More than 12 million elderly people are hospitalized each year in the United States, frequently resulting in functional decline. Family care of hospitalized elders is important given the increasing numbers of hospitalized elders, needs for elder care in the home after hospital discharge, and responsibilities of family caregivers for providing this care. Involving family caregivers in the hospital care of their loved ones may result in positive outcomes for both the elderly patients and their family caregivers. However, there is a paucity of empirical studies that have been conducted to evaluate the effectiveness of interventions to enhance family participation in caring for hospitalized elders. In the proposed study, we will build upon our prior work that has demonstrated the positive effects of theoretically-driven interventions with families of hospitalized patients and older adults at home. The unique contributions of this study include: (a) a randomized controlled design, (b) testing of a theoretically-driven, reproducible intervention that can be easily translated into clinical practice and widely disseminated; (c) the testing of an explanatory model to explain the effects of the intervention, (d) a prospective cost-effectiveness analysis; (e) an intervention that begins early in the hospital stay, and (f) measurement of outcomes both during and up to 2 months following hospitalization. The primary aim of this study is to evaluate the effects of a theoretically-driven, reproducible intervention (CARE: Creating Avenues for Relative Empowerment) on the process and outcomes of hospitalized elders and their family caregivers. The secondary aims are to: (a) explore if type of relationship with the elderly patient moderates the effects of the CARE program, and (b) determine the cost-effectiveness of the CARE program. A randomized controlled trial will be used with 280 family caregivers of hospitalized elders. Measures of both process and outcome variables include family caregivers' outcomes (beliefs, anxiety, worry, depression, role performance, role strain, role adaptation, and role rewards); outcomes of quality of relationship between family caregiver and patient (mutuality); as well as elderly patients outcomes (dysfunctional syndrome, length of hospital stay, readmission, depression, and cognitive status) during hospitalization and after hospital discharge. Findings from a recent pilot study with 49 family caregiver-elder dyads support undertaking this full-scale clinical trial in that family caregivers who received the CARE program, versus those who received a comparison program, had more positive outcomes (e.g., decreased anxiety, depression, and worry during hospital stay, increased care participation and preparedness for follow-up care, decreased role strain and increased role reward during and after hospitalization). Additionally, their hospitalized elderly relatives had more positive outcomes (e.g., decreased confusion, decreased urinary incontinence rate during hospitalization, improved cognitive status and less depression symptoms, shorter hospital stay, and lower readmission rate) during and after hospitalization.
| Li, Hong; Powers, Bethel Ann; Melnyk, Bernadette Mazurek et al. (2012) Randomized controlled trial of CARE: an intervention to improve outcomes of hospitalized elders and family caregivers. Res Nurs Health 35:533-49 |
| Li, Hong; Melnyk, Bernadette Mazurek; McCann, Robert (2004) Review of intervention studies of families with hospitalized elderly relatives. J Nurs Scholarsh 36:54-9 |
