Effect of nursing home care intervention post stroke on the quality of life of family caregivers of elderly people: randomized clinical trial

INTRODUCTION: Taking care of a dependent older adult stroke survivor at home without orientation can affect the quality of life (QL) of family caregiver and taking the older adult to use more often the health services. Nurses are essentials in giving education the patient and caregivers during hospitalization, discharge program and at home. PRIMARY OBJECTIVE: To evaluate the effect of nursing home education intervention in quality of life of family caregivers of older adults post stroke. SECONDARY OBJECTIVES: To verify the relation of nursing home education intervention in health service utilization by older adults post stroke; To assess quality os life perceptions of spouse and non-spouse caregivers of older adults stroke survivors. METHODS: Randomized controlled trial (RCT) with family caregivers of older adults post stroke. It integrates a large ECR called: "Nursing Home Care Intervention Post Stroke (SHARE)". After hospital discharge, patient were randomized in intervention group (IG) and control group (CG). The IG received systematic attendance by nurses in three home visits (HVs) during one month after discharge. The intervention aimed to prepare family caregiver for performing the activities of daily life of the older adults, emotional support and orientations regarding health services utilization. The CG did not receive HVs and had attendance in a conventional health services that had access. The outcome QL of caregiver was assessed by WHOQOL-BREF and WHOQOL-OLD in 7 days, 60 days and 1 year after discharge. The outcome health service utilization by older adults were assessed by instrument prepared to the study in 60 days and 1 year after discharge. The analyses were performed by intention to treat. To compare the baseline characteristics between groups, Student T or Mann-Whitney U tests, Pearson Chi-square or Fisher exact tests were performed. The effect of intervention was analyzed by General Estimated Equations (GEE). Project approved by the Research Ethics Committee from Hospital de Clínicas de Porto Alegre (#16.0181). Clinical Trials registration NCT02807012. RESULTS: Between May/2016 and September/2017, 48 participants 24 allocated to CG and 24 to IG. There was significative difference related to the ageds' marital status of CG compared to IG (p=0.021). The caregivers of IG and CG does not had significative difference in baseline data. There was no interaction effect between CG and IG regarding to General QL (p=0.625) over time. There was significative effect between IG and CG in the Social Relationship domain (p=0.019) and Autonomy facet (p=0.004). Older adults of IG had more use of outpatient hospital service compared to CG (GI=100%, GC=78.3%, p<0.05) in 60 days after discharge. Non-spouse caregivers had the lowest Social Relationship scores in 7 days (p<0.001) and 60 days (p=0.005) after discharge. CONCLUSION: The intervention had significative difference effect in the QL of family caregivers in Social Relations and Autonomy. The IG used more frequently the outpatient hospital service. Non-spouse caregivers had worst perceptions of QL in Social Relationship. The results reveal the importance to perform nursing educative interventions focused in activities of care, emotional support to caregiver and access to health services after discharge and returning home.