Background and Objectives The coronavirus disease 2019 (COVID-19) pandemic has negatively impacted persons with existing chronic health conditions. The pandemic also has the potential to exacerbate stresses of family caregiving. We compare family caregivers with non-caregivers on physical, psychosocial, and financial well-being outcomes during the pandemic and determine family caregivers most at risk for adverse outcomes. Research Design and Methods We conducted a cross-sectional online survey of 576 family caregivers and 2,933 non-caregivers from April-May 2020 in Pittsburgh, PA region with a national supplement. Outcome measures included concurrent anxiety, depression, fatigue, sleep disturbance, social participation; and financial well-being); and perceived changes due to COVID-19 (loneliness, financial well-being, food security). We also measured socio-demographic; caregiving contextual variables; and COVID-related caregiver stressors (COVID Caregiver Risk Index). Results Controlling for socio-demographics, family caregivers reported higher anxiety; depression; fatigue; sleep disturbance; lower social participation; lower financial well-being; increased food insecurity (all p < .01) and increased financial worries (p=.01). Caregivers who reported more COVID-related caregiver stressors and disruptions reported more adverse outcomes (all p < .01). In addition, caregivers who were female, younger, lower income, providing both personal / medical care, and providing care for cognitive / behavioral / emotional problems reported more adverse outcomes. Discussion and Implications Challenges of caregiving are exacerbated by the COVID-19 pandemic. Family caregivers reported increased duties, burdens, and resulting adverse health, psychosocial, and financial outcomes. Results were generally consistent with caregiver stress-health process models. Family caregivers should receive increased support during this serious public health crisis.

S ince the first case of the novel coronavirus SARS-CoV-2 causing the COVID-19 illness was diagnosed in the United States on January 20, 2020, 1 a steady stream of new policy measures have been enacted to protect the public from this growing pandemic. At the forefront of these efforts have been measures to limit interpersonal contact to prevent transmission of the virus. Social distancing, school closures, and the shuttering of nonessential businesses have already led to significant personal, social, and economic hardship. While it has been well publicized that older adults are at highest risk of serious illness and death from COVID-19, 2 they may also be at high risk for negative consequences from the measures being enacted to protect them from the viral threat. Healthcare providers should be aware that their older patients are now particularly vulnerable to social isolation, financial hardship, difficulties accessing needed care and supplies, and anxiety about

Background Patient self-care support via Interactive Voice Response (IVR) can improve disease management. However little is known about the factors affecting program engagement. Methods We compiled data on IVR program engagement for 1,173 patients with: heart failure, depression, diabetes, and cancer who were followed for 28,962 person-weeks. Patients in programs for diabetes or depression (N=727) had the option of participating along with an informal caregiver who received electronic feedback based on the patient’s IVR assessments. Analyses focused on factors associated with completing weekly IVR calls. Results Patients were on average 61 years old, 37% had at most a high school education, and 48% reported incomes < $30,000. Among patients given the option of participating with an informal caregiver, 65% chose to do so. Patients completed 83% of attempted IVR assessments, with rates higher for heart failure (90%) and cancer programs (90%) than for the diabetes (81%) or depression programs (71%) (p<0.001). Among patients in diabetes or depression programs, those opting to have feedback provided to an informal caregiver were more likely to complete assessments (adjusted odds ratio: 1.36; 95% CI: 1.06, 1.75). Older patients had higher call completion rates, even among patients > 75 years of age. Missed clinic appointments, prior hospitalizations, depression program participation, and poorer mental health were associated with lower completion rates. Conclusions Patients with a variety of chronic conditions will complete IVR self-care support calls regularly. Risk factors for missed IVR calls overlap with those for missed appointments. Involvement of informal caregivers may significantly increase engagement.