By Melinda Young
Family caregivers of older people who have experienced a serious fall or another traumatic event sometimes are unprepared for the role.
The authors of a recent study found close to one-third of family caregivers of older trauma patients experience high caregiver burden up to three months after the patient’s discharge.1
“We increasingly see life-changing injuries due to fall, and people are more and more functionally dependent and relying on caregivers,” says Zara Cooper, MD, MSc, study co-author and a Michele and Howard J. Kessler Distinguished Chair in surgery and public health, the director for the Center for Surgery and Public Health and of the Center for Geriatric Surgery at Brigham and Women’s Hospital in Boston. “Data showing the level of burden in caregivers of trauma patients is higher, and we suspect it’s because of acuity of illness. It happens suddenly, and their needs are quite high.”
Cooper and colleagues found caregiver burden was similar at one month and three months after injury. “These folks are having a hard time recovering,” Cooper says. “Many of these older adults, who sustained falls and injuries, are quite infirmed beforehand.”
Older trauma patients primarily were injured because of falls, which could be related to geriatric syndrome — mild cognitive impairment leading to imbalance. “They tend to be a high-risk group regardless, and the fall signifies how at-risk they are,” Cooper adds. Other possible causes of trauma among older adults are automobile crashes and gun violence.
Stress Burden Is High
A main finding involves the high-level stress reported by about one-third of caregivers after three months after discharge, says Masami Tabata-Kelly, MBA, MA, lead study author and a senior project manager at the Center for Surgery and Public Health at Brigham and Women’s Hospital.
“Our study reported higher caregiver burden compared with other studies of seriously ill patients,” Tabata-Kelly notes. “This might be because older adults with traumatic injury suffer severe functional decline compared to other illnesses.”
For instance, caregivers reported lower self-efficacy and a higher chance of experiencing high caregiver burden. “Compared to cancer caregivers, the trajectory of the status is different than cancer, which may result in a gradual decline,” explains Tabata-Kelly, a PhD candidate in health policy at The Heller School for Social Policy and Management at Brandeis University. “With trauma, one day the older adult fell, and after the hospital discharge, they can’t be as active as they were before. They have more needs than they did before.”
Caregiver preparedness was inversely associated with caregiver burden, Cooper says.
Education Is Key
This finding suggests case managers and/or nurses could better educate and inform caregivers about what they are facing when the patient returns home. This could alleviate caregiver burden.
“We need to anticipate these older adults are not going to be as independent as they had been, particularly if they had delirium in the hospital and had cognitive delirium,” Cooper explains. “Caregivers need to anticipate how they’ll adjust their own lives to take care of these individuals, and caregivers need to take care of themselves to be better caregivers.”
Most caregivers are older and may have their own health issues, or they may have to balance multiple family responsibilities that make life difficult.
“We see caregivers suffering because they’re part of the sandwich generation, juggling a job; teenage children; and now they have a mother, father, or in-law who also needs them,” Cooper explains. “We know that older adults have very high rates of unrecognized depression at baseline. Emerging data from our group is showing that with older adults — after they leave the hospital — [depression] gets worse over time.”
Case managers and others involved in care transitions could help caregivers understand the psychological scars from the injury — and possible mental health challenges in themselves. Caregivers will need respite care and support, and case managers, nurses, and social workers are uniquely prepared to help families understand and handle these challenges.
“They’re the members of the healthcare team who are closest to the families and understand the environments these patients are coming from,” Cooper explains. “In my experience, patients and families are more honest with them and may [disclose their] social determinants of health.”
Caregivers and patients may tell case managers about their social isolation and life stressors. “This is an opportunity for social workers and nurses and case managers to be leaders in this space,” Cooper says.
Tabata-Kelly has seen the caregiver burden in her own family. “My grandma [fell] three times, and every time the caregiving has been really challenging, which is what I witnessed at a personal level,” she recalls. “Communication before discharge is so important. There should be an opportunity to have quality communication of family members and to build a high-quality relationship.”
Family caregivers are the main people who provide care for their loved ones after discharge, and their caregiving duties are long-term. “Nurses, social workers, and clinicians can create opportunities to build a relationship and communication and listen to their concerns,” Tabata-Kelly says. “[Case managers] need to prepare caregivers for the future, which can have a tremendous impact.”
For example, case managers, nurses, or social workers can contact caregivers after discharge to see how they are handling caregiving in the first few days. They also can provide verbal support and remind caregivers that it is a marathon and not a sprint because this is a long-term change.
“Often, as healthcare professionals, we’re so focused on the acute event that we don’t necessarily make it a point to talk directly to patients and their families about what the implications of this are,” Cooper explains.
REFERENCE
- Tabata-Kelly M, Ruan M, Dey T, et al. Postdischarge caregiver burden among family caregivers of older trauma patients. JAMA Surg 2023;158:945-952.
Family caregivers of older people who have experienced a serious fall or another traumatic event sometimes are unprepared for the role. The authors of a recent study found close to one-third of family caregivers of older trauma patients experience high caregiver burden up to three months after the patient’s discharge.
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