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Caregiver Interventions for Adults Discharged from the Hospital: Systematic Review and Meta‐Analysis
Author(s) -
Smith Toby O.,
Pearson Matthew,
Pfeiffer Klaus,
Crotty Maria,
Lamb Sarah E.
Publication year - 2019
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.16048
Subject(s) - medicine , psychological intervention , caregiver burden , randomized controlled trial , quality of life (healthcare) , anxiety , meta analysis , stroke (engine) , distress , adverse effect , medline , physical therapy , psychiatry , dementia , disease , nursing , clinical psychology , mechanical engineering , surgery , pathology , political science , law , engineering
OBJECTIVES To review the evidence evaluating the effectiveness of informal caregiver interventions to facilitate the recovery of older people discharged from the hospital. DESIGN Systematic review and meta‐analysis. SETTING Hospital and community. METHODS Published and unpublished randomized and nonrandomized controlled trials assessing the effectiveness of informal caregiver interventions to support the recovery of older people discharged from the hospital were identified (to March 2019). The primary outcome was patient health‐related quality of life (HRQOL). Secondary outcomes included patient function, caregiver burden, caregiver HRQOL, psychological distress, adverse events, and health resource use. Studies were critically appraised and meta‐analyzed. PARTICIPANTS Adults who had been admitted to the hospital. RESULTS A total of 23 studies were eligible (4695 participants). The indication for hospital admission was stroke in 21 trials (91%). Interventions consisted of training and/or skills‐based programs, with or without home visits/telephone follow‐up. Caregiver interventions for patients following stroke may provide no benefit for patient HRQOL at 12 months (standardized mean difference = .29; 95% confidence interval = ‐.12 to .69; low‐quality evidence). Caregiver interventions demonstrated benefit for caregiver burden and both patient and caregiver anxiety at 12 months. No consistent effect was found on functional outcomes, depression, HRQOL, adverse events, or health resource use measures. CONCLUSIONS Informal caregivers who receive training to facilitate the recovery of older people discharged from the hospital following stroke may have a lower burden and reduced anxiety at 12 months compared with those who do not. However, the evidence was moderate to low quality. Further study is warranted to explore whether caregiver interventions can be modified for nonstroke populations such as those with hip fracture. J Am Geriatr Soc 67:1960–1969, 2019