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Informal Caregiver Involvement and Illness Detection Among Cognitively Impaired Nursing Home Residents

Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore.

Address correspondence to Cynthia Lindman Port, PhD, 660 West Redwood Street, Baltimore, MD 21201. E-mail: cport{at}epi.umaryland.edu

Background. The participation of informal caregivers in the care of nursing home (NH) residents has the potential to positively impact care, especially for cognitively impaired residents whose own ability to advocate for their care is often limited. This study examined relationships between the level of informal caregiver involvement (ICI) in the NH and the degree to which residents' common medical conditions were detected by facility staff.

Methods. One hundred pairs of cognitively impaired residents and their primary informal caregivers were enrolled from three facilities in the Baltimore, Maryland area. Data collection involved interviews with informal caregivers and facility staff, as well as a medical evaluation and chart review of residents. A measure of illness detection was created by comparing a medical examination of the resident with chart review information. ICI was measured via staff rating and informal caregiver self-report.

Results. Correlations between illness detection and ICI were significant, with r = –.46 (p <.001) and r = –.39 (p <.001), for staff rating and self-reports, respectively. In regression models taking into account resident characteristics (age, race, gender, comorbidities, payment status, duration of stay, and cognitive impairment) and facility differences, higher ICI and being female predicted higher rates of illness detection.

Conclusions. Though the cross-sectional nature of the study prevents the analysis of causal relationships, the involvement level of informal caregivers in the NH care of cognitively impaired residents was statistically related to higher rates of illness detection. Ramifications for the role of informal caregivers in long-term care are discussed.