We agree with MacKnight and colleagues that caregiver strain is a possible and legitimate cause of hospitalization among the elderly. Any worsening in the health status of the recipient of care may well upset the fragile ecology of home care. Unfortunately, we did not measure caregiver strain directly in our study; therefore, we are unable to document the importance of this problem in our setting.
What we did measure were medical criteria for hospitalization as defined by the Appropriateness Evaluation Protocol (AEP). An admission was inappropriate if none of these criteria were satisfied. Since acute illness alone usually justified a hospitalization by AEP criteria, the joint presence of caregiver strain and acute illness was not a likely cause of inappropriate hospitalization. However, because the AEP does not have perfect sensitivity and specificity, the scenario envisioned by MacKnight and associates remains a possibility. More importantly, we do not know the contribution of caregiver strain to the majority of admissions that were labeled appropriate using the AEP.
Perneger TV, Chopard P, Sarasin FP, Gaspoz J. Caregiver Burdens and Nonmedical Hospital Admissions. Arch Intern Med. 1998;158(5):542-543. doi: