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Kenneth E. Covinsky, MD, MPH; Lee Goldman, MD, MPH; E. Francis Cook, ScD; Robert Oye, MD; Norman Desbiens, MD; Douglas Reding, MD; William Fulkerson, MD; Alfred F. Connors, Jr, MD; Joanne Lynn, MD, MA; Russell S. Phillips, MD; SUPPORT Investigators; Rose Baker, MSHyg; Rosemarie Hakim, PhD; William A. Knaus, MD; Barbara Kreling; Detra K. Robinson, MA; Douglas Wagner, PhD; Jennie D. Dulac, BSN, RN; Joanne Lynn, MD, MA; Joan M. Teno, MD, MS; Beth Virnig, PhD; Marilyn Bergner, PhD; Albert Wu, MD, MPH; Yutaka Yasui, PhD; E. Francis Cook, ScD; Roger Davis, ScD; Lachlan Forrow, MD; Lee Goldman, MD, MPH; Mary Beth Hamel, MD, MPH; Linda Lesky, MD; Lynn Peterson, MD; Russell S. Phillips, MD; Joel Tsevat, MD, MPH; Alfred F. Connors, Jr, MD; Claudia Coulton, PhD; Neal V. Dawson, MD; Mary Kennard, MSN; C. Seth Landefeld, MD; Mary Joan Roach, PhD; Theodore Speroff, PhD; Stuart Youngner, MD; Carlos Alzola, MS; Robert M. Califf, MD; William J. Fulkerson, Jr, MD; Frank E. Harrell, Jr, PhD; Peter Kussin, MD; Lawrence H. Muhlbaier, PhD; Maria Winchell, MS; Steven K. Broste, MS; Norman A. Desbiens, MD; Marilyn Follen, RN, MSN; Michael J. Kryda, MD; Douglas J. Reding, MD; Humberto J. Vidaillet, Jr, MD; Paul E. Bellamy, MD; H. Gill Cryer III, MD; James W. Davis, MD; Jonathan R. Hiatt, MD; HongHu Liu, PhD; Robert K. Oye, MD; Neil S. Wenger, MD; Peter M. Layde, MD, MSc; Hal R. Arkes, PhD; Donald J. Murphy, MD

JAMA. 1994;272(23):1839-1844.

Abstract
Objective.
—To examine the impact of illness on the families of seriously ill adults and to determine the correlates of adverse economic impact.

Design.
—Data were collected during the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment (SUPPORT), a prospective cohort study of outcomes, preferences, and decision making in seriously ill hospitalized adults and their families.

Setting.
—Five tertiary care hospitals in the United States.

Participants.
—The 2661 seriously ill patients in nine diagnostic categories who survived their index hospitalization and were discharged home were eligible for this analysis. Surrogate and/or patient interviews about the impact of illness on the family were obtained for 2129 (80%) of these patients (mean age, 62 years; 43% women; 6-month survival, 75%).

Outcome Measures.
—Surrogates and patients were surveyed to determine the frequency of adverse caregiving and economic burdens. Multivariable analyses were performed to determine correlates of loss of family savings.

Results.
—One third (34%) of patients required considerable caregiving assistance from a family member. In 20% of cases, a family member had to quit work or make another major life change to provide care for the patient. Loss of most or all of the family savings was reported by 31% of families, whereas 29% reported loss of the major source of income. Patient factors independently associated with loss of the family's savings on multivariable analysis included poor functional status (odds ratio [OR], 1.40; 95% confidence interval [CI], 1.10 to 1.78 for patients needing assistance with three or more activities of daily living), lower family income (OR, 1.74; 95% CI, 1.37 to 2.21 for those with annual incomes below $25 000), and young age (OR, 2.85; 95% CI, 2.13 to 3.82 for those younger than 45 years compared with those 65 years or older).

Conclusions.
—Many families of seriously ill patients experience severe caregiving and financial burdens. Families of younger, poorer, and more functionally dependent patients are most likely to report loss of most or all of the family's savings.

(JAMA. 1994;272:1839-1844)

Author Affiliations
ICU Research Unit, Washington University, Washington, DC; Dartmouth Medical School, Hanover, NH; The Johns Hopkins University, Baltimore, MD; Beth Israel Hospital, Boston, Mass; Case Western Reserve University at MetroHealth Medical Center, Cleveland, Ohio; Duke University Medical Center, Durham, NC; Marshfield (Wis) Medical Research Foundation; University of California at Los Angeles; Medical College of Wisconsin, Milwaukee; Ohio University, Athens; Presbyterian-St Luke's Medical Center, Denver, Colo

From the Division of General Medicine and Primary Care (Drs Covinsky and Phillips) and the Division of Clinical Epidemiology (Drs Covinsky, Goldman, Cook, and Phillips), Department of Medicine, Beth Israel Hospital, Boston, Mass; the UCLA School of Medicine, UCLA Medical Center, Los Angeles, Calif (Dr Oye); the Marshfield Medical Research Foundation/Marshfield Clinic, Marshfield, Wis (Drs Desbiens and Reding); the Duke University Medical Center, Durham, NC (Dr Fulkerson); Case Western Reserve University at MetroHealth Medical Center, Cleveland, Ohio (Dr Connors); the Dartmouth-Hitchcock Medical Center, Hanover, NH (Dr Lynn); and the SUPPORT Coordinating Center, George Washington University, Washington, DC. Dr Covinsky is currently affiliated with the Division of General Internal Medicine and Health Care Research, Cleveland Veterans Administration Hospital and University Hospitals of Cleveland, Case Western Reserve University School of Medicine, Cleveland, Ohio. A list of SUPPORT Investigators appears at the end of this article.

Footnotes
Presented, in part, at the annual session of the Society of General Internal Medicine, Washington, DC, April 29, 1993.

The opinions and findings contained herein are those of the authors and do not necessarily represent the views of the Robert Wood Johnson Foundation or their Board of Trustees.

Reprint requests to Division of General Internal Medicine and Primary Care, Beth Israel Hospital, Boston, MA 02215 (Dr Phillips).

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