@article {732, title = {Transitions in spousal caregiving.}, journal = {Gerontologist}, volume = {43}, year = {2003}, month = {2003 Apr}, pages = {230-41}, abstract = {

PURPOSE: This study describes transitions over 5 years among community-dwelling elderly spouses into and within caregiving roles and associated health outcomes.

DESIGN AND METHODS: Participants in the Caregiver Health Effects Study (n = 818) were interviewed four times over 5 years with changes in their caregiving status described. Analyses of the effect on health outcomes of transitions were performed on those for whom four observations were available (n = 428).

RESULTS: Only half (49.5\%) of noncaregivers at baseline remained noncaregivers at 5-year follow-up. The remainder experienced one or more transitions, including moving into the caregiving role, their own or their spouse{\textquoteright}s death, or placement of their spouse in a long-term care facility. The trajectory of health outcomes associated with caregiving was generally downward. Those who transitioned to heavy caregiving had more symptoms of depression, and poorer self-reported health and health behaviors.

IMPLICATIONS: Transitions into and within the caregiving role should be monitored for adverse health effects on the caregiver, with interventions tailored to the individual{\textquoteright}s location in the caregiving trajectory.

}, keywords = {Adaptation, Psychological, Aged, Aged, 80 and over, Caregivers, Female, Health Behavior, Health Status, Humans, Long-Term Care, Male, Residence Characteristics, Spouses, Stress, Psychological, Time Factors}, issn = {0016-9013}, doi = {10.1093/geront/43.2.230}, author = {Burton, Lynda C and Zdaniuk, Bozena and Schulz, Richard and Jackson, Sharon and Hirsch, Calvin} } @article {767, title = {Concurrent and long-term predictors of older adults{\textquoteright} use of community-based long-term care services: the Caregiver Health Effects Study.}, journal = {J Aging Health}, volume = {16}, year = {2004}, month = {2004 Feb}, pages = {88-115}, abstract = {

OBJECTIVE: This study examined concurrent and long-term associations between caregiver-related characteristics and the use of community long-term care services in a sample of 186 older adults caring for a disabled spouse.

METHOD: We used two waves of data from the Caregiver Health Effects Study, an ancillary study of the Cardiovascular Health Study. Caregiver-related need variables as predictors of service use were of primary interest and included caregiving demands, caregiver mental and physical health, and mastery. Their contribution to service use was examined after controlling for known predictors of service use.

RESULTS: At Time 1, more caregiver depressive symptoms predicted greater service use; at Time 2, more caregiver activity restriction and depressive symptoms predicted greater formal service use; increases in caregiver activity restriction and depressive symptomatology over time predicted increases in service use.

DISCUSSION: Caregiver-related need variables play a significant role in defining utilization patterns of community-based long-term care services among older adults.

}, keywords = {Aged, Caregivers, Community Health Services, Disabled Persons, Forecasting, Health Services for the Aged, Humans, Long-Term Care, Regression Analysis, Spouses, United States}, issn = {0898-2643}, doi = {10.1177/0898264303260448}, author = {Bookwala, Jamila and Zdaniuk, Bozena and Burton, Lynda and Lind, Bonnie and Jackson, Sharon and Schulz, Richard} } @article {828, title = {The course of functional decline in older people with persistently elevated depressive symptoms: longitudinal findings from the Cardiovascular Health Study.}, journal = {J Am Geriatr Soc}, volume = {53}, year = {2005}, month = {2005 Apr}, pages = {569-75}, abstract = {

OBJECTIVES: To examine the relationship between persistently high depressive symptoms and long-term changes in functional disability in elderly persons.

DESIGN: A community-based, prospective, observational study.

SETTING: Participant data from the Cardiovascular Health Study.

PARTICIPANTS: From the overall sample of 5,888 subjects, three types of participants were identified for this study: (1) persistently depressed individuals, who experienced an onset of depressive symptoms that persisted over 4 years (n=119); (2) temporarily depressed individuals, who experienced an onset of depressive symptoms that resolved over time (n=259); and (3) nondepressed individuals, with persistently low depressive symptoms throughout the follow-up period who were matched on baseline activity of daily living (ADL) scores, sex, and age to the previous two groups combined (n=378).

MEASUREMENTS: Four consecutive years of data were assessed: validated measures of depression (10-item CES-D), functional disability (10-item ADL/instrumental ADL measure), physical performance, medical illness, and cognition.

RESULTS: The persistently depressed group showed a greater linear increase in functional disability ratings than the temporarily depressed and nondepressed groups. This association between persistent depression and functional disability was robust even when controlling for baseline demographic and clinical/performance measures, including cognition. The persistently depressed group had an adjusted odds ratio (OR) of 5.27 (95\% confidence interval (CI) 3.03-9.16) for increased functional disability compared with the nondepressed group over 3 years of follow-up, whereas the temporarily depressed group had an adjusted OR of 2.39 (95\% CI=1.55-3.69) compared with the nondepressed group.

CONCLUSION: Persistently elevated depressive symptoms in elderly persons are associated with a steep trajectory of worsening functional disability, generating the hypothesis that treatments for late-life depression need to be assessed on their efficacy in maintaining long-term functional status as well as remission of depressive symptoms. These results also demonstrate the need for studies to differentiate between persistent and temporary depressive symptoms when examining their relationship to disability.

}, keywords = {Activities of Daily Living, Aged, Case-Control Studies, Depressive Disorder, Disabled Persons, Female, Humans, Longitudinal Studies, Male, Multivariate Analysis, Risk, United States}, issn = {0002-8614}, doi = {10.1111/j.1532-5415.2005.53202.x}, author = {Lenze, Eric J and Schulz, Richard and Martire, Lynn M and Zdaniuk, Bozena and Glass, Thomas and Kop, Willem J and Jackson, Sharon A and Reynolds, Charles F} }