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ED Visits, Healthcare Costs Increase When Spouses of Disabled Are Suffering

The statistics will come as no surprise to emergency department (ED) staff, but some percentage of visits by disabled older patients might have more to do with their caregivers’ physical or mental state than their own.

An article in the Journal of the American Geriatrics Society describes the phenomenon whereby exhausted or depressed family caregivers can result in more frequent ED visits and higher overall health costs.

Researchers at the University of Michigan focused on 3,101 couples older than 65 years, each with one spouse acting as caregiver for their disabled partner, to gauge the effect. During the six months after the caregiver spouses were tested to measure their fatigue, mood, sleep habits, health, and happiness, the study team analyzed Medicare payments and ED visits for the disabled partner.

Results indicate that during that time, ED visits were elevated 23% among patients whose caregivers had scored high for fatigue or low on their own health status. Those patients also had higher Medicare costs — averaging $1,900 more if the caregiver scored high for fatigue, and $1,300 more if the caregiver scored high for sadness, even after all other factors were considered.

“Many of us who work in clinical settings feel that patients with high home caregiving needs, such as dementia, often rely on the medical system as a source of respite for their spouses or other caregivers, because other respite isn't paid for,” explained lead author Claire Ankuda, MD, MPH. “But there hasn't been a lot of data about it, and only recently has our society been talking about caregivers and potential ways to incentivize and support them as a way of keeping patients living at home.”

“Informal caregivers, including spouses, enable older adults with functional disability to stay out of the nursing home and live at home where they'd prefer to be,” added senior author Deborah Levine, MD, MPH, an assistant professor of internal medicine and neurology at the University of Michigan. “Our findings suggest that we need to do a better job of identifying and supporting caregivers experiencing distress, in order to help caregivers feel better and hopefully improve outcomes in older adults with disability.”

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