Transcript Information Systems and Psychological Issues

Our Aging
Population: Mental Health
in the Advancing Years
Sara J. Czaja
Department of Psychiatry and Behavioral
Sciences
Center on Aging
University of Miami Miller School of Medicine
This research discussed is supported in part by grants from the NIH/NIA, NINR,
Langeloth Foundation, AOA, J&J, and AT&T
Overview of Presentation
• Provide a brief overview of the
current demographic trends.
• Summarize findings regarding
mental health of older adults.
• Summarize findings regarding
family caregiving and mental
health.
• Present examples of on-going
caregiver intervention research at
UM.
Significance of the Issue
• Projected increase in the elderly population especially “oldest
old” who require more care and long term assistance.
Older Adults and Depression
• Diagnosed rates of depression:
– Community Dwelling Older Adults
• Major depression ~ 2%
• Minor depression ~ 10%
• Depressive symptoms ~ 14%
– Primary Care Settings ~7 - 36%
– Hospitalized patient ~ 25%
– Long term care residents ~ 20 – 47%
• Primary health care providers often fail to diagnosis
depression in older patients.
• Ethnic and racial minorities are less likely than
Caucasian elderly to seek specialty mental health care.
Older Adults and Depression
• Prevalence of depression (major and minor) in
persons with dementia: 30-50%.
• Depression is associated with cognitive
impairment.
• History of depression has been shown to be
linked to increased risk to develop
Alzheimer’s disease (AD) and vascular
dementia later in life.
Reasons for Non-Recognition of Geriatric
Depression
• Symptoms attributed to chronic medical conditions
due to somatic presentations.
• Often do not complain of depressed mood or other
symptoms such as crying spells, or irritability.
• Social isolation and withdrawal.
• Symptoms not prominent every day.
• Depression seen as “normal” part of aging.
• Psychosocial and physical losses divert attention from
consideration of depression diagnosis.
• Stigma.
Consequences of Untreated Depression
• Worldwide, depression is a leading cause of
disability adjusted life years (DALY).
• Increased health services utilization.
• Greater morbidity and mortality due to cooccurring cardiovascular disease.
• Increased risk for suicide.
• Withdrawal/social isolation.
• Fatigue/lack of energy.
DEPRESSION AND FAMILY
CAREGIVERS
Significance of the Issue
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Changes in healthcare dynamics – moving towards a
partnership model of care.
Trend from in-patient to out-patient care and increased
reliance on family members to provide needed care and
support.
Family caregivers represent the largest source of long-term care
for older adults.
 29% of the U.S. adult population is providing care for
someone who is disabled, seriously ill or aged and 59%
expects to be a caregiver in the future.
 66% of caregivers are providing caregiver for an adult aged
50+ and 15 million adults are providing care for someone
with Alzheimer’s disease or other dementia.
Health and needs of family caregivers are often overlooked.
Alzheimer’s Association, 2015
Definition of Family Caregiving
 “Extraordinary
care involving significant expenditure of time and
energy often for months or years, requiring the performance of
tasks that may be physically demanding and unpleasant.”
 extraordinary care -- tasks that exceed the bounds of what is
normative or usual for a parental, sibling, or spousal
relationship.
 assistance is provided for no compensation, either voluntarily
or because there are no other alternatives.
 caregivers typically do not receive formal training for the
caregiving role.
Schulz & Quittner (1998). Health Psychology
Caregiving Tasks
• Care Coordination
– Primary Care MD
– Specialist MD
– Physical
Therapist/Occupational
Therapist
– Insurance company
• Personal Care Tasks
–
–
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Bathing
Dressing/Grooming
Eating
Toileting/Transferring
• Household Tasks
– Shopping
– Managing finances
– Transportation
• Medical or Nursing Tasks
– Managing medications, including
IVs
– Operating medical equipment
– Using monitors or assistive devices
– Wound care
• Emotional, Cognitive and
Behavioral Support
– Helping with depression/social
isolation
– Managing wandering
– Managing behavioral agitation
– Helping with memory (names,
locations)
Mental Health Consequences of Caregiving

40 % to 70% of caregivers have clinically significant
symptoms of depression Depression tends to be
higher among:

Female and spousal caregivers

Caregivers of dementia patients and those with mental
illness.

Depression is associated with behavior problems,
cognitive impairments and care burden

Caregivers use prescription drugs for depression,
anxiety, and insomnia 2-3 time more thanthe rest of
the population.
Transition group
Burton, Zdaniuk, & Schulz et al. (2003). The Gerontologist
Caregiver Intervention Studies: Summary of
Findings
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There have been numerous studies aimed at
developing interventions for caregivers
On average, successful in:
 Alleviating burden
 Depression
 Increasing general subjective well-being
 Increasing ability/knowledge
 Delaying placement
Many caregivers do not have access to or take
advantage of existing programs and resources
Community REACH
• Translation of REACH II Multi-componet
Psychosocial Intervention Program to a
Community Agency: United HomeCare
Services
– Largest Community Care for the Elderly
Agency in the State of Florida
• Partners: UM Center on Aging, Alzheimer’s
Association, Alliance on Aging, United
HomeCare Services
Program Design
• Target sample: 150 dyads recruited over three-years.
• The intervention duration was 6-months.
• The intervention consisted of 12 individual sessions (6 home
sessions and 6 telephone sessions) and 5 telephone supportgroup sessions:
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Education about caregiving and dementia
Caregiving skills
Management of behavioral problems
Stress management
Self-care and health
Social support
• The intervention was delivered by United Home Care who
were trained and supervised by the UM team.
• Pre-Post Study Design.
Sample Characteristics (N = 146 dyads)
• Caregiver:
– Gender: Female: 77%; Male: 23%
– Age: mean = 65.7 yrs; SD = 12.8
– Providing care from 6 months to up to 32 years
– Hispanic: 83%
– CESD 16 or > : 47%
• CR:
– Gender: Female 61%; Male 39%
– Age: mean = 82.4 yrs; SD = 6.1
– MMSE: mean = 11.1; SD = 7.80
– ADLs: mean = 4.5; SD = 1.8
– IADLS: mean = 7.21; SD =1.03
Factors Related to Depressive Symptoms
Variable
CESD SCORE
Social Support
R = -.27 (p < .01)
Help with basic activities of daily living
R = .16 (p = .05)
Burden of care
R = .55 (p < .001)
Perceptions of caregiving experience
R = -.33 (p < .001)
Results: 6th month follow-up (n = 109)
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Decrease in CG depressive symptoms (p <.01).
Decrease in overall burden (p <.01).
Significantly less bothered by care recipients behavior (p <.001).
Increased use of formal care and services for CG and CR (p <.01).
Increase in perceived social support (p <.01).
Increase in positive feelings about being in the caregiver role (p
<.05).
• Increase in quality of sleep (p <.01).
Results: 12th month follow-up (n = 101)
• The impact of the intervention on caregiver
outcomes was maintained at 12 months.
• No changes (from 6 mths) in CG depression,
burden, being bothered by CR behavior, or
positive feelings about being a CG.
• Decrease in perceived social support and use
of formal care and services for the CR.
Program Evaluation
• Caregivers indicated that they benefited a great deal from
participating in the intervention (89%).
• The majority felt that the intervention did a great deal to make
caregivers life easier (61%).
• All of the caregivers (100%) indicated that they would
recommend the intervention to a friend.
• Most (85%) indicated that the support groups were valuable.
• Caregiving benefits:
– Better understanding of memory loss
– Better able to provide care for their loved ones
– Helped to keep the CR living at home
– Enhanced the CGs’ life
Sample Caregiver Reaction
“My name is L.D., 80 y/o; caregiver of my 81 y/o husband J.D.
diagnosed with Alzheimer. I don't know how would I have
survived physically and emotionally without the help received
from United Home Care. Through the REACH program where
sharing with other people takes away the feeling of loneliness;
then my counselors have been everything to me. They have
given me the strength and support that have kept me from a
total breakdown; now I have the tools they taught me to care
for myself. The help of having a respite provided me to have
time for myself. Your program provides the help, strength and
support so much needed by families of caregivers. In my case
I could not have continued without REACH.
THANK YOU, L.D.”
A Tailored Technology Intervention
for Diverse Family Caregivers of AD
Patients
Study Aims and Goals
Aims:
• Evaluate the acceptability of a culturally tailored technologybased psychosocial intervention for family caregivers of AD
patients.
• Evaluate the impact of the intervention on caregiver
outcomes (emotional distress, burden, caregiving skills).
• Gather data on ethnic differences in response to the
intervention.
Overall Goals:
Develop an effective intervention program that:
• Improves the quality of life of caregivers of AD patients
• Enhance skills of and access to formal and informal
support for caregivers
Study Design
Summary and Conclusions
Depression is often undiagnosed in older adults
and family caregivers.
 Consequences of depression in late life are
significant.
 Need better strategies for assessment of
depression in older patients and family caregivers.
 Need better information on the link between
cognitive impairment and depression.
 Non-pharmacological intervention approaches are
successful in improving caregiver outcomes.
More information is needed on the biological markers
of depression
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