Development of a Brief Caregiver-centric Screening Tool to Identify Risk of Depression among Caregivers of Hospitalized Older Adults

Abstract

Objectives Caregivers of hospitalized older adults experience elevated levels of stress and are at risk of poor health outcomes. There is a lack of screening tools based on self-reported caregiver variables incorporating both protective and risk factors, for early identification of at-risk caregivers. This study reports the development of a caregiver-centric screening tool to identify risk of depression at admission and predicts 3-month risk of depression and quality of life amongst caregivers of older adults with an unplanned admission. Design, Setting and Participants This prospective cohort study was conducted in the medical wards of a tertiary-care hospital from July 2015 to May 2017. We recruited family caregivers of patients aged 65 years and above who fulfilled the following criteria: a) unplanned admission, b) not residing in nursing homes; and c) requiring assistance in activities of daily living. Measurements We examined 11 candidate caregiver variables (mastery, burden and nine demographic variables). Risk of depression (score ≥8 on Hospital Anxiety and Depression Scale (HADS-D) depression subscale) was the primary outcome, and was assessed during the index admission. Logistic regression models were used to identify risk factors and risk scores (weights). The total risk scores were then stratified into three risk levels. Predictive validity of the screening tool was assessed using 3-months post-discharge risk of depression and health-related quality of life (HRQoL). Results The study included 274 caregiver-patient dyads. The mean (SD) age of the caregivers was 59 ( 10 ) years with 33.6% caregivers screening positive for risk of depression. The final model comprised three caregiver variables: mastery, burden and education. The total risk scores ranged from 0 to 6 and showed good discrimination (AUC:0.82, 95% CI: 0.77 to 0.87). Caregivers were classified into low-risk (0–1 points), intermediate-risk (2–4 points), and high-risk (5–6 points) groups, with corresponding rates of risk of depression (HADS-D≥8) of 10.7%, 44.6% and 73.3%, during admission. Relative risk rates of the intermediate- and high-risk group using the low-risk group as reference were 4.16 and 6.84 respectively. At 3-months post-discharge, the rates of caregivers at risk of depression or having poor HRQoL also increased corresponding to the three risk levels as per baseline, supporting the predictive validity of the tool. Conclusions/Implications The caregiver-centric tool is a novel, practical, self-administered, relatively brief caregiver-centric instrument that can be used for rapid screening and stratification of caregivers at risk of depression. Uniquely, the tool comprised of assessment of protective factor (mastery) in addition to risk factors to provide a holistic assessment of the caregiver. It can be incorporated as part of older adults’ admission evaluation so that promp...

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“…This can include telehealth programs such as the “Circle of Friends” as enhanced use of social media ( 46 ). Care should be taken to screen for dysphoria/depression and provide psychological therapy when it occurs ( 47 ).…”

Family caregivers expect a patient and family centric approach in holistic end-of-life provision

“…The authors postulate that such family expectations for care for themselves is driven by negative psychological outcomes endured by family members, possibly during caregiving or admission of their loved one. Indeed, one study mentioned that 33.6% of caregivers are screened positive for a risk of depression 2…”

A challenging journey: The experience of elderly patients and their close family members after major emergency abdominal surgery

“…Critical illness and hospitalisation of a close relative are also a serious family stressor, and families may be overwhelmed by worries and fear that the patient may not survive (14–16). Serious illness has an impact on both patients and their close family members, and often close family members care for the patients after discharge (17–19).…”

“…This may be satisfying and may improve the relationship with the patient (20); however, it often increases demands on family members, causing them to become both emotionally challenged and physically exhausted (20–22). Studies have found that family caregivers to elderly hospitalised patients and to patients recovering from critical illness are at increased risk of depression and impaired health‐related quality of life (15–17). However, the caregiving burden should be seen in the light of closeness of family relationships, level of patient dependency, number of caregiver obligations and caregiver preparedness (23, 24).…”