What are the consequences of caring for older people and what interventions are effective for supporting unpaid carers? A rapid review of systematic reviews.

Author(s): Spiers, G.F., Liddle, J., Kunonga, T.P. et al.

Published In: BMJ Open, 11 (9): 3046187. (2021)

Study Aim/Purpose:  The authors conducted a review and synthesis of published systematic literature reviews on available findings and gaps in the literature on the impact of caring for older adults on unpaid caregivers and interventions that aim to improve their health and well-being.

Summary of Methods:  The authors conducted “a rapid review” of systematic reviews that focused on caregivers of all ages who care for older adults. Eligible outcomes for analysis were any that related to caregivers’ health, social, and financial well-being, and access to services. The authors deliberately excluded reviews of interventions designed for both caregivers and their care recipients. The authors’ searches were conducted in MEDLINE, PsychInfo, and Epistemonikos for reviews published from January 2000 to January 2020. After identifying the reviews that met the eligibility criteria, the authors categorized each study as having low, moderate, or high risk of bias.

Summary of Key Results:  The authors reviewed 361 systematic reviews, 12  of which met the inclusion criteria. Six identified reviews reported evidence about the consequences for caregivers, of which two were judged by the authors to have moderate risk and four to have high risk of bias. The remaining six reviews summarized findings of evaluations of interventions for caregivers, of which two were judged to have low risk, one to have moderate risk, and three to have high risk of bias.

In their synthesis of findings, the authors point out that the reviews focus on a limited set of outcomes for caregivers, typically only related to caregivers’ mental health but not their physical, social, and financial well-being. They conclude that current reviewed studies fail to fully quantify the impacts that caring for older people has on caregivers’ health and well-being or the effectiveness of interventions designed to support them. The two systematic reviews of respite interventions with low risk of bias focused primarily on mental health and caregiver burden and did not provide strong evidence to suggest that respite improved these outcomes.

Limitations of Studies Reviewed (as cited by authors):  The authors note that because this was a review of systematic reviews, their synthesis may have excluded primary research not yet included in systematic reviews. While they acknowledge this as a limitation of their review, they also note that most of the systematic reviews identified were published within the last three years, suggesting that their synthesis included the majority of recent published research in this area.

Authors’ Discussion/Conclusions:  To address the shortfalls in the current evidence base, the authors recommend three priorities for future research:

  • A high-quality, comprehensive systematic review focusing on the impact of caring for older people on caregivers’ physical health, as well as their social and financial well-being. The authors suggest that this review include non-peer- reviewed sources and qualitative studies.
  • Population-level studies to quantify the difference in prevalence and severity of mental health outcomes and other illnesses for caregivers of older people and the general population.
  • Robust development and evaluation of promising interventions for caregivers of older people that take into account potential pathways to positive outcomes and measure a broader range of relevant outcomes.

To bring greater attention to the needs of caregivers of older people in research, programming, and policy making, the authors conclude by recommending that unpaid caregiving be recognized and classified as a social determinant of health.