Clinical & Translational Science Institute, National Clinician Scholars Program, Duke University.
Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI.
Med Care. 2022 Nov 1;60(11):844-851. doi: 10.1097/MLR.0000000000001771. Epub 2022 Aug 26.
Caring for a partner with dementia poses significant emotional burden and high care demands, but changes in impacts before and after dementia onset is unclear.
Examine changes in depressive symptoms and hours of care provided by caregivers through the course of their partners' cognitive decline.
Retrospective, observational study using household survey data from 2000-2016 Health and Retirement Study and count models to evaluate older individuals' (ages ≥51 y) depressive symptoms (measured using the shortened Center for Epidemiologic Studies Depression Scale) and weekly caregiving in the 10 years before and after their partners' dementia onset (identified using Telephone Interview Cognitive Status screening). Relationships were examined overall and by sex and race.
We identified 8298 observations for 1836 older caregivers whose partners developed dementia. From before to after partners' dementia onset, caregivers' mean (SD) depressive symptoms increased from 1.4 (1.9) to 1.9 (2.1) ( P <0.001) and weekly caregiving increased from 4.4 (19.7) to 20.8 (44.1) ( P <0.001) hours. Depressive symptoms and caregiving hours were higher for women compared with men. Depressive symptoms were higher for Blacks compared with Whites, while caregiving hours were higher for Whites. The expected count of caregivers' depressive symptoms and caregiving hours increased by 3% ( P <0.001) and 9% ( P =0.001) before partners' dementia onset and decreased by 2% ( P <0.001) and 1% ( P =0.63) following partners' dementia onset. No differences observed by sex or race.
Depressive symptoms and instrumental burdens for caregivers increase substantially before the onset of dementia in partners. Early referral to specialty services is critical.
照顾患有痴呆症的伴侣会带来巨大的情感负担和高需求的护理，但在痴呆症发病前后，这些影响的变化尚不清楚。
通过对伴侣认知能力下降过程中的数据进行回顾性观察研究，来评估痴呆症发病前后，护理人员的抑郁症状和护理时间的变化。
使用 2000-2016 年健康与退休研究（Health and Retirement Study）的家庭调查数据进行回顾性观察研究，并使用计数模型来评估年龄在 51 岁及以上的个体（年龄≥51 岁）在其伴侣痴呆症发病前 10 年和发病后（通过电话访谈认知状态筛查确定）的抑郁症状（使用简化版流行病学研究中心抑郁量表进行测量）和每周的护理时间。研究还考察了不同性别和种族的情况。
我们共识别出 1836 名患有痴呆症的老年护理人员的 8298 个观测值。从伴侣痴呆症发病前到发病后，护理人员的平均（标准差）抑郁症状从 1.4（1.9）增加到 1.9（2.1）（P <0.001），每周护理时间从 4.4（19.7）增加到 20.8（44.1）（P <0.001）小时。与男性相比，女性的抑郁症状和护理时间更高。与白人相比，黑人的抑郁症状更高，而白人的护理时间更高。在伴侣痴呆症发病前，护理人员的抑郁症状和护理时间预期计数分别增加了 3%（P <0.001）和 9%（P =0.001），在伴侣痴呆症发病后分别减少了 2%（P <0.001）和 1%（P =0.63）。未观察到性别或种族差异。
在伴侣痴呆症发病前，护理人员的抑郁症状和护理负担会显著增加。早期向专业服务机构转介至关重要。
