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Background: Although  caregivers  are  important  in  the  management  of  frail,  community-dwelling  older  adults,  the  influence  of  different  caregiver  network  types  on  the  risk  of  adverse  healthcare  outcomes  is  unknown.    Objective: To  examine  the  association  between  caregiver  type  and  the  caregiver  network  subtest  of  The  Risk  Instrument  for  Screening  in  the  Community  (RISC),  a  five  point  Likert  scale  scored  from  one  (“can  manage”)  to  five  (“absent/liability”).  To  measure  the  association  between  caregiver  network  scores  and  the  one-year  incidence  of  institutionalisation,  hospitalisation  and  death.  Design: Observational  cohort  study.  Setting  and  Participants:  Community-dwelling  adults,  aged  &gt;65,attending  health  centres  in  Ireland,(n=779).  Procedure  and  Measurements:  The  caregiver  network  subtest  of  the  RISC  was  scored  by  public  health  nurses.  Caregivers were grouped dichotomously into low-risk (score of one) or high-risk (scores two-five). Results: The majority  of  patients  had  a  primary  caregiver  (582/779;75%),  most  often  their  child  (200/582;34%).  Caregiver  network  scores  were  highest,  indicating  greatest  risk,  when  patients  had  no  recognised  primary  caregiver  and  lowest when only a spouse or child was available. Despite this, patients with a caregiver were significantly more likely  to  be  institutionalised  than  those  where  none  was  required  or  identified  (11.5%  versus  6.5%,p=0.047).  The  highest  one-year  incidence  of  adverse  outcomes  occurred  when  state  provided  care  was  the  sole  support;  the  lowest  when  private  care  was  the  sole  support.  Significantly  more  patients  whose  caregiver  networks  were  scored  high-risk  required  institutionalisation  than  low-risk  networks;  this  association  was  strongest  for  perceived difficulty managing medical domain issues, odds ratio (OR) 3.87:(2.22-6.76). Only perceived difficulty managing ADL was significantly associated with death, OR 1.72:(1.06-2.79). There was no association between caregiver network scores and risk of hospitalisation. Conclusion: This study operationalizes a simple method to evaluate  caregiver  networks.  Networks  consisting  of  close  family  (spouse/children)  and  those  reflecting  greater  socioeconomic privilege (private supports) were associated with lower incidence of adverse outcomes. Caregiver network scores better predicted institutionalisation than hospitalisation or death.

MEASURING THE EFFECT OF CARERS ON PATIENTS’ RISK OF ADVERSE HEALTHCARE OUTCOMES USING THE CAREGIVER NETWORK SCORE