“There is more that we can do!”- Health professionals’ perspectives on supporting the health and wellbeing of older carers of older people: a qualitative interview study

Technical Summary: Health Professionals' Perspectives on Supporting Older Carers of Older People

Problem Statement
Older carers (defined as individuals aged ≥50 years providing informal care to persons aged ≥65 years) constitute a critical component of the unpaid workforce, enabling many older adults to remain in the community. However, this demographic faces distinct challenges, including higher levels of loneliness, social isolation, and the management of their own age-related health conditions while caring for others. Despite evidence that caregiving exacerbates health issues, current healthcare models in Australia predominantly focus on the care recipient, often neglecting the carer's own health and wellbeing. Previous research indicates that even when older carers access medical services, their role is frequently unrecognized, and support for their specific needs is rare. There is a lack of systematic understanding regarding how health professionals perceive these gaps and what structural barriers prevent them from providing adequate support.

Methodology
This study employed an exploratory qualitative descriptive design as part of a larger mixed-methods project to co-design a new model of care.

• Participants: 21 health professionals from seven disciplines (Social Work, Physiotherapy, Nursing, Occupational Therapy, Dietetics, Geriatric Medicine, and Psychology) were recruited from specialist outpatient clinics and community services in Victoria and Western Australia. The cohort was 95% female, with 81% possessing over 10 years of clinical experience.
• Data Collection: Semi-structured, in-depth interviews were conducted between December 2021 and April 2022. Interviews were conducted face-to-face, via Zoom, or by telephone, lasting between 12 and 76 minutes.
• Analysis: Data were analyzed using inductive thematic analysis (Braun and Clarke) at a semantic level. Transcripts were coded using NVivo and Excel to identify patterns, which were refined into themes through team discussion. The study adhered to the Consolidated Criteria for Reporting Qualitative Research (COREQ).

Key Contributions and Results
The study identified five primary themes regarding the support landscape for older carers:

1. Recognition of Challenges: Health professionals consistently recognized that older carers face significant personal, physical, and emotional burdens. They observed that carers often view caregiving as a personal responsibility, prioritizing the care recipient over their own health. Professionals noted specific challenges for older male carers, who were perceived as less likely to seek help or disclose emotional struggles compared to female carers.
2. Inconsistent Embedding of Support: Assessment and support for carers were found to be largely informal, opportunistic, and dependent on individual clinician initiative rather than structured service processes. While clinicians often recognized carer needs, these were rarely addressed formally because service models are organized around the care recipient.
3. Limited and Fragmented Support: Existing support primarily consisted of providing generic information, education, and referrals to external organizations (e.g., Carers WA, Stroke Foundation). Direct, tailored support for carers' wellbeing was rare, often limited to brief check-ins or short-term counseling before referral.
4. Systemic Constraints: Significant structural barriers were identified, including:
   • Time Pressures: Clinicians lacked the appointment time to conduct formal carer assessments.
   • Funding Models: Funding arrangements (e.g., Activity Based Funding) are centered on the care recipient, preventing services from formally assessing or documenting carer needs unless the carer is referred as a separate patient.
   • Pathway Limitations: Carers often lack dedicated pathways to access healthcare, forcing them to rely on General Practitioners (GPs) who are also time-constrained.
5. Features of an Optimal Model: Participants advocated for a "carer-centred" approach featuring:
   • Dedicated, multidisciplinary services where the carer is the client.
   • Early, systematic assessment and flexible, stepped-care interventions.
   • Access to tailored education, resources, and peer support.
   • Greater workforce training to recognize carers as integral partners in care.

Significance and Claims
The paper claims that while health professionals possess the knowledge and skills to support older carers, their ability to do so is severely constrained by current service models, funding arrangements, and organizational priorities that prioritize the care recipient. The study highlights a substantial unmet need within existing health services and identifies an underutilized opportunity within the aged care workforce.

The authors state that these findings directly informed the development of a new "Carer Health and Wellbeing Service" designed to support older carers of older people, which is currently being implemented and evaluated. The paper concludes that new models of care are required to leverage existing workforce capabilities and embed support for older carers systematically, rather than relying on ad-hoc, clinician-dependent interventions. The study modestly notes that its findings reflect professional perceptions rather than direct carer accounts, and that the recruitment was limited to two specific health services, suggesting findings may not be fully representative of all care contexts.