title: Measuring the Effect of Carers on Patients' Risk of Adverse Healthcare Outcomes Using the Caregiver Network Score.
abstract: 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.
  
  
  METHODS
  Observational cohort study.
  
  
  METHODS
  Community-dwelling adults, aged >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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Dr Rónán O'Caoimh, Email: rocaoimh@hotmail.com, Telephone: +353214901461, Facsimile: +3534901635.
authors.forename: R
authors.initials: R
authors.lastname: O'Caoimh
authors.forename: N
authors.initials: N
authors.lastname: Cornally
authors.forename: A
authors.initials: A
authors.lastname: Svendrovski
authors.forename: E
authors.initials: E
authors.lastname: Weathers
authors.forename: C
authors.initials: C
authors.lastname: FitzGerald
authors.forename: E
authors.initials: E
authors.lastname: Healy
authors.forename: E
authors.initials: E
authors.lastname: O'Connell
authors.forename: G
authors.initials: G
authors.lastname: O'Keeffe
authors.forename: E
authors.initials: E
authors.lastname: O'Herlihy
authors.forename: Y
authors.initials: Y
authors.lastname: Gao
authors.forename: R
authors.initials: R
authors.lastname: O'Donnell
authors.forename: R
authors.initials: R
authors.lastname: O'Sullivan
authors.forename: P
authors.initials: P
authors.lastname: Leahy-Warren
authors.forename: F
authors.initials: F
authors.lastname: Orfila
authors.forename: C
authors.initials: C
authors.lastname: Paúl
authors.forename: R
authors.initials: R
authors.lastname: Clarnette
authors.forename: D W
authors.initials: DW
authors.lastname: Molloy
mesh_terms: D000328:Adult; D000368:Aged; D017028:Caregivers / Q000145:classification / Q000592:standards / Q000706:statistics & numerical data; D015331:Cohort Studies; D005260:Female; D016330:Frail Elderly / Q000706:statistics & numerical data; D015577:Geriatric Assessment / Q000379:methods; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D057187:Independent Living / Q000592:standards / Q000706:statistics & numerical data; D007326:Institutionalization / Q000706:statistics & numerical data; D007494:Ireland / Q000453:epidemiology; D008297:Male; D009026:Mortality; D017063:Outcome Assessment, Health Care / Q000379:methods / Q000706:statistics & numerical data; D018570:Risk Assessment / Q000379:methods; D012944:Social Support; D012959:Socioeconomic Factors