DEPRESSIVE SYMPTOM SEVERITY AMONG FAMILY MEMBERS OF OLDER ADULTS WITH HETEROGENEOUS COGNITIVE VULNERABILITY

Abstract

Introduction Cognitive vulnerability among community-dwelling older adults (age > 65) refers to living with cognitive impairment due to dementia, experiencing delirium which is associated with longer-term cognitive impairment, and/or living with depression which is a known risk factor for cognitive impairment. Family members of older adults with dementia often report considerable levels of depressive symptoms, and many interventions for these family members aim to reduce their depressive symptoms. However, much less is known about depressive symptoms among family members of older adults with depression or recent episodes of delirium. Therefore, in this study we compared levels of depressive symptoms among family members of older adults based on type and severity of older adults’ cognitive vulnerability. Methods This study utilized baseline data from an ongoing randomized clinical trial testing the efficacy of an in-home multidisciplinary team care management intervention for older adults with cognitive vulnerability. During eligibility assessment, older adults are determined to have dementia based on score of 16 on the Center for Epidemiologic Studies Depression (CESD) Scale, and recent delirium based on the informant version of the Confusion Assessment Method (FAM CAM). Family members of older adults are required to join the clinical trial if older adults have dementia or recent delirium, and they are invited to join if older adults have depression without dementia or delirium. Baseline data are collected during in-person, in-home interviews conducted separately with older adults and with family members; this study includes baseline data from the first 259 dyads enrolled in the trial. We measured older adults’ cognitive vulnerability in 3 ways: (1): whether their eligibility determination was dementia, depression, and/or delirium; groups sizes were dementia only (n=76); depression only (n=70); depression and dementia (n=56); and delirium plus depression and/or dementia (n=57); (2) cognitive impairment severity based on TICS score; and (3) depressive symptom severity based on CESD score. Family member depression severity was measured based on their CESD score. In 3 separate multivariate regression models, family caregiver depression severity was regressed on each of the three measures of cognitive vulnerability; covariates in all models included family member sex, familial relationship of family member to older adults, and number of hours per week the family member reported caring for the older adult. Results Among older adults, 57% were female, mean/sd age=77/6.9, and 91% were White; among family members, 63% were female, mean/sd age=66/13.8, 90% were White, 54% spouses, 24% daughters, 9% sons, the remainder other family members. Controlling for covariates, we found that family member depressive symptom severity was: (1) least severe if older adults had dementia only (CESD adjusted mean=5.6) and most severe if older adults had depression only (CESD adjusted mean score=9.8) (b=4.2; p Conclusions Family members of older adults report greater depressive symptoms when their older relatives also have depression compared to when their older relatives have dementia, even after accounting for familial relationship and how much care family members provide to their older relatives. We conclude that family members of older adults with depression deserve greater clinical and research attention to address their own depressive symptoms. This research was funded by: Patient-Centered Outcomes Research Institute (PCORI Award # IHS-1502-27171)