Caregivers of patients who have been on prolonged artificial respiration may be at risk for depression and poor physical health in the months following hospital discharge. However, a disease management programme designed to provide emotional support and individualised case management services seems to lower the risk of depression. Researchers from the Case Western Reserve University in Cleveland, USA, conducted a study with the caregivers of 290 patients who had been in an intensive care unit and on artificial respiration for three days. Sixty-six patients were directed sent directly to home, while the remaining 224 were discharged to an institutional setting. The eight-week disease management programme, to which 211 of the caregivers were randomly assigned, included emotional support from an advanced practice nurse through discussions, referrals, and reassurance, as well as instrumental support through care coordination, education and communication. There were at least eight nurse-initiated contacts in the intervention group. The other caregivers received usual care, which consisted of referral back to the primary care provider, facility or agency if they had any questions. At the time of the patient's discharge from the hospital, 69 percent of caregivers in the control group and 62 percent in the experimental group exhibited mild or no depression. Two months later, 61 percent of the experimental group and 53 percent of the control group had no more than mild depression scores. The experimental group also had a larger percentage of caregivers who improved or stayed the same. The intervention was, at the two-month point, managing to keep some caregivers from progressing to moderate or severe depression. Providing empathetic listening, support in planning and decision-making, and referrals for support may have been instrumental in minimising depression in some caregivers. The researchers observed that depression test scores after two months were significantly higher among caregivers of patients residing in an institution compared with those who were at home (15 versus 10). There were also significantly worse outcomes associated with disrupted schedule, lack of family support and health problems among those with institutionalized patients. Some possible sources of their risk for depression could be the more debilitated nature of institutionalised patients, possible guilt because the patient is not being cared for at home, and possible frustration by caregivers who have less control over their loved one's care in an institutional setting.
Chest,
December 2005