Reduced patient functioning increases caregiver burden

“Being an orthopaedic traumatologist involves far more than fixing a guy’s left intertrochanteric fracture after he has fallen off a ladder,” says Bruce Ziran, MD. “It’s helping this man’s wife—who is his sole caregiver—identify the resources so the house they have shared for 50 years is not lost to Medicaid subrogation.”

Dr. Ziran has expanded his “patient-centered” care to include the often burdened and forgotten “caregiver.” To study the impact of the patient’s condition on the caregiver, he enlisted the assistance of Mary-Kate Barrette-Grischow, MA, MPH, who recently presented the results of their findings.

Family, friends face “burnout”
The challenges of caring for Alzheimer’s patients and those with chronic diseases are well-documented. But little work has been done on the impact on those who care for orthopaedic surgical patients.

“The patient’s entire family may be adversely affected by this person’s injury—particularly financially,” Ms. Barrette-Grischow reported. “At times, we saw a patient’s closest friend have to relinquish the caregiving role because it had depleted both financial and emotional resources.

“High levels of stress were reported by the caregivers,” continued Ms. Barrette-Grischow. “That stress correlated to the patients’ physical and mental status. As ancillary support services are cut, informal caregivers will have to assume a greater role in convalescent patient care. Clinicians need to understand the dynamics of this link to improve the outcomes of their elderly patients.”

Correlation statistically verified
The patients were asked to complete a standardized Short Form-36 (SF-36) and caregivers were given the Caregiver Burden Scale developed by Montgomery et al.

“The fact that our patient population scored one standard deviation below the national norm on mean SF-36 scores was surprising,” Ms. Barrette-Grischow said. “Our caregiver stress response was also high.” The study found that one third of caregivers reported high life disruption, and that nearly half (47 percent) reported high emotional impact of care responsibilities.

Next steps
After listening to the needs expressed by the caregivers and gathering data from the study, the orthopaedic trauma unit compiled a list of hospital and community resources, reported Ms. Barrette-Grischow.

The trauma unit is applying for a part-time social worker to work directly with the caregiver group—offering counseling and support, resource referral, and community outreach. They are committed to serving the “whole patient,” including the caregiver.

They are also applying for a National Institutes of Health R01 grant to study the issues of caregivers on a multicenter scale.

“The pain of fracture and strain of caregiving: The relationship between patient function and caregiver burden” was presented at the 23rd Annual Meeting of the Orthopaedic Trauma Association in Boston.

Annie Hayashi is the senior science writer for AAOS Now. She can be reached at hayashi@aaos.org