Unpaid caregiver involvement has the potential to be an important component of care giving in nursing homes because of inadequate nursing home resources and the residents' limited ability to care for themselves. This cross-sectional study assessed the relationship between unpaid caregiver involvement and illness detection among cognitively impaired nursing home residents and found that higher involvement by unpaid caregivers was related to higher rates of illness detection. These results further support the significant role played by unpaid caregivers and highlight the need for the establishment of an integrated and collaborative family/staff therapeutic alliance.

Background: Unpaid caregiver involvement has the potential to be an important component of care giving in nursing homes because of inadequate nursing home resources and the residents' restricted ability to care for themselves. Despite the potential benefits of unpaid caregiver involvement, there has been limited research on the influence of their involvement in nursing home settings. One essential feature of 'good care' in any nursing home is care monitoring to detect early signs of medical conditions. Unpaid caregiver involvement represents several possible ways to improve illness detection, e.g., by ensuring the occurrence and accuracy of routine checkups, and by urging staff to conduct more thorough evaluations and provide more personalized and attentive care. This study seeks to show that greater unpaid caregiver involvement is related to higher rates of detection of common medical conditions among cognitively impaired nursing home residents.

Methods: In this study, cognitively impaired nursing home residents and their unpaid caregivers were enrolled in pairs from three facilities, one for-profit and two not-for-profit in Baltimore, Maryland. Unpaid caregiver involvement was measured using a staff-rating scale and an unpaid caregiver self-report. Eight medical conditions were evaluated: hypertension, respiratory problems, oral health problems, skin integrity, weight loss, fever, vision problems, and painful conditions. A geriatric nurse researcher, who was unaware of the level of unpaid caregiver involvement, conducted a medical examination of each resident, documenting the presence or absence of these conditions. The nurse researcher then reviewed residents' chart documents. An "undetected condition" was defined as a condition identified during the examination which was not documented at any time during the preceding three months. Illness detection was measured by comparing the medical examination with the chart documents and controlled for residents' underlying health differences. The relationship between unpaid caregiver involvement and illness detection, and the potential influence of resident characteristics on this relationship were examined.

Findings: Participants included 98 residents and 98 unpaid caregivers. Residents had an average age of 82.3 years and an average of 2.7 co-morbidities. Unpaid caregivers were mostly daughters (32%), sons (17%), and spouses (13%) of the residents. The caregivers were on average age 58.5 years old with mean education of 14.5 years. From both staff-rated and self-reported unpaid caregiver involvement, correlations between illness detection and unpaid caregiver involvement were significant; i.e., residents with higher levels of unpaid caregiver involvement had fewer undetected conditions. Residents with higher levels of unpaid caregiver involvement and female residents had significantly fewer undetected illness. Other characteristics of the resident and the facility were not associated with the relationship between unpaid caregiver involvement and illness detection.

Conclusions: This study revealed that higher involvement by unpaid caregivers of cognitively impaired nursing home residents was related to higher rates of illness detection. The absence of undetected conditions for fever or weight loss suggested that effective monitoring may already be in place. These results further support the significant role played by unpaid caregivers and the need for more research examining the impact of unpaid caregiver involvement on care quality and other issues in nursing homes. Research indicates that staff prefer families to be involved, despite the well-documented tensions and role ambiguities between families and staff. These findings highlight the essential role of unpaid caregivers and the need for the establishment of an integrated and collaborative family/staff therapeutic alliance.

Reference: Port CL. "Informal caregiver involvement and illness detection among cognitively impaired nursing home residents". Journal of Gerontology: Medical Sciences, 2006; 61A(9), 970-974.

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