Caregivers With Poorer Health Are Less Likely to Engage in an Intervention to Prepare for Their Own Health Care Emergency

BACKGROUND AND OBJECTIVES: Preparation for an unexpected caregiver health event may improve outcomes for spouses with dementia. Using the patient activation framework, this study examined characteristics of spousal caregivers who did and did not accept an offer for an emergency preparedness toolkit (EPT), a low-touch intervention designed to help caregivers prepare for their own unexpected health event. RESEARCH DESIGN AND METHODS: Caregivers were linked to spouses with dementia and invited to request the EPT. Pre-exposure characteristics were measured during the 12-months preceding the EPT invitation date; post-exposure measures were captured during the 6-months after invitation. Multivariable logistic regression estimated associations between caregiver characteristics and EPT request, reported as marginal effects expressed in percentage point (pp) differences. Chi-square tests compared post-exposure measures by EPT request. RESULTS: We identified 1,062 eligible caregivers; 489 (46%) requested the EPT and 573 (54%) did not. Each additional chronic condition in the caregiver was associated with a 2.7pp decrease in EPT request. A caregiver hospitalization was associated with a 12.2pp decrease. Post-exposure analyses estimated caregivers not requesting the EPT were 1.9pp more likely to be hospitalized and discharged to a skilled-nursing-facility, and 1.9pp more likely to die during follow-up. DISCUSSION AND IMPLICATIONS: Spousal caregivers with poorer health were less likely to respond to an offer to prepare for their own health event. Yet, caregivers at higher risk for health events may be most in need of emergency preparedness. As reliance on spousal caregivers grows, interventions that better balance caregivers' self-care with responsibilities for a spouse with dementia may strengthen preparedness and improve health outcomes for both partners.