Objectives To compare depressive symptoms between caregivers to persons with dementia and other illnesses, and determine whether caregiver role captivity and care recipient disruptive behaviors mediate this association. Design Prospective cohort study of older women in four U.S. communities followed from 1999 to 2009. Setting Home-based interviews. Participants 345 caregiving participants from the Caregiver-Study of Osteoporotic Fractures. Measurements Caregiver status based on self-report of performing one or more instrumental or basic activities of daily living for care recipient. Depressive symptoms measured using the 20-item Center for Epidemiologic Studies Depression Scale. Scores of 16 or greater represented high depressive symptoms. Caregiver role captivity and care recipient problematic behaviors measured using validated instruments. Results Approximately one-third of the caregivers cared for a person with dementia. High depressive symptoms were more common among dementia caregivers (22.8% vs. 11.2%, p <0.001), (unadjusted odds ratio [OR] 2.12, 95% CI 1.20-3.74). This association was completely mediated by caregiver role captivity and care recipient problematic behaviors. In adjusted results, high depressive symptoms was associated with middle and highest tertiles of role captivity (adjusted odds ratios [AOR] 5.01, 95% CI 2.31-11.05 and 9.41, 95% CI 3.95-22.40 for the middle and highest tertiles, respectively) and care recipient problematic behaviors (AOR 2.52 95% CI 1.02-6.19 and 5.26, 95% CI 2.00-13.8 for each tertile, respectively). Conclusions Older caregivers to persons with dementia are at increased risk of high depressive symptoms. Targeting problematic behaviors among dementia patients and addressing aspects of dementia care that result in role captivity may ameliorate caregiver depression.
Objectives Recent findings of better health outcomes in older caregivers than noncaregivers suggest a healthy caregiver hypothesis (HCH) model may be more appropriate than the stress process model for evaluating the health effects of caregiving. In a cross-sectional study, we tested the HCH on two cognitive domains: verbal memory and processing speed. Method Participants from the Caregiver Study of Osteoporotic Fractures who had a 2-year follow-up interview were categorized as continuous caregivers (n = 194), former caregivers (n = 148), or continuous noncaregivers (n = 574). The Hopkins Verbal Learning Test (HVLT; memory) and Digit Symbol Substitution Task (DSST; processing speed) were administered at the follow-up interview. Results Continuous caregivers had better memory performance and processing speed than continuous noncaregivers: adjusted mean scores for HVLT were 18.38 versus 15.80 (p < .0001), and for DSST were 35.91 versus 34.38 (p = .09). Discussion Results support the HCH model for cognitive outcomes in older women caregivers; however, the relationship may be domain specific.
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