AbstractBackgroundUnderstanding family caregiver factors that influence patient outcomes could open new avenues for improving care. Our previous analysis showed lower risk of downstream patient acute care utilization among people living with dementia (PLWD) versus those without dementia following admission to home palliative care (HomePal). We aimed to examine the association between PLWD caregiver self‐rated health, preparedness, and burden with patient acute care utilization.MethodThe cohort was comprised of 183 PLWD‐caregiver dyads enrolled in a trial testing two models of HomePal. We measured caregiver self‐rated health (good/very good/excellent or fair/poor), preparedness (Preparedness for Caregiving Scale, above or below the CPS median score (23), and burden (Zarit‐12, low (≤12) or high (>12) at admission. We used a proportional hazard competing risk model to assess how the risk of acute care utilization (emergency department visits, observation, and inpatient stays) was associated with baseline caregiver factors. The model was adjusted for selected patient socio‐demographics, comorbidities, hospice enrollment, and caregivers’ age and relationship.ResultThe PLWD cohort had a mean age of 85±8 years, were mostly female (61%) and ethnically diverse (51%, non‐White). Caregivers had a mean age of 63±12 years and were mostly female (85%), adult children (69%). Caregivers residing with PLWD (OR = 3.2, 95%CI: 1.5‐7) and Spanish speakers (OR = 3.1, 95%CI: 0.9‐10.8) were more likely to report poor/fair health. Spousal caregivers scored lower on preparedness than adult children (OR = 2.4, 95%CI: 1.2‐5). Spanish‐speakers reported less burden than English‐speakers (OR = 0.3, 95%CI: 0.1‐1.1). The median follow‐up time was 78 (IQR:171) days. In adjusted models, accounting for the competing risk of death, only caregiver low preparedness (HR = 0.63, 95%CI: 0.39‐1.02, P = .06) but not self‐rated health (HR = 0.78, 95%CI: 0.47‐1.3, P = .34) and burden (HR = 0.99, 95%CI: 0.64‐1.54, P = 0.98) was associated with lower likelihood of acute care utilization. Other PLWD or caregiver factors associated with utilization included patient older age, co‐morbidities, hospice use, and receiving care from a spouse (p<0.1).ConclusionCaregiver factors and characteristics, in addition to patient’s comorbidities, play important roles in the intensity of end‐of‐life care for PLWD. Further qualitative study is warranted to better understand the counterintuitive association between low caregiver preparedness and decreased acute care utilization.