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

Researchers: Hilary Arksey and Caroline Glendinning (SPRU), Joy Adamson and Karen Spilsbury (Dept. of Health Sciences), Mike Drummond, Anne Mason and Helen Weatherly (Centre for Health Economics), Su Golder (Centre for Reviews and Dissemination)

Funder: National Coordinating Centre for Health Technology Assessment

Duration: March 2005 - February 2006

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

Publications

2007

A Systematic Review of the Effectiveness and Cost-effectiveness of Different Models of Community-based Respite Care for Frail Older People and their Carers, 2007
Mason, A., Weatherly, H., Spilsbury, K., Arksey, H., Golder, S., Adamson, J., Drummond, M. and Glendinning, C., National Coordinating Centre for Health Technology Assessment.

The effectiveness and cost-effectiveness of respite for caregivers of frail older people, 2007
Mason, A., Weatherly, H., Spilsbury, K., Golder, S., Arksey, H., Adamson, J. and Drummond, M., Journal of the American Geriatrics Society, 55, 2, 290-99.