Caregiver Emotional Wellbeing Is Related to Nursing Home Admissions Among Veterans

Approximately 14 million US adults require long-term care; most of this care is provided in the community by family caregivers. High intensity care can decrease caregiver wellbeing; caregiver burden is a determinant of nursing home admission. This study extends past research to evaluate the association between caregiver subjective burden, depression, and loneliness and subsequent Veteran nursing home admission.

This study is a time-to-event analysis of Veteran/caregiver pairs. The sample population (n = 1539) includes Veterans aged 26-102 and their caregivers enrolled in the VA's Program of General Caregiver Supports and Services (PGCSS). PGCSS caregivers participated in a telephone survey to assess self-reported caregiver wellbeing (exposure variables: burden, depression, loneliness). The outcome, time to nursing home visits at 3 and 5 years post-survey, was constructed using Veteran medical records. We examined this relationship using the cumulative incidence function stratifying by levels of caregiver burden and depression as well as covariate-adjusted Cox proportional hazard models.

We observed a significantly higher incidence of nursing home admission at the 3-year follow-up for Veterans whose caregivers reported higher burden and depression at baseline. Adjusted Cox models also revealed significantly higher risks of Veteran nursing home entry at the 3-year follow-up when caregivers reported greater depression, burden, and loneliness at baseline.

Our study demonstrates that Veterans were more likely to transition from home-based care to facility-based care within 3 years if their caregivers reported higher rates of burden, depression, and loneliness at baseline. These findings illuminate the importance of support services that improve caregiver emotional wellbeing.