Association of caregiver burden with the healthcare use and outcomes of older patients attending the ED

Background While growing numbers of older patients live independently at home, the availability of home care services is increasingly limited. Therefore, ageing societies increasingly rely on informal caregivers. These caregivers may experience high burden, potentially leading to increased healthcare utilisation. This study explores associations between caregiver burden and healthcare use and outcomes in older patients attending the emergency department (ED). Methods We conducted a prospective observational cohort study in a Dutch teaching hospital. Primary caregivers of older ED patients (≥70 years) were interviewed at baseline and after 1 month. Caregiver burden and mastery were assessed using the Caregiver Strain Index (CSI) and Caregiver Mastery Scale, respectively. Subsequently, we evaluated the association of caregiver burden with hospital admission, hospital length of stay, in-hospital mortality and unscheduled ED revisits. Results 298 patients (mean age 82.3 years) were included. High caregiver burden was reported in 125/298 (42%) of patients. On average, these patients were more dependent and had a lower estimated 10-year survival. High burden was associated with increased hospitalisation (71% vs 56%, p=0.008) and longer length of stay (median 5 days vs 2 days, p<0.001), but not with mortality or ED revisits. However, the association between CSI and hospitalisation could not be confirmed in multivariable analysis in this sample. Conclusion Patients whose primary caregiver reported high caregiver burden were on average more frail and more dependent. Furthermore, burden was more common in caregivers with lower caregiver mastery. Associations with clinical outcomes were less pronounced: caregiver burden was not significantly associated with mortality or ED revisits, and the association with hospitalisation and longer length of stay did not remain significant after multivariable adjustment.