has been largely confined to studies of patients with dementia, and the effects of respite care on relatives caring for physically frail elderly people has not been so thoroughly investigated. The present study set out to examine what immediate effect the 'break' from caring had on carers and how respite admissions affected the functioning of their dependants.

Method

The study was prospective in design. Seventy-one patient/carer pairs referred to Putney and Barnes geriatric services and 37 patient/carer pairs referred to Wandsworth geriatric services formed the sample. There were no significant differences between the two samples in terms of the patients' age, sex, level of dependency, the numbers suffering from stroke or dementia, nor between their carers' age or the amount of stress reported at interview. There were more male carers in the Wandsworth than in the Putney and Barnes sample (19/26 vs. 15/51; [x.sup.2] 11.6; df 1; p < 0.001).

Carers were interviewed in their own homes, where they completed the 28-item version of the General Health Questionnaire (GHQ-28)(7) to assess their emotional health, and the CAPE Behaviour Rating Scale (BRS)(8) as a measure of their dependants' functioning. They were asked their opinion of the respite service, and whether they would like more or whether they would like a different style of service to meet their needs. When the patient was admitted for respite, the carer was contacted and asked to complete the GHQ-28 which was posted to them during the middle of the respite period. Nurses on the wards were also asked to complete the BRS to assess the patients' functioning during their hospital stay.

Results

In the absence of differences between the subgroups of the sample, the 108 patient/carer pairs were treated as a homogeneous group. Seventy-seven carers were successfully interviewed at home; 58 patients experienced respite care during the study period, and 54 carers were successfully re-interviewed: four carers declined to take part in the re-interview. At the initial interview 39 out of 77 [51%] carers scored 4 or more on the GHQ, indicating the presence of significant emotional distress which is considerably higher than the figure of 29% quoted in the manual(7) for a 'normal' population of this age (carers' mean age was 66; range 37-91 years). There was no evidence of any overall improvement in carers' GHQ score during the respite period, although there was a small but significant reduction in depression, and a similarly significant increase in social dysfunction during this time (Table I).

Table I. Change between carers' GHQ scores with dependants at home and

during respite care

        Mean GHQ score (SD)

                                               Paired t test

        Carer at home   Carer during respite

GHQ     (n = 54)        (n = 54)               t      p       df
A       1.7 (1.7)       2.0 (1.9)              -1.1   NS      53
B       2.6 (2.3)       2.3 (2.4)               0.9   NS      53
C       1.4 (1.5)       1.9 (1.7)              -2.4   <0.02   53
D       0.8 (0.8)       0.5 (1.1)               2.0   <0.05   53
Total   6.4 (6.0)       6.6 (5.4)               0.4   NS      53

In the GHQ the subsections correspond to the following areas; A--somatic complaints, B--anxiety and insomnia, C--social dysfunction, D--depression.

Comparison of patient functioning at home and in hospital indicated a significant reduction in overall dependency on the BRS during the respite period, with a marked reduction in both the physical disability and social disturbance subscale scores (Table II). Attempts were made to identify the correlates of improvements in patient functioning during respite care. The nature of the relationship between carer and dependant, the carer's age and sex, reports of any kind of abuse and the patient's level of dependency were not significantly associated with improvement, nor was the presence of stroke. There was a significant association between improvements in social disturbance and the absence of dementia--31 of 40 non-demented patients improved during their respite admission compared with only eight out of 18 patients with dementia [[[chi].sup.2] 6.7; df 1; p<0.05]. Initial levels of carer stress measured by the GHQ were significantly related to improved functioning on the ward--carers of patients whose functioning improved during respite having higher levels of distress than those whose dependant remained stable or deteriorated (Table III).