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Patient depression and caregiver attitudes: Results from The AgeD in HOme Care study
Abstract
The present cross-sectional study was aimed to evaluate the association between care recipient depression and caregiver attitudes.
Data were from The AgeD in HOme Care project, a study enrolling subjects aged >or=65 years receiving home care in Europe. Depression was diagnosed as a score >or=3 on the MDS Depression Rating Scale. Caregiver attitudes were assessed using two measures: 1) caregiver dissatisfaction (the caregiver was dissatisfied with the support received from family and friends); and 2) caregiver distress (the caregiver expressed feelings of distress, anger, or depression).
Mean age of 3415 participants was 82.4 years, 2503 (73.3%) were women and 430 (12.6%) were depressed. Dissatisfaction was significantly more common among caregivers of depressed, compared with those of non depressed patients (32/430, 7.4% vs. 78/2985, 2.6%; p=<0.001). After adjusting for potential confounders, patient depression was still significantly associated with caregiver dissatisfaction (OR: 1.84; 95% CI: 1.12-3.03). Similarly, distress was significantly more common among caregivers of depressed patients, compared with those of non depressed patients (81/430, 18.8% vs. 175/2985, 5.9%; p<0.001). After adjusting for potential confounders, patient depression was still significantly associated with caregiver distress (OR: 2.41; 95% CI: 1.72-3.39).
The cross-sectional design of the study cannot provide the cause-effect relationship between depression and caregiver attitude; no data were collected on caregiver characteristics.
Among older adults depression is associated with increased caregiver dissatisfaction and distress. Knowledge of factors influencing caregiver attitudes may be valuable to study interventions aimed to promote patient and caregiver well being.
... In keeping with its detection capability, the authors propose that DRS scores of one and two also be flagged by assessors as warranting further attention since these individuals have been found to be significantly more likely to be diagnosed with depression at follow-up than the reference group (Martin et al., 2008). To date, depression-detection studies have been conducted successfully using the DRS as the scale of choice for at-risk older adult populations (Achterberg, Pot, Kerkstra & Ribbe, 2006;Dalby et al., 2008;Gruneir, Smith, Hirdes & Cameron, 2005;Onder et al., 2007;Soldato et al., 2008). Research has not yet been conducted on the application of the DRS to dominantly younger adult population. ...
... A score of three or greater was found to maximize sensitivity with minimal loss of specificity. The use of this cut-point was explored across numerous followup studies, some of which supported the use of the recommended threshold (Achterberg, Pot, Kerkstra & Ribbe, 2006;Gruneir, Smith, Hirdes & Cameron, 2005;Soldato, Liperoti, Landi, Carpenter, Bernabei & Onder, 2008), and others of which called it into question (Anderson, Buckwalter, Buchanan, Maas & Imhof, 2003;Snowden, 2004). The fluctuating debate inspired this study's exploration of the DRS threshold and its ability to detect a possible depressed mood state across a range of populations. ...
... n = 1520 A total of 46% of clients reported daily pain at the baseline assessment Participants with daily pain had a significantly higher risk of developing disability, compared with other participants (HR, 1.36; 95% CI, 1.05-1.78). The risk of disability increased with pain severity and with number of painful sites Soldato et al. (2008): The characteristics of informal caregivers of clients with baseline depression were studied. n = 3415 ...
... OR = 1.84, 95% CI 1.12-3.03) [24]. Non-malignant daily pain was associated with an increased risk of disability and need of help [25]. ...
During the 1990s, use of home care sector has increased substantially in Europe. However, research on home care continues to be underreported. This article summarizes the findings from the "Aged in Home Care" (ADHOC) study - carried out from 2001 to 2004 in Europe - and women's situation in European Home Care.
The review is based on 4 book chapters as well as on 23 articles listed in PubMed and published from August 2004 to October 2008. ADHOC used a standardized data set collected with the Resident Assessment Instrument for Home Care (RAI-HC 2.0); this instrument was used to assess 4010 home care clients at 11 European sites. The included articles analyzed the sociodemographic and clinical characteristics, basic physical needs, provision of selected preventive measures, and medication data from the ADHOC sample. In addition home service provision, quality indicators, and selected outcomes of home care intervention during the course of 1 year were assessed.
The mean subject age was 82.3 years; women were on average 2 years older than men and more frequently lived alone, 74% were women. Women suffered more frequently from pain, depression, and extreme obesity. There were marked regional differences in both the functional status of the clients and the characteristics and use of home care services.
The implementation of a common assessment instrument for HC clients may help contribute the necessary wealth of data for (re)shaping home care in Europe. Policy makers and service providers may learn about best practices in the European context.
... 본 연구는 재가 장기요양 노인 가족의 돌봄 스트레스 생성과정을 개념화한 Pearlin 등[15]의 스트레스 과정 모델을 연구의 개념틀로 채택하였다(Figure 1)Daily Living [ADL]), 통증을 포함하였다[3,[16][17][18]. .94였다[14]. ...
Purpose:
The purpose of this study was to examine the association between utilization of home care services under the national long-term care insurance system and family caregiver distress.
Methods:
A secondary data analysis was conducted in this study using data collected in 2011 and 2012 from the Korean version of International Resident Assessment Instrument (interRAI) Home Care assessment system. The study sample included 228 clients receiving community based home care and their family caregivers in Korea. Descriptive statistics, χ² test, t-test, and Heckman selection model analysis were conducted using SAS 9.3.
Results:
Presence of family caregiver distress was significantly associated with days of nurse visits (β=-.89, p=<.001) and home helper visits (β=-.53, p=.014). Level of caregiver distress was also significantly associated with days of nurse visits (β=-.66, p=.028). Other factors which were significantly associated with caregiver distress were depression, cognitive function, inadequate pain control, social support for older adult, and caregiver relationship to the older adult.
Conclusion:
The results of this study show that visiting nurse service and appropriate support programs for Older Adults and family caregivers experiencing caregiver distress should be developed and provided to families based on the health care needs of older adults and their family caregivers for effective and sustainable home care.
... Additionally, symptoms of care recipient depression were associated with caregiver poor relationships with family and friends. In another study caregiver dissatisfaction with family support was reported by those caring for long term care home care recipients with depression (Soldato et al., 2008). Further studies including more sophisticated analysis are needed to better understand the relationship among caregiving dyads especially considering that care recipient treatment of depression may reduce caregiver burden (Martire et al., 2010). ...
The Caregiver Recharge (CR) is an initiative from Mississauga Halton Local Health Integration Network (LHIN) that aims to reduce hospitalizations and allow the care recipient to live longer in their home. The CR is providing flexible hours of care for care recipients based on their health issues and caregivers stress levels. The care recipient health complexity is determined by the Method of Assigning Priority Levels (MAPLe) whereas the caregiver stress is assessed by the Caregiver Strain Index (CSI). Care recipients with MAPLe scores of 4 and 5 associated with caregivers with CSI from 9 to 13 are eligible to participate in the CR. Caregivers are invited to complete the interRAI Caregiver Survey at program entry, 6 and 12 months later for program evaluation. InterRAI caregiver survey is connected with interRAI data of care recipients. Preliminary results of interRAI data related to the care recipient and interRAI Caregiver Surveys completed by caregivers show that the eligibility criteria has been appropriate to target care recipients and caregivers that present higher needs than the overall population receiving home care services from MH community care access centre (CCAC).
... Preliminary evidence of validity was obtained from stratified analyses and examination of the (polychoric) correlations between the DRS and other interRAI PC items. We hypothesized that the DRS would be more highly correlated with other mood items, psychosocial items reflecting general mood, and social support items such as caregiver distress, with these higher correlations suggesting convergent validity (Szczerbinska et al. 2012;Hirdes et al. 2012;Soldato et al. 2008). We expected lower correlations between the DRS and functional ability (Activities of Daily Living Self-performance Hierarchy Scale; ADL SHS) and physical symptoms such as dyspnea and GI disorders, with these lower correlations providing support for divergent validity. ...
A reliable and valid instrument is needed to screen for depression in palliative
patients. The interRAI Depression Rating Scale (DRS) is based on seven items in the
interRAI Palliative Care instrument. This study is the first to explore the dimensionality,
reliability and validity of the DRS in a palliative population. Palliative home care patients
(n = 5,175) residing in Ontario (Canada) were assessed with the interRAI Palliative Care
instrument. Exploratory factor analysis and Mokken scale analysis were used to identify
candidate conceptual models and evaluate scale homogeneity/performance. Confirmatory
factor analysis compared models using standard goodness-of-fit indices. Convergent and
divergent validity were investigated by examining polychoric correlations between the
DRS and other items. The ‘‘known groups’’ test determined if the DRS meaningfully
distinguished among client subgroups. The non-hierarchical two factor model showed
acceptable fit with the data, and ordinal alpha coefficients of 0.83 and 0.82 were observed
for the two DRS subscales. Omega hierarchical (xh) was 0.78 for the bifactor model, with
the general factor explaining three quarters of the common variance. Despite the multidimensionality
evident in the factor analyses, bifactor modelling and the Mokken homogeneity
coefficient (0.34) suggest that the DRS is a coherent scale that captures important
information on sub-constructs of depression (e.g., somatic symptoms). Higher correlationswere seen between the DRS and mood and psychosocial well-being items, and lower
correlations with functional status and demographic variables. The DRS distinguished in
the expected manner for known risk factors (e.g., social support, pain). The results suggest
that the DRS is primarily unidimensional and reliable for use in screening for depression in
palliative care patients.
... Caregiver distress was a risk factor in our study. Other studies using the DRS as a measure of depression have found the same result [77,78]. The broader research on depression and dementia indicates that patient depression is one of the main causes of caregiver stress [79]. ...
Background. Depression reduces the quality of life for individuals who are dying, impairing their ability to interact with others, organize their affairs, and benefit from treatments for pain and other symptoms. Depression is frequently under-diagnosed and under-treated in palliative care (PC) clients even though depression can be treated and clients’ experiences may improve, even in the later stages of end-of-life. Methods. We examined the predictors of signs/symptoms of depression in a sample of 5,700 home and hospice PC clients. Clients were assessed using the interRAI Palliative Care (interRAI PC) tool which is mandated for PC clients receiving home care in Ontario. The interRAI PC is client-focused and collects data on multiple domain areas including physical symptoms, mood, pain, and cognition. Depression was determined based on a score of 3+ on the Depression Rating Scale (DRS), a 7-item validated scale embedded within the interRAI PC. Theory, past research and examination of bivariate associations was used to identify the independent variables that were included in a logistic regression model to predict depression. Results. The prevalence of depression was 9.5%. Our preliminary model identified 9 independent risk factors for depression including daily pain (adjusted OR=2.0), more fatigue (2.27), less family support (1.89), less progress towards completing life goals (1.82) and caregiver distress (1.67). Conclusion: Depression is not uncommon among PC clients in the community and is related to multiple factors encompassing physical symptoms as well as psychosocial and interpersonal factors, many of which can be addressed by care providers in the community.
... Previous studies that have examined depression in palliative care patients have established associations with certain physical symptoms (e.g., sleep disorders, fatigue, dyspnea, pain, functional disability) [2,4,20,21], psychological symptoms (psychological well-being, spirituality, hopelessness, cognitive loss) [20,22,23], demographic variables (e.g., younger age, gender) [2,21,24,25], prognosis [2], prognostic awareness [26,27], social support [5,21,28,29], and caregiver distress [30,31]. However, prior research has been limited in several ways, notably the lack of sufficient sample sizes [5], samples that do not include people being treated in home settings [32], and the use of assessment tools that have not been validated in a palliative population [3,5]. ...
Depression in palliative care patients is important because of its intrinsic burden and association with elevated physical symptoms, reduced immunity and increased mortality risk. Identifying risk factors associated with depression can enable clinicians to more readily diagnose it, which is important since depression is treatable. The purpose of this cross-sectional study was to determine the prevalence of depressive symptoms and risk factors associated with them in a large sample of palliative home care patients.
The data come from interRAI Palliative Care assessments completed between 2006 and 2012. The sample (n = 5144) consists of adults residing in Ontario (Canada), receiving home care services, classified as palliative, and not experiencing significant cognitive impairment. Logistic regression identified the risk factors associated with depressive symptoms. The dependent variable was the Depression Rating Scale (DRS) and the independent variables were functional indicators from the interRAI assessment and other variables identified in the literature. We examined the results of the complete case and multiple imputation analyses, and found them to be similar.
The prevalence of depressive symptoms was 9.8%. The risk factors associated with depressive symptoms were (pooled estimates, multiple imputation): low life satisfaction (OR = 3.01 [CI = 2.37-3.82]), severe and moderate sleep disorders (2.56 [2.05-3.19] and 1.56 [1.18-2.06]), health instability (2.12 [1.42-3.18]), caregiver distress 2.01 [1.62-2.51]), daily pain (1.73 [1.35-2.22]), cognitive impairment (1.45 [1.13-1.87]), being female (1.37 [1.11-1.68]), and gastrointestinal symptoms (1.27 [1.03-1.55]). Life satisfaction mediated the effect of prognostic awareness on depressive symptoms.
The prevalence of depressive symptoms in our study was close to the median of 10-20% reported in the palliative care literature, suggesting they are present but by no means inevitable in palliative patients. Most of the factors associated with depressive symptoms in our study are amenable to clinical intervention and often targeted in palliative care programs. Designing interventions to address them can be challenging, however, requiring careful attention to patient preferences, the spectrum of comorbid conditions they face, and their social supports. Life satisfaction was one of the strongest factors associated with depressive symptoms in our study, and is likely to be among the most challenging to address.
... The delivery of care -as a sociological conception (Fine 2005) -has been identified as a key issue to the effectiveness of the delivery and the quality of healthcare (Falchuk 2007). Soldato et al. (2008) shows that caregivers' distress and dissatisfaction can be associated with patients' depression, suggesting what attitudes are enacted and how they are enacted between healthcare practitioners and healthcare recipients plays an important role in the quality of the system. Besides, there is a rich body of research on intercultural communication in healthcare situations, such as Dogra (2001), Hardoff and Schonmann (2001) and Spencer and Silverman (2001) addressing the issue of designing specific training and professional development for medical students and practitioners in treating culturally and linguistically diverse patients. ...
With the rapid development of telecommunications and the business processing outsourcing (BPO) industry, many companies are establishing call centres for customer service in developing countries, where English is the major language used in the industry but often not spoken as the first language. While there is an abundance of research on call centre communication from the perspectives of business and management, sociolinguistics and applied linguistics, there is still a dearth of information about the use of English in the BPO industry with the coexistence of other languages. This paper presents a comparative study on the use of English and Cantonese in call centre communication conducted in an international healthcare insurance organisation in Hong Kong. English and Cantonese calls with apparent conflicts were transcribed and analysed in terms of how customer service representatives (CSRs) respond to complaints, and how customers enact their negative emotions while complaining.
... Although prevalence of depression differs by the definition and methodology used in assessments, it is reported that the prevalence of depression among nursing home residents is higher than among older people living in the community. An estimated 10–15% of community-dwelling elderly are affected, and the proportion increases to over 20% in nursing homes (Anderson, Buckwalter, Buchanan, Maas, & Imhof, 2003; Duff, 2003; Soldato et al., 2008). Evidence suggests that depression has a bidirectional relationship with physical illness and can complicate recovery and rehabilitation. ...
This study used data from the SHELTER (Services and Health for Elderly in Long TERm care) project to explore the benefits of using the Depression Rating Scale (DRS) as part of a standardised needs assessment in UK nursing homes, including a statistical method of effectively identifying characteristics linking to residents' depression.
About 499 residents in nine nursing homes in south-east England were assessed with interRAI Long Term Care Facilities (interRAI LTCF), a standardised assessment tool containing the validated DRS residents who scored 3 or more on the DRS were considered 'might suffer from depression'. A list of characteristics associated with depression was then examined using bivariate analysis and logistic regression.
Among the 499 residents assessed, 67.5% were not depressed (DRS < 3) and 32.3% might suffer from depression (DRS ≥ 3). The final logistic model showed 'never married' (p = 0.019), 'diagnosis of COPD' (COPD, chronic obstructive pulmonary disease) (p = 0.015), 'feelings of pain' (p = 0.015) and 'trouble sleeping' (p < 0.001) were significantly associated with reporting of DRS score of 3 and more.
The article argued that DRS has distinctive advantages for using in UK nursing homes where a preponderance of residents is cognitively impaired, the procedure of screening depression is not regulated and resources to treat depression is relatively scarce. This article also demonstrated how using the DRS as part of a comprehensive standardised needs assessment facilitates analysis of characteristics linking to depression, which has significant policy implications in improving care quality and management.
Objective:
To assess and compare the health-related quality of life (HRQoL) of spouses living at home with a patient aged 65 years or more suffering from a major depressive disorder and that of matched controls. Secondly, to investigate whether the HRQoL of spouses was correlated with the assessment of their partner's depression, their own depression and the self-perceived level of care burden experienced by the caregiver partner.
Methods:
Assessment of patients was based on the clinical diagnosis of a major depressive disorder as established by the criteria of the DSM-IV-TR, the geriatric depression scale GDS-15 and the LEIPAD questionnaire specific to subjects aged 65 or over living at home. Spouses were assessed by GDS-15, the Zarit scale for assessing caregiver burden and the LEIPAD questionnaire. The HRQoL of controls, who were matched for age, sex and educational level, was assessed by LEIPAD.
Results:
The study sample (n=38) was made up of 19 patients (mean age of 76.6 years, standard deviation 8.1) and their spouses (mean age of 75.3 years, standard deviation 8.2). The HRQoL score of the spouses was significantly poorer for the scale "Sexual functioning" (P=0.0007) than that of controls and was negatively affected by their partner's depression (P=0.02). The HRQoL scores of the spouses for "Physical function", "Depression and anxiety" and "Sexual functioning" were negatively affected by their own depression (correlation coefficients r=0.50, 0.53 and 0.54, respectively). The HRQoL scores for "Self-care", "Sexual functioning" and "Life satisfaction" were also negatively affected in spouses by the self-perceived burden of care (correlation coefficients r=0.59, 0.57 and 0.51, respectively).
Conclusion:
The sexual quality of life of spouses of elderly patients suffering from a major depressive disorder was significantly impaired. The patients' and spouses' depression and the caregivers' burden also had a negative impact on several aspects of the HRQoL of the spouses. It seems to be important, therefore, to assess the mental state, care burden and HRQoL of spouses caring for elderly patients suffering from depression so as to offer help when required to partners in difficulty.
Background:
Measuring quality in long-term residential care involves challenges concerning both the measurement method and the impaired functional ability of many older people. Ensuring quality in care is even more important for people with functional impairments, as this is a vulnerable group who may be unable to report poor quality of care for themselves.
Aims and objectives:
The aim of this study was to analyse how perceived and observed assessments of the quality of care varied according to the residents' functional ability.
Design:
The data (n = 278) used in the analyses included residents', family members' and staff assessments of perceived and observed quality of care combined with the Resident Assessment Instrument (RAI) scales measuring the same residents' functional abilities (physical, psychological, cognitive and social). Observations were included in the data if all four assessment types (by residents, family members, staff and the RAI) were available. The dimensions of quality of care emerging from the factor analysis were used.
Methods:
Linear regression was used to explore the association between resident's functional abilities and assessed quality of care.
Results:
Higher level of depression symptoms and higher level of dependency in activities of daily living (ADL) were significantly associated with lower level of perceived and observed quality of care. By contrast, the level of residents' cognitive functioning was not significantly associated with any quality dimensions. The social aspect was the only dimension of functional ability on which better functional ability indicated better quality of care, although differences between respondent groups were also observed.
Conclusions:
These analyses emphasize the importance of taking residents' functional ability into account when collecting information on and interpreting the results of perceived and observed quality of care reported separately by residents, family members and staff.
Implications for practice:
The information obtained can inform care professionals of how dimensions of residents' functional impairments are associated with perceived and observed quality of care and the quality of older people's care can thereby be improved.
Résumé
Parmi l’ensemble des troubles psychiatriques retrouvés chez le sujet âgé, la dépression représente un enjeu prioritaire de santé publique, par sa prévalence élevée, ses conséquences délétères en termes de morbi-mortalité, notamment par suicide, et par son impact sur la qualité de vie et l’autonomie fonctionnelle. Pourtant, malgré sa fréquence, on constate encore aujourd’hui un filtre majeur d’accès à des soins spécialisés. Les raisons en sont multiples, que ce soit le manque de repérage précoce, la sous-estimation des affects dépressifs par l’entourage et par le patient lui-même, mais également du fait des spécificités cliniques de la symptomatologie dépressive du sujet âgé, et de la nécessité de proposer une prise en charge thérapeutique adaptée. Cette approche thérapeutique spécifique doit tenir compte des particularités d’utilisation des antidépresseurs et des stratégies psychothérapiques propres au sujet âgé. Enfin, une attention particulière doit être portée sur les réactions liées aux deuils face auxquels le sujet âgé peut se révéler particulièrement vulnérable.
La dépression est particulièrement fréquente chez le sujet âgé de 65 ans et plus. Pourtant, elle reste sous-diagnostiquée et insuffisamment traitée, avec un délai moyen allongé pour l’instauration d’un traitement. Le taux de rechute d’une dépression chez un sujet âgé et le risque de passage à la chronicité sont élevés. Les états dépressifs d’expression symptomatique atténuée, plus nombreux dans l’avancée en âge, évoluent dans une forte proportion vers une dépression majeure. De multiples facteurs, en particulier les affections somatiques, peuvent aussi modifier l’expression de la dépression du sujet âgé. Ces particularités peuvent mettre en difficulté le clinicien pour diagnostiquer un état dépressif. Pourtant, l’identification précoce de symptômes dépressifs est essentielle, tout comme le repérage des situations à risque de dépression, des facteurs de risque ou aggravant l’évolution. Cela justifie une sensibilisation particulière des praticiens amenés à prendre en charge la population âgée. La dépression gériatrique est associée à une surmortalité et à un risque suicidaire élevé, à une péjoration de la qualité de vie et est à l’origine d’une consommation importante de soins et de coûts croissants. La prise en charge d’un état dépressif gériatrique est multimodale et pluridisciplinaire. Les différentes approches de soins comprennent les soins somatiques, les traitements psychotropes, les techniques de stimulation cérébrale, la psychothérapie et les interventions médicosociales. Certaines situations ou cas complexes justifient une demande d’avis psychiatrique : sévérité de l’épisode, troubles cognitifs associés, polypathologie et risque iatrogénique important, chimiorésistance.
The relationship between care recipients' depressive symptoms and those of caregivers remains unknown. We evaluated the association between the depressive status of caregivers and that of community-dwelling disabled care recipients.
A prospective cohort study of 893 care recipients and paired caregivers was conducted. The care recipients were all eligible for a universal-coverage long-term care insurance program and their ages ranged from 65 to 104 years. They and their paired caregivers (age range 31-90 years) completed the 15-item Geriatric Depression Scale (GDS-15, score range: 0-15) assessment at baseline. The GDS-15 was used to measure the depression of caregivers and recipients with a threshold of <6/6+. The data included each care recipient's demographic characteristics, overall health status, basic activities of daily living, and comorbidities. The data also included the caregiver's demographic characteristics, including the caregiver's relationship to the recipient, and the caregiver's subjective burden as assessed by the Japanese version of the Zarit Burden Interview (ZBI).
The mean GDS-15 scores of care recipients and caregivers were 6.7 points and 5.6 points, respectively. There was a positive correlation between the GDS-15 scores of caregivers and care recipients (r = 0.307, p<0.001). Multivariate logistic regression analysis adjusting for potential confounders including ZBI score indicated that the depressive symptoms of caregivers were associated with those whose care recipients were in the groups with moderate and high GDS-15 scores (OR: 1.97, 95% CI: 1.39-2.81, OR: 3.13, 95% CI: 1.87-5.24, respectively).
Caregivers' depressive symptoms are associated with the depressive mood of the care recipients even after adjusting for confounders including caregiver burden.
Home care for older adults is a common phenomenon worldwide because it allows older adults to remain in their home environment. Research has shown that depression is frequently found in older recipients of home care services. Nonetheless, it is often poorly recognized and treated. Untreated or poorly treated depression in older home care recipients has been associated with a variety of negative outcomes, including increased morbidity and mortality, greater likelihood of nursing home institutionalization and higher caregiver distress.
The present review outlines some of the challenges associated with appropriate recognition and treatment of depression in older home care recipients.
Our review demonstrates that more aggressive management of depressive symptoms and the employment of an interdiciplinary team can result in beneficial outcomes.
Further research is needed, especially in the area of psychotherapeutic interventions as these should be flexible enough to meet the unique and evolving needs of this frail population of older adults.
To identify factors associated with distress of caregivers of home care patients in Europe and to assess whether caregivers response to distress varies among countries.
Cross-sectional study among older adults receiving home care in 11 European countries.
A total of 3,449 older adults receiving home care in Europe.
Caregiver distress was assessed by asking whether caregiver was distressed, angry, depressed, or in conflict because of caring for the participant.
Mean age of study participants was 82.4 years, and distress was present in 7.5% of their caregivers. In all the country sample, number of depressive symptoms (OR 1.38, 95% CI: 1.27-1.49), cognitive performance scale score (OR 1.19, 95% CI: 1.10-1.30), number of impaired Activities of Daily Living (OR 1.36, 95% CI: 1.25-1.47), and number of behavioral symptoms (OR 1.28, 95% CI: 1.04-1.58) were significantly associated with caregivers distress. These associations were consistent among caregivers in all countries. Overall, 295 caregivers (8.6%) felt that participant would be better off in another living environment, and 1,444 (41.9%) caregivers were willing to increase help. Despite an elevated rate of distress, a low proportion of caregivers in Italy (3.0%), Germany (6.1%), and France (5.5%) felt that participants would be better off in another living environment. By contrast, in countries with lower rate of distress, as Iceland and the Netherlands, this rate was more elevated (15.5% and 20.6%, respectively).
Distress of caregivers is associated with patient cognitive and functional status, depressive, and behavioral symptoms, and there are national differences in the response to distress.
To describe the mental health of a community sample of carers of elderly people with dementia, depression, or physical disability and to compare that with the mental health of other adults living in the household and of those living alone.
Assessment of psychiatric morbidity and physical disability with standardised questionnaire in randomly selected enumeration districts; subjects were interviewed at home.
London Borough of Islington.
700 people aged > or = 65 and other coresidents.
Depression measured with standardised interview.
The prevalence of depression was not significantly higher in carers overall (15%) than in coresidents (11%). Being a woman carer was a significant predictor of psychiatric illness. Depression was more common in the carers of people with a psychiatric disorder than in coresidents (24% v 11%, P < 0.05) and in those living alone (19%). Depression was most common (47%) in women carers of people with dementia.
The increase in psychiatric morbidity reported in carers of people with psychiatric disorders may reflect the lack of a confiding relationship.
Background:
since its original implementation in the USA, the Resident Assessment Instrument (RAI) has been used in many countries in languages other than English. This paper describes the efforts that have been made to test the inter-rater reliability of the core set of items forming the minimum data set items in the USA and in non-English speaking countries (Denmark, Iceland, Italy, Japan, Sweden and Switzerland).
Results:
a large proportion (from 70 to 96%) of the items in the RAI achieved an adequate to excellent level of reliability, with no substantial differences across countries. The RAI met the standard for good reliability (i.e. a kappa value of 0.6 or higher) in crucial areas of functional status, such as memory, activities of daily living self-performance and support, and bowel and bladder continence in most of the countries. Indicators of mood and behavioural problems achieved adequate reliability levels of 0.4 or higher.
depression is common but under-diagnosed in nursing-home residents. There is a need for a standardized screening instrument which incorporates daily observations of nursing-home staff.
to develop and validate a screening instrument for depression using items from the Minimum Data Set of the Resident Assessment Instrument.
we conducted semi-structured interviews with 108 residents from two nursing homes to obtain depression ratings using the 17-item Hamilton Depression Rating Scale and the Cornell Scale for Depression in Dementia. Nursing staff completed Minimum Data Set assessments. In a randomly assigned derivation sample (n = 81), we identified Minimum Data Set mood items that were correlated (P < 0.05) with Hamilton and Cornell ratings. These items were factored using an oblique rotation to yield five conceptually distinct factors. Using linear regression, each set of factored items was regressed against Hamilton and Cornell ratings to identify a core set of seven Minimum Data Set mood items which comprise the Minimum Data Set Depression Rating Scale. We then tested the performance of the Minimum Data Set Depression Rating Scale against accepted cut-offs and psychiatric diagnoses.
a cutpoint score of 3 on the Minimum Data Set Depression Rating Scale maximized sensitivity (94% for Hamilton, 78% for Cornell) with minimal loss of specificity (72% for Hamilton, 77% for Cornell) when tested against cut-offs for mild to moderate depression in the derivation sample. Results were similar in the validation sample. When tested against diagnoses of major or non-major depression in a subset of 82 subjects, sensitivity was 91% and specificity was 69%. Performance compared favourably with the 15-item Geriatric Depression Scale.
items from the Minimum Data Set can be organized to screen for depression in nursing-home residents. Further testing of the instrument is now needed.
Depression is perhaps the most frequent cause of emotional suffering in later life and significantly decreases quality of
life in older adults. In recent years, the literature on late-life depression has exploded. Many gaps in our understanding
of the outcome of late-life depression have been filled. Intriguing findings have emerged regarding the etiology of late-onset
depression. The number of studies documenting the evidence base for therapy has increased dramatically. Here, I first address
case definition, and then I review the current community- and clinic-based epidemiological studies. Next I address the outcome
of late-life depression, including morbidity and mortality studies. Then I present the extant evidence regarding the etiology
of depression in late life from a biopsychosocial perspective. Finally, I present evidence for the current therapies prescribed
for depressed elders, ranging from medications to group therapy.
Uncertainties exist about prevalence and correlates of major depressive disorder (MDD).
To present nationally representative data on prevalence and correlates of MDD by Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria, and on study patterns and correlates of treatment and treatment adequacy from the recently completed National Comorbidity Survey Replication (NCS-R).
Face-to-face household survey conducted from February 2001 to December 2002.
The 48 contiguous United States.
Household residents ages 18 years or older (N = 9090) who responded to the NCS-R survey.
Prevalence and correlates of MDD using the World Health Organization's (WHO) Composite International Diagnostic Interview (CIDI), 12-month severity with the Quick Inventory of Depressive Symptomatology Self-Report (QIDS-SR), the Sheehan Disability Scale (SDS), and the WHO disability assessment scale (WHO-DAS). Clinical reinterviews used the Structured Clinical Interview for DSM-IV.
The prevalence of CIDI MDD for lifetime was 16.2% (95% confidence interval [CI], 15.1-17.3) (32.6-35.1 million US adults) and for 12-month was 6.6% (95% CI, 5.9-7.3) (13.1-14.2 million US adults). Virtually all CIDI 12-month cases were independently classified as clinically significant using the QIDS-SR, with 10.4% mild, 38.6% moderate, 38.0% severe, and 12.9% very severe. Mean episode duration was 16 weeks (95% CI, 15.1-17.3). Role impairment as measured by SDS was substantial as indicated by 59.3% of 12-month cases with severe or very severe role impairment. Most lifetime (72.1%) and 12-month (78.5%) cases had comorbid CIDI/DSM-IV disorders, with MDD only rarely primary. Although 51.6% (95% CI, 46.1-57.2) of 12-month cases received health care treatment for MDD, treatment was adequate in only 41.9% (95% CI, 35.9-47.9) of these cases, resulting in 21.7% (95% CI, 18.1-25.2) of 12-month MDD being adequately treated. Sociodemographic correlates of treatment were far less numerous than those of prevalence.
Major depressive disorder is a common disorder, widely distributed in the population, and usually associated with substantial symptom severity and role impairment. While the recent increase in treatment is encouraging, inadequate treatment is a serious concern. Emphasis on screening and expansion of treatment needs to be accompanied by a parallel emphasis on treatment quality improvement.
Attention to caregiving consequences has been mainly restricted to schizophrenia, although studies suggest that relatives of depressed patients also experience considerable distress. These studies, however, were conducted on small samples or with nonvalidated instruments. In our study, the caregiving consequences of 260 spouses and relatives of depressed patients were assessed with a well-validated 31-item questionnaire, the Involvement Evaluation Questionnaire (IEQ).
The IEQ was mailed to spouses and relatives of patients with major depression, dysthymic disorder, or other depressive disorders. Other instruments used were the Ways of Coping Checklist (WCC), a Dutch Social Support Questionnaire, and the Zung Self-rating Depression Scale (SDS).
About 25-50% of caregivers worried about the patient's general health, treatment, safety, and future. They had to urge the patient to undertake activities, or took over tasks. There were relational strains, and they felt burdened, especially when the patient was in an acute phase. Caregivers often felt distressed and had to visit a (mental) health practitioner. Also, children were affected; caregivers reported high levels of difficult behavior, loss of appetite, sleeplessness, less playing, and less attention at school. Caregiving consequences occur less often than in schizophrenia, but the patterns are quite comparable.
Caregiving consequences in depression occur frequently and cause distress in caregivers and patient's children. Attention should be paid to support relatives and spouses of depressed patients. Special attention should be paid to patient's children.
Community care for older people is increasing dramatically in most European countries as the preferred option to hospital and long-term care. While there has been a rapid expansion in Evidence-Based Medicine, apart from studies of specific interventions such as home visiting and hospital at home (specialist visits or hospital services provided to people in their own homes in the community), there is little evidence of characteristics of the recipients of community care services or the organisation of services that produce the best outcomes for them and their informal carers. The AdHOC Study was designed to compare outcomes of different models of community care using a structured comparison of services and a comprehensive standardised assessment instrument across 11 European countries. This paper describes the study and baseline data.
4,500 people 65 years and older already receiving home care services within the urban areas selected in each country were randomly sampled. They were assessed with the MDS-HC (Minimum Data Set-Home Care) instrument, containing over 300 items, including socio-demographic, physical and cognitive characteristics of patients as well as medical diagnoses and medications received. These data were linked to information on the setting, services structures and services utilization, including use of hospital and long-term care. After baseline assessment, patients were re-evaluated at 6 months with an abbreviated version of the instrument, and then at the end of one year. Data collection was performed by specially-trained personnel. In this paper, socio-demographics, physical and cognitive function and provision of hours of formal care are compared between countries at baseline.
The final study sample comprised 3,785 patients; mean age was 82+/-7.2 years, 74.2% were females. Marital and living status reflected close family relationships in southern Europe relative to Nordic countries, where 5 times as many patients live alone. Recipients of community care in France and Italy are characterised by very high physical and cognitive impairment compared with those in northern Europe, who have comparatively little impairment in Activities of Daily Living and cognitive function. The provision of formal care to people with similar dependency varies extremely widely with very little formal care in Italy and more than double the average across all levels of dependency in the UK.
The AdHOC study, by virtue of the use of a common comprehensive standardised assessment instrument, is a unique tool in examining older recipients of community care services in European countries and their widely varied organisation. The extreme differences seen in dependency and hours of care illustrate the probable contribution the study will make to developing an evidence based on the structure, quantity and targeting of community care, which will have major policy implications.
Depression is a common disorder among older adults, and it has been associated with adverse outcomes, including increased risk of morbidity and mortality as well as incomplete or delayed recovery from illness and disability. The objective of this study was to examine whether depressive symptoms and anemia are associated among older adults living in the community.
We used data from the "Invecchiare in Chianti" (Aging in the Chianti area, InCHIANTI) study, a prospective population-based study of older people living in the community. Anemia was defined by the World Health Organization (WHO) criteria: hemoglobin concentration below 12 g/dl in women and below 13 g/dl in men. Depressive symptoms were measured by using the Center for Epidemiological Studies Depression Scale (CES-D). Participants with a CES-D score > or = 16 were considered to be depressed.
Mean age of the 986 participants was 75 years, and 56% were female; 313 (32%) study participants were depressed. Anemia was recorded in 48 of the 313 (15%) participants with depression and in 53 of the 673 (8%) participants without depression (p <.001). After adjusting for potential confounders, depression was associated with a significant higher risk of anemia (odds ratio = 1.93; 95% confidence interval, 1.19-3.13). The risk of anemia progressively and significantly increased with increasing CES-D score (signifying more severe depression). Compared with nondepressed participants (CES-D score <16), the odds ratio for anemia were 1.74, 2.04, and 2.10 for participants with mild (score = 16-20), moderate (score = 21-26), and severe depression (score > 26), respectively (p for linear trend =.01).
Depressive symptoms are associated with anemia in a general population of older persons living in the community.
Objective:
To determine the emotional and social distress of caring for a patient with Parkinson's disease and to explore the impact of motor and mental symptoms in subjects with Parkinson's disease on their caregivers' situation.
Design:
Cross-sectional, population-based study using self-report questionnaires to measure caregiver distress and rating scales to assess patient symptomatology.
Setting:
Neurology and old age psychiatry services in Stavanger, Norway.
Subjects:
Caregivers of 94 home-dwelling patients with Parkinson's disease. Two control groups (patients with diabetes mellitus and healthy elderly).
Outcome measures:
Measures of social and emotional distress in caregivers, including the Relative Stress Scale, Beck Depression Inventory and the General Health Questionnaire.
Results:
Caregivers, in particular spouses, had more severe depression and a higher proportion reporting tiredness, sadness and less satisfaction with life compared with healthy elderly subjects. Using linear regression analysis, patient predictors of caregiver distress were depression, functional and cognitive impairment, agitation, aberrant motor behaviour and delusions.
Conclusions:
Caring for a spouse with Parkinson's disease is associated with emotional and social distress, underlining the importance of also assessing the needs of carers. Mental symptoms of parkinsonian patients were the most consistent and powerful predictors of caregiver distress, suggesting that identification and treatment of mental symptoms may reduce distress in caregivers of subjects with Parkinson's disease.
There is strong consensus that caring for an elderly individual with disability is burdensome and stressful to many family members and contributes to psychiatric morbidity. Researchers have also suggested that the combination of loss, prolonged distress, the physical demands of caregiving, and biological vulnerabilities of older caregivers may compromise their physiological functioning and increase their risk for physical health problems, leading to increased mortality.
To examine the relationship between caregiving demands among older spousal caregivers and 4-year all-cause mortality, controlling for sociodemographic factors, prevalent clinical disease, and subclinical disease at baseline.
Prospective population-based cohort study, from 1993 through 1998 with an average of 4.5 years of follow-up.
Four US communities.
A total of 392 caregivers and 427 noncaregivers aged 66 to 96 years who were living with their spouses.
Four-year mortality, based on level of caregiving: (1) spouse not disabled; (2) spouse disabled and not helping; (3) spouse disabled and helping with no strain reported; or(4) spouse disabled and helping with mental or emotional strain reported.
After 4 years of follow-up, 103 participants (12.6%) died. After adjusting for sociodemographic factors, prevalent disease, and subclinical cardiovascular disease, participants who were providing care and experiencing caregiver strain had mortality risks that were 63% higher than noncaregiving controls (relative risk [RR], 1.63; 95% confidence interval [CI], 1.00-2.65). Participants who were providing care but not experiencing strain (RR, 1.08; 95 % CI, 0.61-1.90) and those with a disabled spouse who were not providing care (RR, 1.37; 95% CI, 0.73-2.58) did not have elevated adjusted mortality rates relative to the noncaregiving controls.
Our study suggests that being a caregiver who is experiencing mental or emotional strain is an independent risk factor for mortality among elderly spousal caregivers. Caregivers who report strain associated with caregiving are more likely to die than noncaregiving controls.
Objective. The main hypothesis was that carers of elderly patients attending a day hospital with chronic depression experience considerable stress. A subsidiary hypothesis was that this stress is equivalent to that experienced by carers of dementia patients attending the same day hospital.Design. All attenders of the day hospital with a diagnosis of depression or dementia coresident with their principal carers.Setting. An urban psychogeriatric day hospital in the UK.Patients. A consultant diagnosis of dementia or depression with a history of present illness in excess of 12 months in patients over 65. The total sample was 57, 32 dementia and 25 depression (19 major depressive episode).Measures. Dementia patients: Mini-Mental State Examination (MMSE), Clifton Assessment Schedule (CAPE). Depressed patients: MMSE, Montgomery–Asberg Depression Rating Scale (MADRS) and Brief Psychiatric Rating Scale (BPRS). Carers: Semi-structured questionnaire, General Health Questionnaire (GHQ-30) and Relatives Stress Scale (RSS).Results. Dementia patients were older than depressed (75.66 vs 71.84). The two groups were of comparable severity. The dementia carers were significantly more stressed on the GHQ and RSS than depression carers but these carers also exceeded the threshold for psychiatric ‘caseness’. Important negative views about life upset and carer burden were expressed by both groups.Conclusions. The main hypothesis but not the subsidiary one is supported. More sophisticated study of the burden of caring for chronic depressive illness is required. © 1998 John Wiley & Sons, Ltd.
OBJECTIVES: To study a cohort of participants in home- and community-based services (HCBS) in Michigan to evaluate the relationship between (1) caregiver attitudes and participant characteristics and (2) the risk of hospitalization.
SETTING: HCBS programs funded by Medicaid or state/local funds in Michigan.
PARTICIPANTS: Five hundred twenty-seven individuals eligible for HCBS in Michigan were studied. These HCBS participants were randomly selected clients of all agencies providing publicly funded HCBS in Michigan from November 1996 to October 1997.
MEASUREMENTS: Data for this study were collected using the Minimum Data Set for Home Care. Assessments were collected longitudinally, and the baseline (initial admission assessment) and 90-day follow-up assessments were used. Key measures were caregiver attitudes (distress, dissatisfaction, and decreased caregiving ability) and HCBS participant characteristics (cognition, functioning, diseases, symptoms, nutritional status, medications, and disease stability). Multinomial logistic regression was used to evaluate how these characteristics were associated with the competing risks of hospitalization and death within 90 days of admission to HCBS.
RESULTS: We found a strong association between caregiver dissatisfaction (caregiver dissatisfied with the level of care the home care participant was currently receiving) and an increased likelihood of hospitalization. HCBS participant cancer, chronic obstructive pulmonary disease, pain, and flare-up of a chronic condition were also associated with increased hospitalization. Poor food intake and prior hospitalization were associated with hospitalization and death.
CONCLUSIONS: We conclude that, within a cohort of people receiving HCBS who are chronically ill, highly disabled, and at high risk for hospitalization and death, interventions addressing caregiver dissatisfaction, pain control, and medical monitoring should be evaluated for their potential to decrease hospitalization.
This study assessed variables associated with increased severity of depressive symptoms among 321 informal caregivers of demented subjects living in the community identified by a Canadian national population-based survey. Measures included patient and caregiver demographic variables; patient behavioral disturbance, activities of daily living, and cognitive impairment; living arrangement, and duration of disease. Depressive symptoms were measured with the Center for Epidemiologic Studies Depression Scale (CES-D). Multiple regression analyses indicated that a higher CES-D score was significantly associated with three caregiver characteristics (being a spouse or child of the patient, self-identified ethnicity other than English and French Canadian, and lower education), and two patient characteristics (greater behavioral disturbance and moderate to severe functional impairment).
The National Long-Term Care Survey, 1982-1984, and the Informal Caregivers Survey were used to test the importance of caregiver burden for risk of admission to a nursing home. This study was based on a subsample of 940 older persons with sole spouse or adult child caregivers in 1982. Using logistic regression, nursing home entrants (127) were compared to 624 continuous community residents. Characteristics of the older person included age, race (White), and number of instrumental activities of daily living limitations. Predictors related to the caregiving context included caregiver burden and use of formal services.
Aspects of patient status and caregiver perceptions considered important contributors to caregiver burden were examined in a sample of 46 pairs of elderly psychiatric patients and their caregivers. The patients had been referred to a geriatric assessment unit. Significant predictors of caregiver burden included disruptive patient behavior, caregiver distress, and patients' functional limitations. The results, and those from previous studies, suggested that predictors of caregiver burden vary with the elderly patients' diagnoses.
The MDS is a core set of items, definitions, and response categories used to assess all of the nation's 1.5 million nursing home residents who reside in facilities participating in the Medicare or Medicaid programs. Further, the Health Care Financing Administration (HCFA) has proposed a rule that would require facilities to computerize MDS data and submit it to state and federal agencies, paving the way for a national database. This article describes the process of testing the reliability of the MDS items in 13 nursing homes in five states. The results demonstrate that MDS data gathered in a research effort attain reliabilities that make such data useful. MDS items met a standard for excellent reliability (i.e., intraclass correlation of .7 or higher) in key areas of functional status, such as cognition, ADLs, continence, and diagnoses. Sixty-three percent of the items achieved reliability coefficients of .6 or higher. Eighty-nine percent of the items in the MDS achieved .4 or higher.
To describe the results of an international trial of the home care version of the MDS assessment and problem identification system (the MDS-HC), including reliability estimates, a comparison of MDS-HC reliabilities with reliabilities of the same items in the MDS 2.0 nursing home assessment instrument, and an examination of the types of problems found in home care clients using the MDS-HC.
Independent, dual assessment of clients of home-care agencies by trained clinicians using a draft of the MDS-HC, with additional descriptive data regarding problem profiles for home care clients.
Reliability data from dual assessments of 241 randomly selected clients of home care agencies in five countries, all of whom volunteered to test the MDS-HC. Also included are an expanded sample of 780 home care assessments from these countries and 187 dually assessed residents from 21 nursing homes in the United States.
The array of MDS-HC assessment items included measures in the following areas: personal items, cognitive patterns, communication/hearing, vision, mood and behavior, social functioning, informal support services, physical functioning, continence, disease diagnoses health conditions and preventive health measures, nutrition/hydration, dental status, skin condition, environmental assessment, service utilization, and medications.
Forty-seven percent of the functional, health status, social environment, and service items in the MDS-HC were taken from the MDS 2.0 for nursing homes. For this item set, it is estimated that the average weighted Kappa is .74 for the MDS-HC and .75 for the MDS 2.0. Similarly, high reliability values were found for items newly introduced in the MDS-HC (weighted Kappa = .70). Descriptive findings also characterize the problems of home care clients, with subanalyses within cognitive performance levels.
Findings indicate that the core set of items in the MDS 2.0 work equally well in community and nursing home settings. New items are highly reliable. In tandem, these instruments can be used within the international community, assisting and planning care for older adults within a broad spectrum of service settings, including nursing homes and home care programs. With this community-based, second-generation problem and care plan-driven assessment instrument, disability assessment can be performed consistently across the world.
The main hypothesis was that carers of elderly patients attending a day hospital with chronic depression experience considerable stress. A subsidiary hypothesis was that this stress is equivalent to that experienced by carers of dementia patients attending the same day hospital.
All attenders of the day hospital with a diagnosis of depression or dementia coresident with their principal carers.
An urban psychogeriatric day hospital in the UK.
A consultant diagnosis of dementia or depression with a history of present illness in excess of 12 months in patients over 65. The total sample was 57, 32 dementia and 25 depression (19 major depressive episode).
Dementia patients: Mini-Mental State Examination (MMSE), Clifton Assessment Schedule (CAPE). Depressed patients: MMSE, Montgomery-Asberg Depression Rating Scale (MADRS) and Brief Psychiatric Rating Scale (BPRS). Carers: Semi-structured questionnaire, General Health Questionnaire (GHQ-30) and Relatives Stress Scale (RSS).
Dementia patients were older than depressed (75.66 vs 71.84). The two groups were of comparable severity. The dementia carers were significantly more stressed on the GHQ and RSS than depression carers but these carers also exceeded the threshold for psychiatric 'caseness'. Important negative views about life upset and carer burden were expressed by both groups.
The main hypothesis but not the subsidiary one is supported. More sophisticated study of the burden of caring for chronic depressive illness is required.
Background:
The challenges presented by the increasing public health and social impact of caring for people with dementia have become clear in recent years. Previous research has identified that, while there are positive as well as negative elements to the caring role, carers are at high risk of mental health problems and that the comprehensive burden of caring has social, economic and health based elements. Co-resident carers, especially spouses, are of primary importance in maintaining people with dementia in their own homes in the community rather than in institutional settings which may be both more costly and have greater environmental poverty. There have, however, been few studies which have sought to investigate factors associated with carer burden and differences and similarities between countries. In this study we aimed to produce a cross-national profile of co-resident spouse carers across the European Community, with particular attention to: living arrangements; formal and informal support; service satisfaction; perceived burden; and psychological well-being.
Method:
Twenty co-resident spouse carers of people with NINCDS-ADRDA probable dementia, who had been diagnosed as such within the past 12-36 months, were recruited from service contacts in each of 14 out of the 15 countries of the EU. All completed a semi-structured interview which included: sociodemographic data; data on health and social service use; the Carer Burden Inventory (CBI); the General Health Questionnaire-12 (GHQ-12); and open-ended qualitative questions about the experience of caring.
Results:
Two hundred and eighty couples were recruited. There was marked variation in all variables of interest between countries, but there were consistently high ratings of carer burden (mean CBI scores between 28 and 52) and psychological distress (between 40% and 75% scoring 4 or more on the GHQ-12). Using multivariate analyses (generalized linear modelling) to estimate the individual associations of variables of interest with carer burden, controlling for the effects of all other variables in the model, the following results were obtained: 11.4% (p = 0.003) of the variance was accounted for by between-country variation; 4.9% (p < 0.001) by expressed financial dissatisfaction; 4.5% (p = 0.001) by lower carer age; 3.2% (p = 0.004) by difficulties with spouse behavioural deficits; and 2.0% (p = 0.024) by perceived negative social reactions. There was a low level of contact with support groups and Alzheimer's disease societies despite the samples having been of service contacts.
Conclusions:
This study confirms the high level of burden and mental distress in spouse carers for people with Alzheimer's disease in the European Community. It suggests that there are elements of burden which may vary by country but also elements which have a common effect in all. These data suggest avenues for the primary and secondary prevention of burden by addressing clinical issues (e.g. behavioural disturbance); public attitudes and education (e.g. negative social reactions); economic support for carers (e.g. financial dissatisfaction); and higher risk groups (e.g. younger spouse carers).
To determine the emotional and social distress of caring for a patient with Parkinson's disease and to explore the impact of motor and mental symptoms in subjects with Parkinson's disease on their caregivers' situation.
Cross-sectional, population-based study using self-report questionnaires to measure caregiver distress and rating scales to assess patient symptomatology.
Neurology and old age psychiatry services in Stavanger, Norway.
Caregivers of 94 home-dwelling patients with Parkinson's disease. Two control groups (patients with diabetes mellitus and healthy elderly).
Measures of social and emotional distress in caregivers, including the Relative Stress Scale, Beck Depression Inventory and the General Health Questionnaire.
Caregivers, in particular spouses, had more severe depression and a higher proportion reporting tiredness, sadness and less satisfaction with life compared with healthy elderly subjects. Using linear regression analysis, patient predictors of caregiver distress were depression, functional and cognitive impairment, agitation, aberrant motor behaviour and delusions.
Caring for a spouse with Parkinson's disease is associated with emotional and social distress, underlining the importance of also assessing the needs of carers. Mental symptoms of parkinsonian patients were the most consistent and powerful predictors of caregiver distress, suggesting that identification and treatment of mental symptoms may reduce distress in caregivers of subjects with Parkinson's disease.
The impact of chronicity and changes in depression on physical decline over time in older persons has not been elucidated.
This prospective cohort study of 2121 community-dwelling persons aged 55-85 years uses two measurement occasions of depression (CES-D scale) over 3 years to distinguish persons with chronic, remitted, or emerging depression and persons who were never depressed. Physical function is assessed by self-reported physical ability as well as by observed performance on a short battery of tests.
After adjustment for baseline physical function, health status and sociodemographic factors, chronic depression was associated with significantly greater decline in self-reported physical ability over 3 years when compared to never depressed persons (odds ratio (OR)=2.83, 95% confidence interval (CI)=1.86-4. 30). In the oldest old, but not in the youngest old, chronic depression was also significantly predictive of greater decline in observed physical performance over 3 years (OR=2.22, 95% CI=1.43-3. 79). Comparable effects were found for older persons with emerging depression. Persons with remitted depression did not have greater decline in reported physical ability or observed performance than persons who were never depressed.
Our findings among community-dwelling older persons show that chronicity of depression has a large impact on physical decline over time. Since persons with remitted depression did not have greater physical decline than never depressed persons, these findings suggest that early recognition and treatment of depression in older persons could be protective for subsequent physical decline.
Earlier studies have yielded inconsistent findings regarding gender differences with respect to burden and depression among informal community caregivers of dementia patients.
The aim of the study was to determine whether or not there were gender differences in the prevalence of burden and depression among informal caregivers of community-residing dementia patients.
Data from 259 female and 68 male caregivers who were part of the Canadian Study of Health and Aging were analyzed. Depressive symptoms were measured using the Center for Epidemiologic Studies--Depression Scale (CES-D). Burden was assessed using Zarit's Burden Interview. Associations between the outcome variables (depressive symtoms and burden) and the independent variable, gender, were examined using logistic regression.
In multivariable analysis, female caregivers were found to have significantly higher odds than male caregivers of having a score of 33 or higher on Zarit's Burden Interview (OR=2.6; 95% CI 1.0, 6.7). The OR comparing women to men with respect to a high level of depressive symptoms (defined as a score of 16 or more on the CES-D) was not significant (OR=1.3; 95% CI 0.6, 2.9). Poor perceived caregivers health and more behavior disturbance in the patient were associated with significantly higher odds of high levels of caregiver burden and depression.
Adequate assistance must be given to women caregivers to ensure that they are not strained beyond what is clinically healthy. In addition, interventions should target caregivers of behaviorally disturbed patients as well as caregivers who report poor physical health to reduce the negative psychological impact of caregiving.
Mental disorders are among the most prevalent chronic conditions in old age, depression being the most widespread. The aim of this study was to examine the burden and distress reported by carers of elderly patients with depression.
Patients aged 60 or over starting outpatient treatment for depression and their relatives were included. Patients were assessed for the severity of depressive symptoms, behaviour and mood disturbance, and abilities of daily living. Relatives were assessed for burden and emotional distress.
Eighty-two patients and their relatives were included. Levels of carers' burden were high. Multiple linear regression showed that patients' behaviour and mood disturbance and relatives's emotional distress scores were independently associated with relatives' burden.
Levels of burden were similar to those found in studies with carers of elderly people with dementia, indicating that depressive symptoms can be considered an important source of distress for caregivers.
Depression and the behavioral symptoms associated with dementia remain two of the most significant mental health issues for nursing home residents. The extensive literature on these conditions in nursing homes was reviewed to provide an expert panel with an evidence base for making recommendations on the assessment and treatment of these problems.
Numerous assessment instruments have been validated for depression and for behavioral symptoms. The Minimum Data Set, as routinely collected, appears to be of limited utility as a screening instrument for depression but is useful for assessing some behavioral symptoms. Laboratory evaluations are often recommended, but no systematic study of the outcomes of these evaluations could be found. Studies of nonpharmacological interventions out‐number those of pharmacological interventions, and randomized, controlled trials document the efficacy of many interventions. Antidepressants are effective for major depression, but data for minor depressive syndromes are limited. Recreational activities are effective for major and minor depression categories. Neither pharmacological nor nonpharmacological interventions totally eliminate behavioral symptoms, but both types of interventions decrease the severity of symptoms. In the absence of comparison studies, it is unclear whether one approach is more effective than another. Despite federal regulations limiting their use, antipsychotics are effective and remain the most studied medications for treating behavioral symptoms, whereas benzodiazepines and antidepressants have less support. Structured activities are effective, but training interventions for behavioral symptoms had limited results. There are sufficient data to formulate an evidenced‐based approach to treatment of depression and behavioral symptoms, but more research is needed to prioritize treatments.
This study examines depressive symptoms among adult children of elderly parents; it views the parents' care needs and child's care activities as two separate stressors, different combinations of which may affect both caregiving and noncaregiving family members. Design and Methods: A sample of 4,380 women and 3,965 men from the first wave of the Health and Retirement Study was analyzed by use of four alternative forms of multiple regression analysis. Using the Center for Epidemiological Studies Depression scale, respondents reported on their depressive symptoms, as well as on parental disability and care provided by themselves, their spouses, and siblings.
Noncaregivers reporting severe parental disability were significantly more likely to experience depression symptoms. Evidence of increased manifestations of depression was not found among those caring for severely disabled relatives; nor was it found among those providing care in the absence of severe parental care needs. Having a caregiving sibling was associated with increased CES-D scores among noncaregivers.
In the current literature, personal care needs of a close relative are named among significant disturbances in the lives of caregivers. By extending this approach to members of a family network regardless of caregiver status, this study allows us to distinguish the magnitude of negative outcomes of serious parental care needs while clarifying the impact uniquely attributable to caregiving activities.
To examine the relationship between depression among medically ill, frail elders and family caregivers' hours of care, health status, and quality of life.
A cross-sectional study of 193 family caregivers of seniors treated in the emergency department (ED) was conducted. Measures included patient depression (Geriatric Depression Scale-15), and caregivers' hours of care, mental health and physical functioning (SF-36), and quality of life (EQ-5D).
Mean caregiver age was 60.0 +/- 16.1 years and 70.5% were female. More caregivers of depressed seniors provided more care in the previous month (37.3% vs 22.4%, p = 0.03), had poor mental health (63.5% vs 47.0%, p = 0.03), and poor perceived quality of life (63.5% vs 50.4%, p = 0.04) compared to caregivers of non-depressed seniors. Multiple logistic regression analyses indicated that patient depression was associated with poor caregiver quality of life (OR = 3.15, 95% CI 1.48, 6.73), and poor mental health in spousal and adult child caregivers (OR = 2.72, 95% CI = 0.88, 8.39, and OR = 3.29, 95% CI = 1.10, 9.86, respectively).
Psychosocial support may be needed for caregivers of depressed seniors.
To assess the association between pain and depression in a population of older adults.
We conducted a cross-sectional study using data from the Aged in Home Care (AdHOC) database, which contains information on older adults receiving home care services in 11 European countries from 2001 to 2003. Pain was defined as any type of pain or discomfort manifested over the 7 days preceding the assessment. Depression was defined as a score >or= 3 on the Minimum Data Set Depression Rating Scale.
Mean age of 3976 subjects entering the study was 82.3 years, and 2948 (74.1%) were women. Of the total sample, 2380 subjects presented with pain (59.9%), but its prevalence differed substantially among countries. Depression was diagnosed in 181 (11.3%) of the 1596 participants without pain and in 464 (19.5%) of the 2380 participants with pain (p < .001). After adjusting for potential confounders, pain was significantly associated with depression (odds ratio [OR] 1.76, 95% confidence interval [CI] = 1.43 to 2.17). This association seemed to be modified by sex. Compared to male participants without pain, women with pain were significantly more likely to present with depression (OR = 1.77; 95% CI = 1.29 to 2.42), while no significant difference was observed for women without pain (OR = 0.86; 95% CI = 0.61 to 1.22) and men with pain (OR = 1.24; 95% CI = 0.86 to 1.79). Among women, the association of pain and depression became progressively more pronounced as pain severity, pain frequency, and number of painful sites increased.
This study documented that in a large sample of older adults living in the community, pain is associated with depression, especially among women.
Caregivers of people with dementia are at high risk of psychological morbidity and associated breakdown in care. Many psychologically based interventions have been designed to help caregivers of people with dementia. More work is needed to identify which, if any, are helpful for such caregivers.
We conducted a systematic review of the immediate and long term efficacy of different types of psychological interventions for the psychological health of caregivers of people with dementia, using standardized criteria, to assist clinicians in implementing rational, evidence-based management recommendations. We reviewed studies examining the effects of any therapy derived from a psychological approach that satisfied pre-specified criteria. Using the Oxford Centre for Evidence-Based Medicine criteria we rated the quality of each study, extracted data and gave overall ratings to different types of intervention.
We identified 244 references in our search of which 62 met our inclusion criteria.
Our findings are limited by lack of good quality evidence, with only ten level 1 studies identified.
We found excellent evidence for the efficacy of six or more sessions of individual behavioral management therapy centered on the care recipient's behavior in alleviating caregiver symptoms both immediately and for up to 32 months. Teaching caregivers coping strategies either individually or in a group also appeared effective in improving caregiver psychological health both immediately and for some months afterwards. Group interventions were less effective than individual interventions. Education about dementia by itself, group behavioral therapy and supportive therapy were not effective caregiver interventions.
EUROCARE: a cross-national study of co-resident spouse carers for people with Alzheimer's disease: I. Factors associated with carer burden
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