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Systematic Review and Meta-Analysis of the Impact of Carer Stress on Subsequent Institutionalisation of Community-Dwelling Older People

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  • Nora-Ann Donnelly
  • Anne Hickey
  • Annette Burns
  • Paul Murphy
  • Frank Doyle

Abstract

Background: In the caregiving literature there is a common assertion that a higher level of carer stress is a critical determinant of premature ending of homecare. However, this contention has not been systematically assessed. We therefore systematically reviewed and meta-analysed the prospective association between various forms of carer stress and subsequent institutionalisation of community-dwelling older people. Methods: Systematic literature search of prospective studies measuring carer stress at baseline and institutionalisation at follow-up. Given substantial interchangeability in the measurement of carer stress, we included a wide number of exposure measures, namely: carer stress, burden, depression, distress, anxiety, burnout, and strain. Institutionalisation included both acute and long-term care utilisation. The standardised mean difference between stressed and non-stressed carers was the primary measure of effect. We assessed study quality with the Crowe Critical Appraisal Tool (CCAT). Pre-planned sensitivity analysis included examination of estimates according to study size; decade published; study quality according to quartiles of CCAT scores; population; follow-up period; study design and impact of adjusted or unadjusted estimates. Results: The search yielded 6,963 articles. After exclusions, we analysed data from 54 datasets. The meta-analysis found that while carer stress has a significant effect on subsequent institutionalisation of care recipients, the overall effect size was negligible (SMD=0·05, 95% CI=0·04–0·07). Sensitivity analyses found that, the effect size was higher for measurements of stress than for other measures, though still relatively small (SMD=0·23, 95% CI=0·09–0·38). Thus, whether analysing the association between carer stress, burden, distress, or depression with either acute or long-term care, the effect size remains small to negligible. Concurrently, we found estimates reduce over time and were smaller with larger studies and those of higher quality, according to the CCAT scores. Conclusion: Despite strong statements to the contrary, it appears that the effect of carer stress on subsequent care recipient institutionalisation is small to negligible. The current findings point to a biased literature, with significant small study effects. The results suggest a need to re-evaluate the degree to which carer stress predicts premature ending of home care. Concurrently, other factors may be more crucial in institutional placement than carer stress and should be investigated.

Suggested Citation

  • Nora-Ann Donnelly & Anne Hickey & Annette Burns & Paul Murphy & Frank Doyle, 2015. "Systematic Review and Meta-Analysis of the Impact of Carer Stress on Subsequent Institutionalisation of Community-Dwelling Older People," PLOS ONE, Public Library of Science, vol. 10(6), pages 1-19, June.
    • Handle: RePEc:plo:pone00:0128213
    DOI: 10.1371/journal.pone.0128213
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    References listed on IDEAS

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    1. John P A Ioannidis, 2005. "Why Most Published Research Findings Are False," PLOS Medicine, Public Library of Science, vol. 2(8), pages 1-1, August.
    2. Thomas J. Steichen & Matthias Egger & Jonathan Sterne, 1999. "Tests for publication bias in meta-analysis," Stata Technical Bulletin, StataCorp LP, vol. 8(44).
    3. Anton Kühberger & Astrid Fritz & Thomas Scherndl, 2014. "Publication Bias in Psychology: A Diagnosis Based on the Correlation between Effect Size and Sample Size," PLOS ONE, Public Library of Science, vol. 9(9), pages 1-8, September.
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    1. Elizabeth Benninger & Shazly Savahl, 2017. "A Systematic Review of Children’s Construction of the Self: Implications for Children’s Subjective Well-being," Child Indicators Research, Springer;The International Society of Child Indicators (ISCI), vol. 10(2), pages 545-569, June.
    2. Aman, Hiroyuki & Beekes, Wendy & Berkman, Henk & Bohmann, Marc & Bradbury, Michael & Chapple, Larelle & Chang, Millicent & Clout, Victoria & Faff, Robert & Han, Jianlei & Hillier, David & Hodgson, All, 2019. "Responsible science: Celebrating the 50-year legacy of Ball and Brown (1968) using a registration-based framework," Pacific-Basin Finance Journal, Elsevier, vol. 56(C), pages 129-150.
    3. Donnelly, Nora-Ann & Humphries, Niamh & Hickey, Anne & Doyle, Frank, 2017. "“We don’t have the infrastructure to support them at home”: How health system inadequacies impact on long-term care admissions of people with dementia," Health Policy, Elsevier, vol. 121(12), pages 1280-1287.

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