Caring for someone with advanced health care needs, dementia, or a difficult diagnosis can take a mental, physical and financial toll on the caregiver. It is important for providers to recognize, address and assist caregivers in as many ways as possible. Providing physicians with a readily available patient-education template in Epic may improve outreach and communication with increasingly isolated patients and caregivers and improve care for all without burdening physicians more.https://scholarworks.uvm.edu/fmclerk/1579/thumbnail.jp

Lynch, Elizabeth Anne

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UVM ScholarWorks

University of Vermont ScholarWorks @ UVM Family Medicine Clerkship Student Projects Larner College of Medicine 2019 Caregiver Burnout Elizabeth Anne Lynch Follow this and additional works at: https://scholarworks.uvm.edu/fmclerk  Part of the Medical Education Commons, and the Primary Care Commons Recommended Citation Lynch, Elizabeth Anne, "Caregiver Burnout" (2019). Family Medicine Clerkship Student Projects. 532. https://scholarworks.uvm.edu/fmclerk/532 This Book is brought to you for free and open access by the Larner College of Medicine at ScholarWorks @ UVM. It has been accepted for inclusion in Family Medicine Clerkship Student Projects by an authorized administrator of ScholarWorks @ UVM. For more information, please contact donna.omalley@uvm.edu. Caregiver BurnoutElizabeth Lynch Colchester Family MedicineSeptember, 2019Project Mentors: Dr. Sean Maloney, Dr. Zail Berry, Dr. Stephen Berns 1Problem Identification- By 2030, one in five adults will be > 65 - Estimated 39.5 million Americans are providing care for an adult currently- On average, caregivers provide care for 4 years with commitment ranging from 21.4 hours/ week (average) to higher-hour care closer to 44.6 hrs/week (spouse or partner care)- Higher hour caregivers have more stress, physical and financial difficulty and are at greater risk for poor healthcare themselves- Often assist with Instrumental Activities of Daily Living (IADL) and Activities of Daily Living (ADL’s)  - Worst health outcomes reported in caregivers caring for patients with: - A) mental health issues - B) complex health needs - C) co-resident status - D) performing medical or nursing tasks2Cost-Increased rate of depression in caregivers, especially if caring for persons with dementia -Caregivers report decline in quality of life and an increase in health complications-The higher the caregiver burden the more likely it is the patient will have unmet  health needs-63% higher mortality rate in older caregivers living with a patient compared to non caregivers -One study found 74% of caregivers reported chronic pain which is shown to impact caregivers perception of the patients pain: overestimating pain when serving as a proxy and underestimating pain when depressed3Community Perspective -“The problem is if they (caregiver) are caring for someone they can’t come in to get their own care. It is not a primary care physician problem, it is a system problem. In the Netherlands they can bring them (elderly) to adult day care … We don’t have that here. It is a very isolating role. ”- “I am always encouraging caregivers to take care of themselves, put on your own oxygen mask first because if something happens to you this person is up a creek.”- “A lot of times family caregivers are forced into the position based on finances. It comes down to socioeconomics, people just don’t have the money. It is not just easier, if you are on a fixed income, it is more money than you have (to get outside care).”  *Dr. Zail Berry, Associate Director of Hospice and Palliative Care in the UVM Health Network4Room for improvement:1) Awareness- clinicians should be aware of some illnesses causing higher rates of caregiver burden (dementia as one of the biggest). 2) Funds for caregivers- too many times disease fundraising goes to finding a cure. Although that is very important, we also need to find ways to care for caregivers who have higher rates of burnout, illnesses, stress. I would ask philanthropy and also insurers to start thinking about creating caregiver programs for counseling, resources and giving them relief.3) Family Leave- employers should model off of Europe and do longer FMLA programs so people can care for a loved one.Role of Primary Caregivers:1) Screening- screening for burnout on visitors for patients who have diseases that are at higher risk of caregiver distress2) Awareness- they should be aware of resources that are available and advocate for caregivers3) Empathy- they should validate the emotions and stress that the caregivers have. Conversations should be person centered and include responding to emotion.*Dr. Stephen Berns, Director of Talk Vermont, Hospice and Palliative Care Department, UVM Medical CenterCommunity Perspective:*Tracey Shamberger, Director of Community Outreach and Business Development at Age Well Vermont “ One of the biggest challenges we’ve identified for the ageing population is social isolation.  Especially in Franklin and Grand Isle counties. We aren’t reaching enough of the population there.”“We need more communities serving local people... to be more engaged. We have over 1000 volunteers that do everything from talk about baseball to go to shows with clients so that they are still active and a part of the community. But we always need more.”“The ageing New American population needs services too and we provide translators for doctors visits, meals cooked by native Nepalese chefs, Bhutanese events etc.” 5Intervention and Methodology1. Raise my own awareness of the issue as well as provider awareness via a presentation on the topic 2. Provide patient information in the form of an Epic SmartPhrase so providers can seamlessly share resources with patients as part of standard patient communication and discharge instructions3. Empower providers to name the challenges caregivers face so caregivers know:a. They are not wrong for feeling overwhelmed and frustrated b. They are not alone in their struggle c. That their provider is someone they can be honest and open with and who can offer them supports 6Results/ Response1. .caregiverburnout phrase now available in Epic with local resources for caregivers2. Shared with every provider at Colchester Clinic a. Under My Smart Phrases, click “open” (file folder icon)b. Search Caregiverburnoutc. Template should appeard. Add to “my smartphrases”e. Each provider added as editor so can change as neededf. Now can be inserted into patient education notes 7Effectiveness/ LimitationsLimitations: -Colchester specific, not generalizable- Requires awareness and vigilance to screen and intervene -Physicians already responsible for many other screenings in addition to managing patients concerns on each visit-Resources for caregivers are limited and adequate support isn’t built into our healthcare system yet8Effectiveness: -Will be difficult to assess because requires data collection on whether caregivers follow up on resources provided. We know caregivers often can’t come to appointments or follow up due to constraints on their time- Requires caregivers to reach out for help rather than resources contacting caregivers, which puts the burden on already overwhelmed caregivers- Not a system based change, only a small intervention that acts more as a temporary solution to a much larger structural issue Recommendations**Increase screening for caregiver burnout*Use Caregiver Self-Assessment Questionnaire** Advocate for caregiver support during community planning meetings, through roles in UVM Medical Center administration and through conversations with other family members so they are aware of the challenges caregivers faceScreening interventions: A)During Rooming Process: have you recently become a caregiver for anyone in your family? B) Physician screening:  have there been any updates in your family health history? Are you a primary caregiver for anyone in your family currently? C) Give questionnaire to every patient over 40 coming in for annual visit along with SODH screening forms 9References“Executive Summary: Caregiving in the U.S.” National Alliance for Caregiving and AARP Public Policy Institute. June 2015 https://www.aarp.org/content/dam/aarp/ppi/2015/caregiving-in-the-united-states-2015-executive-summary-revised.pdfSwartz, K., Collins, LG. “Caregiver Care”. June 2019. American Family Physician; 99 (11): 699-706 https://www.aafp.org/afp/2019/0601/p699.html#afp20190601p699-b6Schulz, Richard, and Sherwood, Paula.  “Physical and Mental Health Effects of Family Caregiving.” The American Journal of Nursing vol. 108,9 (2008): 23-27. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2791523/Sharma, Nidhi et al. “Gender differences in caregiving among family- caregivers of people with mental illnesses.” World Journal of Psychiatry vol. 6, (1) 7-17. Mar 2016 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4804270/Bevans, Margaret, and Esther M Sternberg. “Caregiving burden, stress and health effects among family caregivers of adult cancer patients.” JAMA, vol. 307,4 (2012): 398-403. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3304539/https://www.healthinaging.org/sites/default/files/media/pdf/Caregiver-Self-Assessment-Questionnaire.pdf10

Caregiver Burnout

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Caregiver Burnout

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