What are the consequences of caring for older people and what interventions work best to promote caregivers’ health and wellbeing? A rapid review of reviews

Problem

Approximately 6.5 million adults provide unpaid care in England, with risks to their own health, social and financial wellbeing. Supporting unpaid carers of older people is a high priority for current policy. To support policymaking for this population a clear picture is needed, of what is known and where there are gaps in the current evidence. A rapid review of systematic reviews was undertaken to map current evidence about a) the consequences of caring for older people and b) effective interventions for this group of caregivers.

Approach

Searches were conducted in Medline, PsychInfo and Epistemonikos (January 2020). Systematic reviews published in English after 2000 were included if they reported evidence about a) the impact of caregiving on carers’ health, social and financial wellbeing, and/or b) the effectiveness of caregiver interventions. Caregiver populations were those of any age and sex, whilst care recipients were older people (as defined in the review). Reviews must have met three out of five DARE criteria to be considered for inclusion. Titles and abstracts were screened: 20% by two researchers independently and the remainder by a single researcher. Full texts were screened against review criteria. Review risk of bias was appraised and a narrative synthesis undertaken by a single researcher.

Findings

Sixty-nine systematic reviews were eligible for inclusion. Fifty-seven of these were specific to dementia caregivers. To avoid duplication of existing umbrella reviews for this population, the synthesis focused on systematic reviews that reported evidence about those caring for non-dementia older populations (n=12). Systematic reviews about the consequences of caregiving (n=6) typically focused on carers’ mental health, quality of life and burden. Few systematic reviews (n=1) included evidence about the impact on carers’ physical health, and none reported the social and financial impact of caregiving. There was a consensus across systematic reviews that caregivers experienced poor mental health, quality of life and burden. However, estimates of prevalence and severity were either very variable or not reported at all. Limited evidence from these systematic reviews also indicated that carers experienced poorer mental health compared to that of the general population. Six systematic reviews reported evidence about interventions to support carers of older people. Interventions included respite, psychosocial, educational, cognitive and multicomponent. Evidence suggested that respite care, cognitive, and educational interventions were not beneficial to caregivers. Some psychosocial and multicomponent interventions were promising, with positive outcomes for carers. However, evidence for these was limited in quantity and from reviews with moderate and high risk of bias.

Consequences

This rapid review of reviews highlights a need for a robust synthesis of primary studies focusing on physical health, social and financial wellbeing outcomes for carers of older people. Further evidence is also required to ascertain the benefits of some psychosocial and multicomponent interventions.