Review of the effectiveness and cost-effectiveness of different models of community-based respite care for frail older people and their carers

Family members and friends often need support as they cope with being the main caregivers for their older, sick or disabled loved ones.

One source of such support is respite care, but there is no clear proof that it benefits those who use it, according to a new review from England.

Respite care is a service provided for those who are sick, frail or disabled in settings such as nursing homes, residential homes, hospices and day centers. Caregivers use respite care for temporary relief from some of the stress and burden of their responsibility.

University of York researchers aimed to assess whether different types of respite care are effective or cost-effective when targeted at caregivers of frail older people

The reviewers found that the positive effects of respite on older people and those who care for them are modest. However, they found no reliable evidence that respite “adversely affects” those who receive care.

The review is published in the latest issue of Health Technology Assessment , the international journal series of the Health Technology Assessment programme, part of the National Institute for Health Research in the United Kingdom.

The 22 studies evaluated included five conducted in the United Kingdom and 11 in the United States. The studies looked at “older” persons — not all studies specified age — living with disability, frailty, dementia or cancer who received respite care, as well as those who cared for them.

Many of the studies reported that caregivers were highly satisfied with respite care and adult day care programs did seem to lower the caregivers' feelings of hostility when they sought help early on in the caregiving process.

The reviewers found only five studies that evaluated the economics of respite care. They concluded that day care is “at least as costly as usual care.” Lead author Anne Mason said they found no clear evidence that the cost of respite was a barrier to caregivers seeking help and support.

Mason said she and her colleagues were unable to draw any other firm conclusions about the effectiveness of respite because of the low quality of available data.

“We identified very few high-quality studies in our review, and findings from these studies were difficult to generalize to other settings.” Mason said. “Typically, standards for trial design, analysis and reporting were astonishingly poor … and basic methodological and analytic errors were not uncommon.”

She said these factors made it difficult to draw reliable conclusions about the benefits, harms and costs of respite.

“Without this information, it's very difficult for policy makers, purchasers and providers to make evidence-based decisions about how to best give carers the support they need,” Mason added.

However, respite care is in demand. According to the Family Caregiver Alliance, up to 7 million Americans (family, friends and neighbors) provide care to persons 65 years of age and older who need assistance with everyday activities. Bonnie Lawrence, alliance spokeswoman, said that in the 30-year history of the organization, the need for respite care has become paramount to caregivers who seek support.

“When caregivers call us, they have three top needs,” said Lawrence. “Those are: information, emotional support and respite. Caregivers may need two or three hours a week or they may need respite daily, depending on how well they handle personal stress, but they all want some type of break from the responsibility.”

Mason A, et al. A systematic review of the effectiveness and cost-effectiveness of different models of community-based respite care for frail older people and their carers. Health Technology Assessment 11(15), 2007.

The HTA programme is part of the National Institute for Health Research and produces high quality research information about the effectiveness, costs and broader impact of health technologies, with over 360 projects published since its inception. About 50 are published each year, all available for free download. It is coordinated by the National Coordinating Centre for Health Technology Assessment, based at the University of Southampton. Visit http://www.hta.ac.uk for more information.