Systematic Review and Meta-Analysis of the Impact of Carer Stress on Subsequent Institutionalisation of Community-Dwelling Older People

Oct 3, 2026

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Systematically reviewed and meta-analysed the prospective relationship between multiple forms of carer stress and subsequent institutionalisation among community-dwelling older people. Background claims that higher carer stress determines premature ending of homecare were tested because prior evidence had not been assessed systematically. Prospective studies measuring baseline carer stress and follow-up institutionalisation were synthesized, using standardised mean differences and assessing quality with the Crowe Critical Appraisal Tool. Results indicated a small-to-negligible overall effect.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages19

Reading Time48 min

AccessFree to download

Abstract

Background

Methods

Results

Conclusion

Introduction

OPEN ACCESS Citation: Donnelly N-A, Hickey A, Burns A, Murphy P, Doyle F (2015) Systematic Review and MetaAnalysis of the Impact of Carer Stress on Subsequent Institutionalisation of Community-Dwelling Older People. PLoS ONE 10(6): e0128213 . doi:10 . 1371/ journal.pone.0128213 Academic Editor: Yiru Guo, University of Louisville, UNITED STATES Received: February 26, 2015 Accepted: April 24, 2015 Published: June 2, 2015 Copyright: © 2015 Donnelly et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: All relevant data are within the paper and its Supporting Information Files. Funding: This work was funded by the Health Research Board (HRB) in Ireland under Grant No. PHD/2007/16. The funder had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript. Competing Interests: The authors have declared that no competing interests exist. RESEARCH ARTICLE Systematic Review and Meta-Analysis of the Impact of Carer Stress on Subsequent Institutionalisation of Community-Dwelling Older People Nora-Ann Donnelly1 *, Anne Hickey1, Annette Burns1, Paul Murphy2, Frank Doyle1 1 Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland, 2 Mercer Library, Royal College of Surgeons in Ireland, Dublin, Ireland * [noraadonnelly@rcsi.ie](noraadonnelly@rcsi.ie) Abstract Background In the caregiving literature there is a common assertion that a higher level of carer stress is a critical determinant of premature ending of homecare. However, this contention has not been systematically assessed. We therefore systematically reviewed and meta-analysed the prospective association between various forms of carer stress and subsequent institutionalisation of community-dwelling older people. Methods Systematic literature search of prospective studies measuring carer stress at baseline and institutionalisation at follow-up. Given substantial interchangeability in the measurement of carer stress, we included a wide number of exposure measures, namely: carer stress, burden, depression, distress, anxiety, burnout, and strain. Institutionalisation included both acute and long-term care utilisation. The standardised mean difference between stressed and non-stressed carers was the primary measure of effect. We assessed study quality with the Crowe Critical Appraisal Tool (CCAT) . Pre-planned sensitivity analysis included examination of estimates according to study size; decade published; study quality according to quartiles of CCAT scores; population; follow-up period; study design and impact of adjusted or unadjusted estimates. Results The search yielded 6,963 articles. After exclusions, we analysed data from 54 datasets. The meta-analysis found that while carer stress has a significant effect on subsequent institutionalisation of care recipients, the overall effect size was negligible (SMD=0􀀁05, 95% CI=0􀀁04–0􀀁07) . Sensitivity analyses found that, the effect size was higher for measurements of stress than for other measures, though still relatively small (SMD=0􀀁23, 95% CI=0􀀁09– 0􀀁38) . Thus, whether analysing the association between carer stress, burden, distress, or depression with either acute or long-term care, the effect size remains small to negligible. Concurrently, we found estimates reduce over time and were smaller with larger studies and those of higher quality, according to the CCAT scores. Conclusion Despite strong statements to the contrary, it appears that the effect of carer stress on subsequent care recipient institutionalisation is small to negligible. The current findings point to a biased literature, with significant small study effects. The results suggest a need to reevaluate the degree to which carer stress predict

FAQs

What question does the systematic review and meta-analysis address?

It tests the prospective association between various forms of carer stress and subsequent institutionalisation of community-dwelling older people.

How did the study measure carer stress and institutionalisation?

It used prospective studies assessing carer stress at baseline and institutionalisation at follow-up, including multiple exposure measures such as burden, depression, anxiety, distress, burnout, and strain.

What were the main findings about the effect size?

Carer stress showed a significant but negligible overall effect on subsequent institutionalisation, with sensitivity analyses indicating slightly higher effects for stress measurements than other measures, still relatively small.

Oct 3, 2026

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