Outcomes/Effectiveness Research

Informal caregiving for survivors of critical illness takes a toll on the health and lifestyle of caregivers

Previous studies of post-intensive care unit (post-ICU) informal caregivers have demonstrated that burden is common, and can be manifested in many ways including depression and reduced employment. It is unclear, however, whether caregiver burden occurs as a direct result of the patient's critical illness, when, in fact, the measured burden may be due to conditions that preceded the patient's illness.

University of Pittsburgh researchers examined whether informal caregiver burden occurs as a direct result of critical illness. They compared those caring for patients who were previously healthy (59 percent), with those caring for patients who were physically disabled (41 percent) before their episode of critical illness. The researchers measured patient and caregiver outcomes at 2, 6, and 12 months after the patient's mechanical ventilation. Most patients were men in their midfifties and most caregivers were women about the same age. Over the course of the 1-year study, the proportion of functionally dependent survivors decreased from 91.2 percent at 2 months to 78.1 percent at 6 months to 69.6 percent at 1 year.

The respective proportion of patients living at home increased from 49.6 percent at 2 months to 77.4 percent at 6 months to 88.0 percent at 1 year. Caregivers reported spending nearly 6 hours per day providing assistance for most the study period, most often helping with problem solving, shopping, laundry, housekeeping, and finance management.

At 2 months, one-third of caregivers were at risk of depression, only 29 percent of caregivers were employed, and 13 percent indicated that they had stopped working in order to provide care. Caregivers reported moderate or great restriction in a mean of 3.5 lifestyle activities. The prevalence of caregiver depression risk was high at 2, 6, and 12 months (33.9, 30.8, and 22.8 percent, respectively), and did not vary by patient pre-ICU functional status. This suggests that the burden observed among these informal caregivers occurs as a direct result of the patient's critical illness. Lifestyle disruption and reduced employment were also common and persistent.

The study was supported in part by the Agency for Healthcare Research and Quality (HS11620).

See "Informal caregiver burden among survivors of prolonged mechanical ventilation," by David C. Van Pelt, M.D., Eric B. Milbrandt, M.D., M.P.H., Li Qin, Ph.D., and others, in the January 15, 2007, American Journal of Respiratory and Critical Care Medicine 175(2), pp. 167-173.

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