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Table.  Characteristics of 1230 Community-Living Older Adults With Disability and 1861 Family and Unpaid Caregivers and Associated Adjusted Odds of Caregiver Traininga
Characteristics of 1230 Community-Living Older Adults With Disability and 1861 Family and Unpaid Caregivers and Associated Adjusted Odds of Caregiver Traininga
1.
National Academies of Sciences, Engineering, and Medicine.  Families Caring for an Aging America. Washington, DC: The National Academies Press; 2016.
2.
Wolff  JL, Spillman  BC, Freedman  VA, Kasper  JD.  A national profile of family and unpaid caregivers who assist older adults with health care activities.  JAMA Intern Med. 2016;176(3):372-379. doi:10.1001/jamainternmed.2015.7664PubMedGoogle ScholarCrossref
3.
Nuckols  TK, Keeler  E, Morton  S,  et al.  Economic evaluation of quality improvement interventions designed to prevent hospital readmission: a systematic review and meta-analysis.  JAMA Intern Med. 2017;177(7):975-985. doi:10.1001/jamainternmed.2017.1136PubMedGoogle ScholarCrossref
4.
Kasper  JD, Freedman  VA. National Health and Aging Trends Study (NHATS) user guide: rounds 1-7. http://www.nhats.org. Published 2018. Accessed November 8, 2018.
5.
Montori  VM, Hargraves  I, McNellis  RJ,  et al.  The care and learn model: a practice and research model for improving healthcare quality and outcomes.  J Gen Intern Med. 2019;34(1):154-158. doi:10.1007/s11606-018-4737-7PubMedGoogle ScholarCrossref
6.
Wolff  JL, Feder  J, Schulz  R.  Supporting family caregivers of older Americans.  N Engl J Med. 2016;375(26):2513-2515. doi:10.1056/NEJMp1612351PubMedGoogle ScholarCrossref
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    Research Letter
    April 8, 2019

    Factors Associated With Receipt of Training Among Caregivers of Older Adults

    Author Affiliations
    • 1Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
    • 2Center on Aging and Health, Division of Geriatric Medicine and Gerontology, Johns Hopkins School of Medicine, Baltimore, Maryland
    • 3Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College, New York, New York
    JAMA Intern Med. 2019;179(6):833-835. doi:10.1001/jamainternmed.2018.8694

    Nearly 18 million family and unpaid caregivers assist older American individuals with disabilities.1,2 Caregivers are a crucial source of care for older adults with disabilities and complex care needs but often report feeling unprepared and poorly supported in their caregiving role.1 Emerging evidence suggests that support of family caregivers, including education and training, can improve health outcomes for caregivers and care recipients.1,3 However, to our knowledge, no previous work has examined whether caregiver characteristics are associated with receipt of training.

    Methods

    We used data from the 2015 National Health and Aging Trends Study (NHATS), a nationally representative survey of Medicare beneficiaries 65 years and older, and the linked National Survey of Caregivers (NSOC), a companion survey administered to family and unpaid caregivers identified by NHATS participants.4 This study includes 1861 family caregivers of 1230 NHATS study participants who were living in traditional community settings and receiving help with daily activities related to self-care, mobility, and household activities for health and function reasons.

    Receipt of training was measured as a binary indicator from affirmative responses to the NSOC question, “In the last year, have you received any training to help you take care of [care recipient]?” Multivariable logistic regression was used to assess the association between older adult and caregiver characteristics and receipt of training; we adjusted for a range of older adult, caregiver, and caregiving relationship characteristics that were posited to affect receipt of training. Analyses were performed using Stata, version 14 (StataCorp) and included survey weights and design variables that account for the complex survey design of the NHATS and NSOC. The P value level of significance was .05, and all P values were 2-sided.

    Results

    Among the 1861 caregivers included in our sample, 1241 (66.3%) are female and the mean age was 60.2 years; among 1230 older adults included in our sample, 825 (67.1%) are female and the mean age was 81.8 years. Our analysis found that 7.3% of family and unpaid caregivers reported receiving training related to their caregiving role (1.3 million of 17.9 million in a weighted estimate). In the weighted, adjusted regression model, caregivers assisting older adults who had been hospitalized in the prior year were twice as likely to receive training (adjusted odds ratio [aOR], 1.97; 95% CI, 1.27-3.06; P = .003) as those assisting older adults who had not been hospitalized. Caregivers who were paid were 4 times more likely to receive training (aOR, 4.40; 95% CI, 1.94-9.98; P = .001). Caregivers of white older adults were less likely to receive training (aOR, 0.61; 95% CI, 0.39-0.96; P = .03) (Table).

    Discussion

    We found that 93% of older adults’ family caregivers did not report receiving role-related training. Neither older adults’ health status, caregiver burden, nor assisting with health care tasks were significantly associated with training. This work is subject to several limitations; we cannot provide causal inferences given the use of cross-sectional data. We are unable to comment on the mode, frequency, or quality of training or the extent to which training affects caregiving capacity. Nevertheless, results indicate that few family caregivers receive role-related training and that access to training is not significantly associated with caregiver or older adult needs.

    Low levels of caregiver training are a missed opportunity for the health care system. Prior work suggests that training to better prepare family caregivers may improve health and reduce service utilization for those they assist.1,3 The emerging model of a learning health system,5 together with developing consensus that clinicians and caregivers must be partners in care,6 suggests benefits may accrue to integrated health systems that incorporate family caregiver support as part of quality improvement efforts. Clinicians and systems that incorporate the family perspective into treatment discussions and consider caregiver capacity and needs may be better positioned to deliver higher-quality, more efficient person-centered and family-centered care. The results of this study highlight a gap between older adults’ family caregivers and access to supportive services; addressing this lack of support is an area of opportunity for health systems in stimulating the delivery of high-value care.

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    Article Information

    Corresponding Author: Julia Burgdorf, BS, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Room 698, Baltimore, MD 21205 (julia.burgdorf@jhu.edu).

    Accepted for Publication: December 18, 2018.

    Published Online: April 8, 2019. doi:10.1001/jamainternmed.2018.8694

    Author Contributions: Ms Burgdorf had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

    Concept and design: Burgdorf, Roth, Wolff.

    Acquisition, analysis, or interpretation of data: Burgdorf, Riffin, Wolff.

    Drafting of the manuscript: Burgdorf, Wolff.

    Critical revision of the manuscript for important intellectual content: All authors.

    Statistical analysis: Burgdorf, Roth.

    Obtained funding: Wolff.

    Administrative, technical, or material support: Burgdorf, Wolff.

    Supervision: Wolff.

    Critical input regarding policy implications: Riffin.

    Conflict of Interest Disclosures: None reported.

    Funding/Support: Ms Burgdorf and Dr Wolff reported grants from National Institutes of Health–National Institute on Aging during the conduct of the study.

    Role of the Funder/Sponsor: The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

    References
    1.
    National Academies of Sciences, Engineering, and Medicine.  Families Caring for an Aging America. Washington, DC: The National Academies Press; 2016.
    2.
    Wolff  JL, Spillman  BC, Freedman  VA, Kasper  JD.  A national profile of family and unpaid caregivers who assist older adults with health care activities.  JAMA Intern Med. 2016;176(3):372-379. doi:10.1001/jamainternmed.2015.7664PubMedGoogle ScholarCrossref
    3.
    Nuckols  TK, Keeler  E, Morton  S,  et al.  Economic evaluation of quality improvement interventions designed to prevent hospital readmission: a systematic review and meta-analysis.  JAMA Intern Med. 2017;177(7):975-985. doi:10.1001/jamainternmed.2017.1136PubMedGoogle ScholarCrossref
    4.
    Kasper  JD, Freedman  VA. National Health and Aging Trends Study (NHATS) user guide: rounds 1-7. http://www.nhats.org. Published 2018. Accessed November 8, 2018.
    5.
    Montori  VM, Hargraves  I, McNellis  RJ,  et al.  The care and learn model: a practice and research model for improving healthcare quality and outcomes.  J Gen Intern Med. 2019;34(1):154-158. doi:10.1007/s11606-018-4737-7PubMedGoogle ScholarCrossref
    6.
    Wolff  JL, Feder  J, Schulz  R.  Supporting family caregivers of older Americans.  N Engl J Med. 2016;375(26):2513-2515. doi:10.1056/NEJMp1612351PubMedGoogle ScholarCrossref
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