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Caregiver stress has only a minimal impact on the institutionalization of elderly people who need care

Donnelly NA, Hickey A, Burns A, et al.  Systematic review and meta-analysis of the impact of carer stress on subsequent institutionalisation of community-dwelling older people  PLOS ONE. 2015 Jun;10(6):e0128213.

Review question

Do higher levels of caregiver stress lead to the institutionalization of community-dwelling elderly people who are receiving care?


Informal or family caregivers are at risk of stress and psychological health problems, which could negatively affect their ability to continue providing care for the elderly living in the community, and jeopardize the sustainability of home care.

There is a commonly held view that caregiver stress increases the chance the people they are caring for will be institutionalized. However, this has only been shown to be the case in a small number of individual studies.

Therefore, it is important to conduct a thorough systematic review including a wide variety of articles that examine the effects of “carer stress” and related predictors of community -living elderly people being institutionalized.

How the review was done

A detailed search of a number of electronic databases for studies published up until January 2014 was conducted. Studies that focused on people 65 years of age or older with a chronic condition who were receiving care at home, and that reported measures of psychological stress in their informal caregivers were included in the review.

A total of 4,701 studies were identified in searches, and 54 were included in the review after assessments for eligibility.

This review was funded by the Health Research Board in Ireland.

What the researchers found

The review found that caregiver burden, stress and anxiety had a small effect on the likelihood of the elderly people receiving care being institutionalized.

Lower-quality studies included in the review, which did not account for factors such as sex, age, and type and severity of disease, tended to overestimate the impact of carer stress compared to higher-quality studies.

Other factors that may be more critical in determining whether someone is institutionalized were identified,  including cognitive or functional impairment and a prior history of nursing home use.


This review found that carer stress has a small to negligible effect on the likelihood of elderly people receiving home care being institutionalized, and suggests there are other factors that may be more important in predicting institutionalization. Additional evidence from robust studies is required to confirm the relationship between caregiver stress and subsequent institutionalization of those for whom care is provided.


Systematic review
A comprehensive evaluation of the available research evidence on a particular topic.

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