Emotional and physical demands on caregivers in home care to the elderly in Switzerland and their relationship to nursing home admission

Background: Planning the home care of growing numbers of old, dependent peo ple must include the caregivers' burden. Methods: A convenience sample of 1 29 caregivers of elderly patients with multiple diagnoses was interviewed a bout the caregiving context, burden, caregivers' tolerance of patients' tro ublesome behaviours and physical symptoms, mutuality and feelings of closen ess between caregiver and patient. Continued maintenance of home care was a ssessed by a follow-up telephone call. Results: Caregivers were mainly spou ses (67%) and female (73%), and the mean duration of care was 5.5 years. In five activities of daily living (ADL) 50-69% of the patients needed full h elp. Caregivers reported predominantly negative effects of caregiving on th eir physical and mental health, rest and sleep, leisure time and social lif e, problems with patients' symptoms and behaviours and little or no convers ing (51%) or exchanging feelings with patients (71%). Predictive models: Co ntributors to variance were for burden (35%), impact of care on caregivers' mental health, social relations and leisure time, patients' gender, accumu lation of patients' symptoms and behaviours; for caregivers' tolerance towa rd patients' symptoms and behaviours (17%) caregivers' physical health, pat ients' level of confusion, feelings of mutuality; for mutuality (22%) and f or closeness (19%) caregivers' mental health, patients' accumulation of sym ptoms and behaviours. Within 23 months 19% of the patients had been institu tionalized. Factors giving a higher likelihood of institutionalization were : being male, caregiver was not a partner, and less closeness between careg iver and patient. Conclusion: Caregiving of older persons has bio-psychosoc ial ramifications for caregivers. Closeness between caregiver and patient s eems to be a key factor in determination of the long-term outcome.