The effectiveness and cost-effectiveness of respite for caregivers of frail older people.

Study Aim/Purpose: The authors’ aim was to conduct a systematic review of the literature on the effectiveness and cost-effectiveness of community-based respite for caregivers of frail older people. 

Summary of Methods: Authors searched 37 databases for studies from 1980 through March 2005, including databases of systematic reviews, old age and aging, health and social care, economics, conference proceedings, ongoing research, dissertations, and other gray literature. The searches were not limited by study design, outcome measure, disease area, or language. For the effectiveness and economic studies, data were extracted and study quality assessed by one reviewer and checked by another. For uncontrolled studies, one reviewer assessed quality and a second checked it using a quality appraisal checklist. The authors used meta-analysis to synthesize or pool the findings on similar measures from the controlled studies. Effect sizes of the pooled findings were estimated using standardized mean differences for studies assessing the same outcome but using different scales. 

Summary of Key Results: The authors found 22 effectiveness and 5 cost studies that met inclusion criteria. Of the former group, ten used randomized controlled study designs, seven were quasi-experimental studies, and 5 were uncontrolled studies, included because no controlled study was identified for the type of respite or patient group studied. Of the cost studies, 2 conducted cost-effectiveness analysis and 3 analyzed costs or cost differences of respite vs. different or no care. In summary of results, the authors said: “Of the 17 randomized control and quasi-experimental studies, all but one compared the effect of a respite intervention with usual care. These studies provided usable data for only two caregiver outcomes―burden and depression.” They report that for all types of respite, the effects on caregiver burden and caregiver mental and physical health were generally small, with better controlled studies finding modest benefits for certain subgroups and “no reliable evidence that respite care delays entry to residential care or adversely affects frail older people.” At the same time, the authors found many studies that reported high levels of caregiver satisfaction with respite. “The economic evaluations all assessed adult day services and found them to be associated with similar or higher costs than usual care.” 

Authors’ Discussion/Conclusions: The authors conclude that “the existing evidence base does not allow any firm conclusions about effectiveness or cost-effectiveness to be drawn” for two principal reasons. First, there are serious problems with the methodological quality of many studies underpinning the evidence base. Second, where better-quality evidence exists, the implications for other populations are unclear.” Furthermore, they note that the relative effects found in these studies are highly dependent on how the intervention and comparator services were configured, resourced, delivered, and accessed.” The authors recommend pilot studies be conducted to inform full-scale controlled trials and that these studies “identify one or more target groups (i.e. caregiver and care receiver dyads), establish clear definitions of services to be compared, and determine the main outcomes to be measured, such as caregiver quality of life or institutionalization rate.” The authors suggest that future research should combine qualitative and quantitative methods.