Fatigue in family caregivers of adult intensive care unit survivors

Abstract

Context: Family caregivers are a vital resource in the recovery of intensive care unit (ICU) survivors. Of concern, the stress associated with this role can negatively affect caregiver health. Fatigue, an important health indicator, has been identified as a predictor of various illnesses, greater use of health services, and early mortality. Examining the impact of fatigue on caregivers' physical health can assist in identifying critical time points and potential targets for intervention.

Objectives: To describe self-reported fatigue in caregivers of ICU survivors from patients' ICU admission to ≤ 2 weeks, two- and four-months post-ICU discharge.

Methods: Patient-caregiver pairs were enrolled from a medical ICU. Caregiver fatigue was measured using the Short-Form 36 Health Survey Vitality subscale (SF-36 Vitality). Caregiver psychobehavioral stress responses included depressive symptoms, burden, health risk behaviors, and sleep quality. Patient data included self-reported physical symptoms and disposition (home vs. institution).

Results: Forty-seven patient-caregiver pairs were initially enrolled. Clinically significant fatigue (SF-36 Vitality ≤ 45) was reported by 43%-53% of caregivers across the time points, and these caregivers reported worse scores in measures of depressive symptoms, burden, health risk behaviors and sleep quality, and patients' symptom burden. In 26 caregivers with data for all time points (55% of the total sample), SF-36 Vitality scores showed trends of improvement when the patient returned home and greater impairment when institutionalization continued.

Conclusion: In caregivers of ICU survivors, fatigue is common and potentially linked with poor psychobehavioral responses. Worsening fatigue was associated with greater symptom distress and long-term patient institutionalization.

Keywords: Intensive care unit; burden; caregiver health; depressive symptoms; family caregivers; fatigue; long-term outcomes.

Conflict of interest statement

Disclosures

The authors declare no conflicts of interest.

Copyright © 2014 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Figures

Fig. 1

Participant enrollment and follow-up. Participant enrollment occurred between November 2008 and July 2010 (over 21 months). In 19 pairs who refused, reasons for refusal include: “too busy” (n=10, 53%), “feel stressed” (n=4, 21%), “other family members disagree” (n=2, 10.5%), “not interested” (n=2, 10.5%), and “do not feel comfortable” (n=1, 5%). a A total of 38 caregivers and 32 patients participated in data collection because: a caregiver skipped measurement (n=1); patients were unable to answer (n=5, RASS score −3 to −1); a patient refused to answer (n=1). b A total of 29 caregivers and 28 patients participated in data collection because: missing data occurred because: caregivers skipped measurement (n=2); a patient was unable to answer (n=1, RASS score −3 to −1); patients refused to answer (n=2). c A total of 26 caregivers and 26 patients participated in data collection because: missing data occurred because: a caregiver was unavailable (n=1); a patient refused to answer (n=1). ICU = intensive care unit; RASS = Richmond Agitation Sedation Score.

Fig. 2

Description of the trends in SF-36 Vitality scores by timing of patients’ home discharge in a subsample of caregivers (n=26) who participated at all data follow-up points.

Fig. 3

Comparison of the scores of measure indicating caregivers’ psychobehavioral responses (a–d) and patients’ symptom burden (e) by caregivers grouped based upon SF-36 Vitality scores. Black blocks indicate scores reported in caregivers with SF-36 Vitality scores ≤ 45 (scores indicating clinically significant fatigue). White blocks indicate scores reported in caregivers with SF-36 Vitality scores of > 45. CES-D 10 = Center for Epidemiologic Studies-Depression 10 items; Zarit-12 = Brief Zarit Burden Score; CHB = caregiver health behavior; PSQI = Pittsburgh sleep quality index; MGSAT = Modified Given Symptom Assessment Tool.