Caregivers of Long-term Ventilator Patients: Physical and Psychological Outcomes

doi:10.1378/chest.123.4.1073

Chest

Volume 123, Issue 4, April 2003, Pages 1073-1081

https://doi.org/10.1378/chest.123.4.1073 Get rights and content

Study objectives:

The physical and psychological effects of caregiving have been examined in several populations. To date, no one has examined the effects of caregiving on caregivers of patients receiving long-term mechanical ventilation (LTV) [patients who required > 4 days of continuous in-hospital mechanical ventilation] who reside in a home or institutional setting after hospital discharge. The purpose of this study was to describe the characteristics and examine depression, burden, overload, and physical health in this caregiver population over a 6-month period after hospital discharge.

Design:

This was a prospective longitudinal descriptive study of posthospital outcomes for patients receiving LTV and their caregivers.

Setting and participants:

Caregivers of 135 patients receiving LTV admitted to the ICUs of a university medical center, a Veterans Administration hospital, and small community hospital were enrolled.

Measurements and results:

Interviews of caregivers were conducted at hospital discharge and 6 months later. Descriptive statistics, analysis of variance, and multiple regression analyses were used to analyze the data. Established tools were used to assess caregiver depression, burden, overload, and physical health. Caregivers reported a drop in physical health scores from hospital discharge to 6 months after discharge (p = 0.0001). Caregivers of patients residing in an institution reported higher depression (p = 0.039) and overload scores (p = 0.002) than did caregivers of patients residing at home 6 months after discharge; 51.2% of caregivers at discharge and 36.4% at 6 months after discharge reported symptoms consistent with some degree of depression. In addition, 12.2% of caregivers at hospital discharge and 15.6% at 6 months after discharge were classified as having symptoms consistent with severe depression. Caregiver physical health (p = 0.025) and overload (p = 0.006) made statistically significant contributions to explaining caregiver depression.

Conclusions:

Caregivers of patients receiving LTV in our sample have similar characteristics to other caregiving populations. However, our sample had higher depression scores than those reported for many other caregiver groups.

Section snippets

Materials and Methods

This study was part of a larger prospective longitudinal descriptive study designed to examine outcomes after hospital discharge for patients receiving continuous LTV > 4 days while in the ICU. While the focus of this study was on outcomes after hospital discharge, the eligibility criterion of > 4 days of continuous mechanical ventilation while in the ICU was established while the patient was still in the hospital. A majority of the patients in our sample required no mechanical ventilation

Results

The enrollment period began in February 1997 and ended in August 1998. For a detailed diagram of subject identification and enrollment, see Figure 1. Based on data from a pilot study in which every patient receiving mechanical ventilation in all of the ICUs was tracked for 6 weeks, we established that 25% of all patients admitted to the ICUs received mechanical ventilation, and that 78.5% of all patients receiving mechanical ventilation were ineligible for our study because they received

Discussion

In general, the caregivers of patients receiving LTV demonstrated similar characteristics as found with other groups, but some differences were noted. First, caregivers were relative young and, correspondingly, a greater percentage were employed than had been reported elsewhere (30 to 55%). This may also explain why our sample spent slightly less time in caregiving activities than reported for caregivers of patients with Alzheimer disease or elderly patients (4 to 8.5 h/d) and why our sample

ACKNOWLEDGMENT

The authors thank Helen Foley, Siobhan Martin, and Toni Ross for their roles in the data collection process.

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: This study was funded by a grant from the National Institute of Nursing Research, Grant No. R01-NR04318.

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Chest

Clinical InvestigationsVENTILATIONCaregivers of Long-term Ventilator Patients: Physical and Psychological Outcomes

Study objectives:

Design:

Setting and participants:

Measurements and results:

Conclusions:

Section snippets

Materials and Methods

Results

Discussion

ACKNOWLEDGMENT

Nurs Clin North Am

Clin Psychol Rev

Arch Phys Med Rehabil

Chest

Chest

Chest

The impact of serious illness on patients' families

JAMA

Informal costs of dementia care: estimates from the National Longitudinal Caregiver Study

J Gerontol B Psychol Sci Soc Sci

Caregivers of the frail elderly: a national profile

Gerontologist

Family stress related to home of Alzheimer disease patients and implications for support

J Neurosci Nurs

Psychosocial consequences of caring for a spouse with multiple sclerosis

J Clin Exp Neuropsychol

Estimating the cost of informal caregiving for elderly patients with cancer

J Clin Oncol

Impact of a husband's chronic illness (COPD) on the spouse's life

Res Nurs Health

Social support and caregiver distress: a replication analysis

J Gerontol B Psychol Sci Soc Sci

Caregiving: where families need help

Soc Work

Clinical Investigations
VENTILATION
Caregivers of Long-term Ventilator Patients: Physical and Psychological Outcomes