The Effectiveness and Cost-Effectiveness of Respite for Caregivers of Frail Older People

Centre for Health Economics, University of York, York, United Kingdom.
Journal of the American Geriatrics Society (Impact Factor: 4.57). 03/2007; 55(2):290-9. DOI: 10.1111/j.1532-5415.2006.01037.x
Source: PubMed


The proportion of frail elderly people in the industrialized world is increasing. Respite care is a potentially important way of maintaining the quality of life for these people and their caregivers. The objective of this systematic review was to determine the effectiveness and cost-effectiveness of different models of community-based respite care for frail older people and their caregivers. To identify relevant studies, 37 databases were searched, and reference checking and citation searches were undertaken. Well-controlled effectiveness studies were eligible for inclusion, with uncontrolled studies admissible only in the absence of higher-quality evidence. Studies assessed the effect of community-based respite on caregivers of frail elderly people relative to usual care or to another support intervention. Eligible economic evaluations also addressed costs. Where appropriate, data were synthesized using standard meta-analytic techniques. Ten randomized, controlled trials, seven quasi-experimental studies and five uncontrolled studies were included in the review. For all types of respite, the effects upon caregivers were generally small, with better-controlled studies finding modest benefits only for certain subgroups, although many studies reported high levels of caregiver satisfaction. No reliable evidence was found that respite care delays entry to residential care or adversely affects frail older people. The economic evaluations all assessed day care, which tended to be associated with similar or higher costs than usual care. Given the increasing numbers of frail elderly people and the lack of up-to-date, good-quality evidence for all types of respite care, better-quality evidence is urgently needed to inform current policy and practice.

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    • "This will necessitate new, innovative ways of delivering services to older people. However, no reliable evidence was found that respite care delays entry to residential care or adversely affects frail older people [8]. "
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    • "In summary, the multicomponent intervention and specifically those involving the patient are usually the most effective interventions. It is worthy to mention that the respite care, despite it improves the satisfaction, does not affect the overburden and they neither reach to postpone the institutionalization [23,24]. "
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    • "Health-related quality of life (HRQOL) is a multidimensional measure that assesses patients' perceptions of their functional limitations as it relates to their physical, social, and emotional functional. HRQOL may be a key measure to assess ADS outcomes because it potentially could inform individual care plans and quality assessments (Kane, 2003; Mason et al., 2007; Norris et al., 2008). However, little is known whether ADS attendance is associated with participants' quality of life. "
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