Other Support Roles

Informal caregivers frequently coordinate and arrange medical appointments for older adults. In fact, the time that they spend performing this function has given rise to a new line of elder care referral services, which employers have begun to offer as a way to save lost work time among employees. Caregivers frequently accompany older patients to office visits, and they are often involved in treatment decisions (Deimling et al., 1990; Kapp, 1991), particularly those involving patients who are older and who carry a greater disease burden (Ende et al., 1989; Ishikawa et al., 2005). In the case of critically ill and hospitalized patients, families and friends are often kept apprised of the patient’s health status, they advocate for needed services and attention, and they provide patients with emotional support (Hickey, 1990). Family may also assume a role in coordinating patient transitions across settings of care—for example, from hospital to home (Coleman, 2003; DesRoches et al., 2002). In addition, as providers of assistance to frail older adults with physical and cognitive disabilities, informal caregivers often help to ensure the safety of the home environment.

When older adults do not speak English, health care providers often ask family members or friends to interpret. In fact, it is estimated that 79 percent of hospitals frequently rely on family and friends to serve as interpreters (Wilson-Stronks and Galvez, 2007). This practice risks misinterpretation and the transmission of inaccurate information, especially when the translators are young children. As a result, recent state laws prevent using the family for this purpose and several organizations have developed reports and guidelines about how to implement language services in health care organizations.

Still, the knowledge that family members have about the patient and their ability to articulate this knowledge allow them to advocate on the patient’s behalf and to enhance the provider’s understanding of the older adult’s social environment, health conditions, and care preferences. Similarly, family members’ understanding of the providers’ treatment recommendations and their ongoing interactions with the patient at home and in the community can influence the patient’s behaviors, treatment adherence, and health.

Impact on Outcomes

There is strong evidence that informal caregivers have a profound effect on long-term care processes and outcomes. Engaging families in patient care has been shown to improve outcomes in dementia (Mittelman et al., 2006; Vickrey et al., 2006) and in schizophrenia care (Glynn et al., 2006) and also to postpone institutionalization (Miller and Weissert, 2000; Yoo et



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