Strengthening self-care after hospital discharge: how can caregivers support and be supported

This invited commentary refers to ‘Dynamic trends and influencing factors of self-care behaviours among Chinese older adults with chronic heart failure during vulnerable period: a longitudinal study’, by Y. Chen et al., https://doi.org/10.1093/eurjcn/zvaf197. The study by Chen et al. provides valuable insights into how self-care behaviours develop over time among older adults with chronic heart failure in China.1 By examining changes in self-care maintenance, symptom perception, and self-care management during the vulnerable post-discharge period, the authors illustrate not only when patients are most open to improving their self-care, but also when they are most likely to struggle. The identification of a particularly critical point at two weeks after discharge, where the most rapid improvements occur, yet support quickly declines, has important implications for both clinical practice and healthcare organization. While the study concentrates on patient-related factors such as cardiac function, education, heart failure knowledge, and self-care confidence, it is equally important to consider the role of caregivers, if patients consent to their involvement. In an ageing society marked by multi-morbidity and increasing pressure on healthcare services, caregivers, mostly unpaid family members, play a central role in supporting ongoing self-care at home. The study shows that self-care maintenance reaches its highest level 2 weeks after discharge, followed by a gradual decline, whereas symptom perception and self-care management continue to rise over the subsequent months. This pattern highlights the complexity of self-care after hospitalization. Patients often leave the hospital motivated and equipped with new information, but once they return home, they may find it increasingly difficult to maintain these behaviours. Cognitive impairment,2 physical limitations, and fluctuating symptoms can all contribute to this challenge.3 Recurrent or worsening symptoms may also create uncertainty about how to interpret or respond to changes in health status. For many older adults, sustaining self-care behaviours requires ongoing support, the support that, in the home environment, often comes from caregivers. Caregivers frequently assist with daily routines, medication management, symptom monitoring, fluid restriction, and medical appointments, as well as offering emotional support.4,5 These responsibilities correspond closely to the three self-care domains described in the study. For self-care maintenance, caregivers can reinforce key information provided at discharge, for example, reminding patients about medications, maintaining routines, and helping structure everyday activities. They also serve as a link between the home and healthcare providers. With regard to symptom perception, caregivers often notice subtle changes before the patient does, particularly when the patient has cognitive decline or fatigue. Their observations can help detect early deterioration and guide appropriate responses. In terms of self-care management, caregivers can encourage timely action, help the patient follow treatment recommendations, and support persistence with self-care strategies. However, for caregivers to be effective, they need appropriate knowledge, skills, and confidence.6 Many are themselves older adults and may feel uncertain about managing complex care tasks. This underscores a key issue: although caregivers are essential for sustaining patient self-care, they are seldom provided with the support they require. The authors1 propose several patient-focused strategies, including telemonitoring, video-based educational libraries, wearable devices, individualized coaching, and AI-supported guidance. These interventions can strengthen patients’ self-care abilities, but similar support is also relevant for caregivers. Caregivers may benefit from resources that help them recognize early symptoms of deterioration, manage medications, and assist with daily self-care tasks. Providing individualized support for self-care management to both patients and caregivers is therefore essential, ensuring that each receives tailored guidance aligned with their needs and responsibilities.7 In addition, the physical and emotional strain of caregiving calls for psychoeducational support aimed at reducing burden and strengthening coping strategies. While some caregivers may access the same programmes as patients, others may require caregiver-specific guidance to develop confidence in their role. Interventions aiming to improve self-care during the 2-week window should therefore include caregivers as active participants. Digital tools and tailored education can be adapted to support both patients and caregivers, offering a more co-ordinated approach to self-care at home. However, enhancing education alone is insufficient, consistent with the well-established complexity of self-care processes.8 In this context, optimizing dyadic dynamics is equally critical, as evidence shows that interventions targeting both partners’ perceptions, motivation, and roles are more effective in supporting self-care. Strengthening professional-caregiver collaboration during this vulnerable transitional phase further reinforces these dyadic models, fostering a more sustainable and confident, and resilient approach to self-care in the home environment.9–11 This study demonstrates clear patterns in how self-care behaviours develop after discharge among older adults with chronic heart failure and identifies a crucial opportunity for targeted intervention at two weeks post-discharge.1 To fully utilize this window, caregivers need to be integrated into post-discharge planning and follow-up. Because caregivers already play a significant role in daily self-care, it is essential to involve them early, preferably before discharge, to ensure they understand their role and receive adequate support. However, integrating caregivers is not only about providing information; it also requires strengthening the dyadic dynamics between patients and caregivers. Supporting caregivers is as important as supporting patients, and recognizing their needs, both practical and emotional, is vital for promoting resilient, effective, and lasting self-care behaviours over time. Magda Eriksson-Liebon (Conceptualization [equal], Writing—original draft [lead], Writing—review & editing [equal]) and Tiny Jaarsma (Conceptualization [equal], Supervision [lead], Writing—original draft [supporting], Writing—review & editing [equal]) No funding was received. This commentary does not contain new data.