The role of carer stress in acute and long-term care utilisation by community-dwelling older people
Background: In examining the sustainability of homecare, gerontological researchers have increasingly recognised how stressful caregiving can be. Indeed, several researchers have postulated that carer stress could increase the risk of institutional care utilisation by care recipients. However, this contention has not been critically analysed. Therefore, this thesis asks to what extent, if any, carer stress influences institutional care utilisation by community-dwelling older people.
Methods: A mixed methods approach was adopted. Study 1 systematically reviewed and meta-analysed the strength of the effect of carer stress on subsequent institutionalisation of community-dwelling older people. Study 2 qualitatively analysed healthcare professionals’ (n=22) and carers’ (n=16) perceptions of how carer stress and health system factors may influence long-term care (LTC) admissions. Study 3 compared different theoretically-informed models to determine factors that may influence institutional care utilisation by community-dwelling older people (n=205). This was a secondary analysis of The Irish Longitudinal Study of Ageing (TILDA).
Results: Study 1 found that while carer stress has a significant effect on subsequent institutionalisation of care recipients, the overall effect size was negligible (N= 54 studies; standardised mean difference =0.05, 95% CI=0.04-0.07). Study 2 found the escalation of care recipients’ needs, to the extent that the carer or community care cannot meet these needs, drove both carer stress and LTC admissions. This suggests that carer stress is an epiphenomenon of the journey to LTC. This was represented in a proposed alternative theoretical model. This model was examined in Study 3, which found the effects of institutional care utilisation on carer stress were as convincing as the effect of carer stress on institutional care utilisation.
Conclusions: Carer stress is not a risk factor for care recipient institutionalisation. It appears to co-occur with the need for institutional care utilisation rather than driving this utilisation. The thesis proposed and tested an alternative theoretical model to represent this, which has considerable implications for the caregiving literature. Future research should further test this model in prospective structural analysis with other sufficiently-powered samples.