To our knowledge, none studies have been conducted on caregivers of a non-dependent old age population without serious chronic disease living at home. Most of studies focused on caregivers of dependent populations.
Our results show that the population of caregivers of non-dependent old persons has a similar profile to those of caregivers of dependent old persons (26,27) or with disabling illness (28–31). They have the same socio-demographic profile as caregivers of dependent persons, and also a similar level of burden following the help they provide to the old person, which also has a negative impact on their health (27,30–32). These results show that the caregiver's burden appears well in advance of the caregiver's dependence. Moreover, the number of hours and tasks carried out are as numerous as those carried out by the caregivers of dependent persons (27).
PPS had been implemented for 83% of seniors. The vast majority of the dyads were satisfied and considered that it covered their needs. To the extent that almost all subjects benefited from the PPS, the impact measurement was limited in the absence of a significant control group (569 with the PSS versus 117 without the PSS).
The results show that, at the follow-up, the burden level had improved for 73% of caregivers, whether or not they had the PSS.
According to literature review, the burden includes several component : a psychological component related to the difficulties experienced and an emotional component related to the relationship with the old person and finally a physical component related to the type and number of tasks performed (33). The fact that the burden is improving for all caregivers suggests that the consultation of social workers with the caregivers to identify the needs of the old person for the implementation of the PPS had a positive impact on two of the three components of burden the psychological and emotional components. Indeed, the consultation could be felt for caregivers as a space to talk, a time to listen, which allowed them to express their difficulties and which broke their feeling of loneliness. This consultation probably reassured them, and they were able to project themselves towards the possibility of obtaining future support if it became necessary (34).
The perceived health and frailty level of informal caregivers improved only for one in five caregivers, unrelated to obtaining the PSS (35).
The fact that the burden, perceived health and frailty have improved independently of the implementation of the PSS, shows that the impact of the approach is very positive overall, as shown in the bibliography (36).
Obtaining the PSS has, as expected, reduced the amount of time the caregiver spends performing the tasks. The results show that obtaining specific help reduces not only the time spent on the targeted task but also the time spent on other tasks. This is particularly true for caregivers who were ironing or cleaning before obtaining the PSS and many (30% and 20% respectively) reported reducing the time spent on this task, even if the assistance provided by the PSS is not specific to the task. It is likely that the professionals involved do more than the targeted service and that the old person have been able to refocus on fewer tasks but more effectively, which indirectly relieve the caregiver. This could also explain the improvement in the difficulties experienced by the caregiver, which was correlated with the implementation of the PSS and affected 56% of caregivers with the PSS compared to 39% of those without it (p < 0.05).
However, the number of hours to the old person has not decreased since obtaining the PPS, excepted for 38 patients. However, the number of hours and weekly visits to the senior has not decreased since obtaining the PPS. Several explanations are possible. First data were collected only for caregivers who did not live with the old person, this may have biased the potential positive impact of the PPS. We found that spouses were the caregivers who did the most work. This data was not collected during follow-up, it is possible that the effect of the PPS may not be highlighted. Secondly, it is possible that the needs may have increased during the 6 months or that they were not fully covered by CARSAT, and therefore that the impact on the amount of time may be moderate It. Finally, maintaining the number of hours devoted to assistance may not have the same qualitative significance. Thanks to the PPS, the caregiver spends less time performing domestic tasks but spends more time in the relationship with the old person.
The financial contribution requested from the old person could be linked to a first selection bias. Our population is precarious: the rate of caregivers close to the poverty line is much higher than that of the general population of the PACA region: 17% in PACA against 49.9% for our study (37). However, some caregivers may have underestimated their incomes because they feared that CARSAT would refuse the social support requested or that the contribution requested would be too high. There is a second potential selection bias. We included old persons who asked for help with daily living tasks. Thus, the status of the old persons included in our study is in an intermediate level of autonomy. Our results showed that only 5% of the old persons were assessed as at low risk of frailty according to the FRAGIRE grid.
There is a third limitation regarding the measurement bias on the health status of caregivers, we did not collect objective health elements, such as walking speed. As a result, comparisons of pre- and post-PPP health status were based solely on perceived health.
The originality of this study is its target: caregivers of old persons without serious chronic diseases, autonomous and living at home. Few studies targeted theses kind of caregivers, although in terms of frequency, they are certainly the most numerous and constitute a real public health challenge, especially in future.
Moreover, while most of the studies focus on psychological or medical support activities, our study concerns the impact of exclusively social assistance. Our study is based on a large sample size and a small proportion of people lost to follow-up. In addition, the measurement tools used are all validated tools, allowing us to compare our results with those in the literature review. All these points constitute a good level of internal validity.
These results seem to underline the importance of supporting natural caregivers, and the benefit of a dedicated consultation
There are many organizations founded and managed by informal caregivers, whose purpose is to provide information and support to peers (6). Unfortunately, they are not always easily accessible. They require that the caregiver be aware of his or her role as a caregiver, and that he or she has sufficient distance to be focused not only on the needs of the person he or she supports, but also on his or her own needs and/or difficulties. In addition, these organizations are often highly focused on a particular pathology, which may exclude caregivers of elderly people with no particular pathology.
The first action would therefore be to systematically identify during routine medical consultations whether the patient is a natural caregiver in order to advise and refer them to dedicated organizations and associations.
Action should be taken before physical and/or psychological disorders appear. We could consider setting up a specific consultation for them, as is done in the context of dependent old persons. Most of these types of consultations are medicalized or for psychological care. We believe that these consultations could first identify the needs of caregivers and make a situational diagnosis that would make it possible to offer personalized support.