63. BEST PRACTICES IN FAMILY CAREGIVER SUPPORT OF THE MEDICALLY COMPLEX OLDER ADULT

Introduction

Medically complex older adults in geriatric psychiatry often find themselves requiring additional layers of social support to access optimal care, including transportation to various medical appointments, housing support, and coordination of care between multiple specialties. Of particular importance is the need for psychosocial support in the form of close family, friends, and peers, especially since these key pillars of support tend to diminish with age. Preserving the wellbeing of these caregivers and mitigation of caregiver burden are among some of the major priorities in supporting these patients throughout their psychiatric care [1]. The purpose of this poster is to promote best practices in caregiver support and to raise awareness regarding the need for more research in this area.

Methods

This case focuses on Mr. M, a 69 yo male with a psychiatric history of schizophrenia and major depressive disorder with multiple medical comorbidities including malignant tumor of bladder currently undergoing chemotherapy. Patient’s clinical documents in our electronic medical records system were reviewed. A literature survey was performed on the topics of caregiver burden and strategies to alleviate this burden. Mr. M has had multiple suicide attempts in the past and four recorded psychiatric hospitalizations and has baseline aggression and perseverative speech concerning for neurocognitive dysfunction. Mr. M receives multiple layers of support that assist him in continuing to receive both psychiatric and medical care, including subsidies for independent living, case management, and his sister, Ms. S, who acts as his primary caregiver and attends all appointments with him. Mr. M has had multiple risks of eviction in the context of psychiatric decompensation as a result of medication nonadherence. However, Ms. S, as his primary caregiver, has assisted Mr. M in not only adherence to medication but also by advocating for him at home and at medical appointments. While Ms. S has cited the emotional and psychological constraints of long-term caregiving, acknowledgement of caregiver burden and provision of psychosocial support has helped in reducing caregiver distress.

Results

The review of recent literature supports family caregiving as an important factor in promoting health in older adults while also providing best practice guidelines in how to mitigate caregiver burden and continue promoting patient health throughout the course of their psychiatric illness. These strategies are broadly categorized in three main groups: first, psychosocial interventions such as addressing information needs and providing communication and stress management skills; second, meditative interventions such as mindfulness-based cognitive therapy, acceptance and commitment therapy; third, physical activity interventions which promote psychological well-being [2]. Notably, evidence shows a reduction in caregiver distress but not necessarily caregiver burden for the psychosocial strategies, whereas meditative and physical activity interventions reduced both caregiver distress and subjective caregiver burden. Next steps for Mr. M’s case could include recommending mindfulness or acceptance and commitment therapy for his sister who is his primary caregiver. We could also recommend Ms. S to join support groups which encourage mindfulness and physical activity with other caregivers.

Conclusions

Providers should continue on providing both patient-centered and family-centered care to support medically complex older adults with psychiatric illness. Awareness and provision of resources and interventions to mitigate caregiver burden are of particular importance in improving long-term outcomes in both patients and their caregivers. While psychosocial interventions such as education and providing information about psychiatric or medical conditions may be helpful in reducing distress, they have not been shown to reduce caregiver burden. Instead, meditative interventions such as mindfulness-based therapy and acceptance and commitment therapy and physical activity interventions have been shown to reduce both caregiver distress and burden. However, the broad nature of caregiver interventions and outcomes along with difficult objective measurable markers create several obstacles in understanding what methods are most useful for our patients and their caregivers. This highlights the need for further research for interventions in caregiver support.