Respite care for frail older people: an appraisal of effectiveness and cost effectiveness

SPRU research team

• Hilary Arksey
• Caroline Glendinning

External collaborators

• Joy Adamson, Department of Health Sciences, University of York
• Karen Spilsbury, Department of Health Sciences, University of York
• Mike Drummond, Centre for Health Economics, University of York
• Anne Mason, Centre for Health Economics, University of York
• Helen Weatherley, Centre for Health Economics, University of York
• Su Golder, Centre for Reviews and Dissemination, University of York

Project summary

The last 40 years has seen an increasing proportion of older people in the UK population. Most disabled and elderly people live in the community; the care they receive is almost wholly provided by family, friends or neighbours. Providing informal care for frail older people can adversely affect carers' quality of life. Respite care is regarded as one of the key interventions to alleviate the stress of caring, and is a service that carers have identified as critical to their caring efforts. Paradoxically, respite and short-term breaks are known to have low utilisation rates.

Aims

The aim of the study was to assess the effectiveness and cost-effectiveness of different types of community-based respite care for frail older people and their carers. Where the data permits, we attempted to identify subgroups of carers and care recipients for whom respite care is particularly effective or cost-effective.

Methodology

Systematic review of the effectiveness and cost-effectiveness literature on community-based respite care for frail older people and their carers.

Types of respite care  included, but were not limited to:

• Day care
• In-home respite
• Host family respite
• Institutional / overnight respite
• Respite programmes
• Video respite.

The effectiveness review focused on randomised controlled trials, although lower levels of evidence were considered where necessary.

The quality of both effectiveness and cost-effectiveness studies were appraised. If insufficient economic data was found, an economic model of respite care was constructed to explore the key drivers determining the cost-effectiveness of respite care. Language restrictions were not applied. An Expert Reference Group were used to provide a consumer perspective. Incorporating carers, service providers and representatives from consumer groups, the Group helped to identify relevant studies, provide comments on the draft report and were invited to discuss the likely effects of a range of policy options and the practical, policy and research implications of the study results.

Sample Group

People aged 65 or above who were receiving respite care, and their carers.

Studies of persons with frailty, disability, dementia or cancer will be eligible for inclusion in the review. We defined 'frail' as 'having one or more long-term health problems and / or difficulties in one or more aspects of personal care, such that support to live independently is required.'

Outcome measures

These included, but were not limited to:

• Quality of life (carer / client)
• Physical health (carer / client)
• Mental / psychological health (carer / client)
• Satisfaction (carer / client)
• Carer burden
• Utilisation of any health and social services (carer / client)
• Utilisation of informal or voluntary support services (carer / client)
• Time to institutionalisation
• Time spent on caring tasks.