The impact of carer stress on institutionalisation of care recipients: systematic review and meta-analysis

Abstract

Background: In the caregiving literature there is a belief that higher levels of carer stress could undermine the sustainability of homecare. However, this has not been systematically analysed. Therefore we systematically reviewed and meta-analysed the prospective association between carer stress and subsequent institutionalisation of older care recipients. Methods: Systematic literature search of prospective studies measuring carer stress at baseline and institutionalisation at follow-up. The standardised mean difference between stressed and non-stressed carers was the primary measure of effect. Findings: The search yielded 6,963 articles. After exclusions 54 papers were analysed. The meta-analysis found that carer stress has a negligible effect on institutionalisation of care recipients (SMD=.05, 95%CI=.04-.07; I2=79.2%; p=<.001). The sensitivity analysis found that estimates reduce over time, with larger and better quality studies. Discussion: It appears that over time larger and better quality studies found less of an effect of carer stress on institutionalisation. The results suggest a need to re-examine the belief that higher levels of carer stress could undermine the sustainability of homecare.