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Having caregiving responsibilities affects management of fragility fractures and bone health

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Abstract

Summary

In this secondary analysis of six qualitative studies, we found that approximately one-quarter of individuals with fragility fracture were serving as informal caregivers. The caregiving role appeared to be a cause of the fracture for some and was prioritized over bone health, acting as a barrier to bone health management.

Introduction

Among fragility fracture patients serving as informal caregivers, our objective was to examine how caregiving responsibilities were associated with, and possibly impacted by, the fracture experience and the resulting management of bone health.

Methods

We conducted a secondary analysis (amplified analysis) of six qualitative studies to understand caregiver responsibilities and the relationship between these responsibilities and patients’ management of the fracture and bone health. The primary studies and the secondary analysis were conducted from a phenomenological approach. Eligible individuals in the primary studies were English-speaking men and women who were 45+ years old recruited from three settings (local, provincial, and national).

Results

Without being prompted to talk about their experience of caregiving, 33 of 145 (23%) individuals reported they were providing care to a family member or friend at the time of their fracture or during recovery post-fracture. The experience of having caregiving responsibilities was related to the fracture and bone health in two ways: (1) the caregiving role appeared to be a cause of the fracture in some participants and (2) caregiving was prioritized over participants’ own bone health and was a barrier to bone health management.

Conclusion

Fragility fracture is associated with, and potentially leads to an impairment of, an important social role in patients providing physical and emotional support and supervision for dependents as caregivers. Further, an important cause of fragility fracture can occur in the act of caregiving.

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References

  1. Macleod M, Chesson RA, Blackledge P et al (2005) To what extent are carers involved in the care and rehabilitation of patients with hip fracture? Disabil Rehabil 27:1117–1122

    Article  Google Scholar 

  2. Nahm E-S, Resnick B, Orwig D, Magaziner J, Degrezia M (2010) Exploration of informal caregiving following hip fracture. Geriatr Nurs 31:254–262

    Article  Google Scholar 

  3. Williams MA, Oberst MT, Bjorklund BC, Hughes SH (1996) Family caregiving in cases of hip fracture. Rehabil Nurs J 21:124–131 138

    Article  CAS  Google Scholar 

  4. Lin P-C, Hung SH, Liao M-H et al (2006) Care needs and level of care difficulty related to hip fractures in geriatric populations during the post-discharge transition period. J Nurs Res 14:251–259

    Article  Google Scholar 

  5. Hollander MJ, Liu G, Chappell NL (2009) Who cares and how much? The imputed economic contribution to the Canadian healthcare system of middle-aged and older unpaid caregivers providing care to teh elderly. Healthc Q 12:42–49

    Article  Google Scholar 

  6. Mental Health Commission of Canada (2015) Informing the future: mental health indicators for Canada. Calgary, Canada, MHCC. Ref Type: Report

  7. Sinha M (2013) Portrait of caregivers, 2012: spotlight on Canadians: results from the General Social Survey. Catalogue no. 89-652-X - no. 001, 1-21. Ref Type: Report

  8. National Alliance for Caregiving, AARP Public Policy Institute (2015) Caregiving in the U.S. 2015. 1–87. Greenwald & associates. Ref Type: Report

  9. Johnell O, Kanis JA (2006) An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int 17:1726–1733

    Article  CAS  Google Scholar 

  10. Leslie WD, Metge CJ, Azimaee M, Lix LM, Finlayson GS, Morin SN, Caetano P (2011) Direct costs of fractures in Canada and trends 1996-2006: a population-based cost-of-illness analysis. J Bone Miner Res 26:2419–2429

    Article  Google Scholar 

  11. Local Health Integration Networks (2008) Aging at home strategy. Ref Type: Report

  12. MacCourt P, Krawczyk M (2012) Supporting the caregivers of seniors through policy: the caregiver policy lens. 1-46. Vancouver, B.C., British Columbia Psychogeriatric Association. Ref Type: Report

  13. Schwandt TA (2001) Dictionary of qualitative inquiry. Sage Publications, Inc., Thousand Oaks

    Google Scholar 

  14. Sokolowski R (2000) Introduction to phenomenology. Cambridge University Press, Cambridge

    Google Scholar 

  15. Giorgi A (1997) The theory, practice, and evaluation of the phenomenological method as a qualitative research procedure. J Phenomenol Psychol 28:235–260

    Article  Google Scholar 

  16. Giorgi A (2008) Concerning a serious misunderstanding of the essence of the phenomenological method in psychology. J Phenomenol Psychol 39:33–58

    Article  Google Scholar 

  17. Wertz FJ (2005) Phenomenological research methods for counseling psychology. J Couns Psychol 52:167–177

    Article  Google Scholar 

  18. Heaton J (2008) Secondary analysis of qualitative data. Hist Soc Res 33:33–45

    Google Scholar 

  19. Hinds PS, Vogel RJ, Clarke-Steffen L (1997) The possibilities and pitfalls of doing a secondary analysis of a qualitative data set. Qual Health Res 7:408–424

    Article  Google Scholar 

  20. Jasper MA (1994) Issues in phenomenology for researchers of nursing. J Adv Nurs 19:309–314

    Article  CAS  Google Scholar 

  21. Bogoch ER, Elliot-Gibson V, Beaton DE et al (2006) Effective initiation of osteoporosis diagnosis and treatment for patients with a fragility fracture in an orthopaedic environment. J Bone Joint Surg (Am Vol) 88(1):25–34

    Google Scholar 

  22. Jaglal SB, Hawker G, Cameron C, Canavan J, Beaton D, Bogoch E, Jain R, Papaioannou A, Osteoporosis Research, Monitoring and Evaluation Working Group (2010) The Ontario Osteoporosis Strategy: implementation of a population-based osteoporosis action plan in Canada. Osteoporos Int 21:903–908

    Article  CAS  Google Scholar 

  23. Kvale S, Brinkmann S (2009) Interviews: learning the craft of qualitative research interviewing. Sage Publications Ltd., Thousand Oaks

    Google Scholar 

  24. Novick G (2008) Is there a bias against telephone interviews in qualitative research? Res Nurs Health 31:391–398

    Article  Google Scholar 

  25. Sturges JE, Hanrahan KJ (2004) Comparing telephone and face-to-face qualitative interviewing: a research note. Qual Res 4:107–118

    Article  Google Scholar 

  26. NVivo 11 (2016) Victoria, Australia, Qualitative Solutions and Research Pty Ltd. Ref Type: Computer Program

  27. Malterud K (2001) Qualitative research: standards, challenges, and guidelines. Lancet 358:483–488

    Article  CAS  Google Scholar 

  28. Kvale S (1996) Interviews: an introduction to qualitative research interviewing. Sage Publications, Thousand Oaks

    Google Scholar 

  29. Carter SM, Little M (2007) Justifying knowledge, justifying method, taking action: epistemologies, methodologies, and methods in qualitative research. Qual Health Res 17:1316–1328

    Article  Google Scholar 

  30. Gearing RE (2004) Bracketing in research: a typology. Qual Health Res 14:1429–1452

    Article  Google Scholar 

  31. Paoletti I (2002) Caring for older people: a gendered practice. Discourse Soc 13:805–817

    Article  Google Scholar 

  32. Dixon-Woods M, Shaw RL, Agarwal S, Smith JA (2004) The problem of appraising qualitative research. Qual Saf Health Care 13:223–225

    Article  CAS  Google Scholar 

  33. Creswell JW (1998) Qualitative inquiry and research design: choosing among five traditions. Sage Publications, Thousand Oaks

    Google Scholar 

  34. Provencher C, Milan A, Hallman S (2018) D’Aoust C. Report on the demographic situation in Canada. Fertility: overview, 2012 to 2016. Catalogue no. 91-209-X ISSN 1718-7788. Statistics Canada. Ref Type: Report

  35. Martin JA, Hamilton BE, Osterman MJK, et al (2017) National vital statistic reports - births: final data for 2015. Volume 66, Number 1. Ref Type: Report

  36. Mittelman MS, Ferris SH, Shulman E et al (1995) A comprehensive support program: effect on depression in spouse-caregivers of AD patients. Gerontologist 35:792–802

    Article  CAS  Google Scholar 

  37. Conti A, Garrino L, Montanari P, Dimonte V (2016) Informal caregivers’ needs on discharge from the spinal cord unit: analysis of perceptions and lived experiences. Disabil Rehabil 38:159–167

    Article  Google Scholar 

  38. Bremault-Phillips S, Parmar J, Johnson M et al (2016) The voices of family caregivers of seniors with chronic conditions: a window into their experience using a qualitative design. SpringerPlus 5:620

    Article  Google Scholar 

  39. Berglund E, Lytsy P, Westerling R (2019) Living environment, social support, and informal caregiving are associated with healthcare seeking behaviour and adherence to medication treatment: a cross-sectional population study. Health Soc Care Community 27:1260–1270

    PubMed  PubMed Central  Google Scholar 

  40. Epstein RM, Street RL (2011) The values and value of patient-centred care. Ann Fam Med 9:100–103

    Article  Google Scholar 

  41. Candy B, Jones L, Drake R et al (2011) Interventions for supporting informal caregivers of patients in the terminal phase of a disease. Cochrane Database Syst Rev 6

  42. Lincoln YS, Guba EG (1985) Naturalistic inquiry. Sage Publications, Newbury Park

    Book  Google Scholar 

  43. Brazil K, Thabane L, Foster G, Bedard M (2009) Gender differences among Canadian spousal caregivers at the end of life. Health Soc Care Commun 17:159–166

    Article  Google Scholar 

  44. Navaie-Waliser M, Spriggs A, Feldman PH (2002) Informal caregiving: differential experiences by gender. Med Care 40:1249–1259

    Article  Google Scholar 

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Funding

Funding for the primary studies was provided by the Dean’s Fund, Faculty of Medicine, University of Toronto and the following grants from the Canadian Institutes of Health Research: CGA-86802; IMH-102813; CBO-109629; MOP-119522; and MOP-136934. Joanna Sale held a Canadian Institutes of Health Research New Investigator Salary Award at the time the research was conducted (Funding Reference Number COB-136622). Joanna Sale was in part funded by the Ontario Ministry of Health and Long-Term Care, Osteoporosis Strategy. Views expressed are those of the researchers and not the Ministry.

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Authors and Affiliations

  1. Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, 30 Bond Street, Toronto, Ontario, M5B 1W8, Canada

    J.E.M. Sale, L. Frankel, J. Paiva, J. Saini, S. Hui, J. McKinlay, S. Sharma & L. Cheng

  2. Institute of Health Policy, Management & Evaluation, University of Toronto, 4th Floor – 155 College Street, Toronto, Ontario, M5T 3M6, Canada

    J.E.M. Sale

  3. Department of Surgery, St. Michael’s Hospital, Unity Health Toronto, University of Toronto, 30 Bond Street, Toronto, Ontario, M5B 1W8, Canada

    E. Bogoch

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  1. J.E.M. Sale
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  2. L. Frankel
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  3. J. Paiva
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  4. J. Saini
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  7. S. Sharma
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  8. L. Cheng
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  9. E. Bogoch
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Correspondence to J.E.M. Sale.

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Sale, J., Frankel, L., Paiva, J. et al. Having caregiving responsibilities affects management of fragility fractures and bone health. Osteoporos Int 31, 1565–1572 (2020). https://doi.org/10.1007/s00198-020-05385-1

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  • DOI: https://doi.org/10.1007/s00198-020-05385-1

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