03320nas a2200373 4500008004100000022001400041245008300055210006900138260001600207300001100223490000800234520230600242653003102548653000902579653002202588653001502610653002102625653001102646653001802657653001702675653001102692653000902703653001402712653003202726653002402758653001702782653002602799653001202825653002602837653001802863100001402881700001602895856003502911 1999 eng d a0098-748400aCaregiving as a risk factor for mortality: the Caregiver Health Effects Study.0 aCaregiving as a risk factor for mortality the Caregiver Health E c1999 Dec 15 a2215-90 v2823 a

CONTEXT: There is strong consensus that caring for an elderly individual with disability is burdensome and stressful to many family members and contributes to psychiatric morbidity. Researchers have also suggested that the combination of loss, prolonged distress, the physical demands of caregiving, and biological vulnerabilities of older caregivers may compromise their physiological functioning and increase their risk for physical health problems, leading to increased mortality.

OBJECTIVE: To examine the relationship between caregiving demands among older spousal caregivers and 4-year all-cause mortality, controlling for sociodemographic factors, prevalent clinical disease, and subclinical disease at baseline.

DESIGN: Prospective population-based cohort study, from 1993 through 1998 with an average of 4.5 years of follow-up.

SETTING: Four US communities.

PARTICIPANTS: A total of 392 caregivers and 427 noncaregivers aged 66 to 96 years who were living with their spouses.

MAIN OUTCOME MEASURE: Four-year mortality, based on level of caregiving: (1) spouse not disabled; (2) spouse disabled and not helping; (3) spouse disabled and helping with no strain reported; or(4) spouse disabled and helping with mental or emotional strain reported.

RESULTS: After 4 years of follow-up, 103 participants (12.6%) died. After adjusting for sociodemographic factors, prevalent disease, and subclinical cardiovascular disease, participants who were providing care and experiencing caregiver strain had mortality risks that were 63% higher than noncaregiving controls (relative risk [RR], 1.63; 95% confidence interval [CI], 1.00-2.65). Participants who were providing care but not experiencing strain (RR, 1.08; 95 % CI, 0.61-1.90) and those with a disabled spouse who were not providing care (RR, 1.37; 95% CI, 0.73-2.58) did not have elevated adjusted mortality rates relative to the noncaregiving controls.

CONCLUSIONS: Our study suggests that being a caregiver who is experiencing mental or emotional strain is an independent risk factor for mortality among elderly spousal caregivers. Caregivers who report strain associated with caregiving are more likely to die than noncaregiving controls.

10aActivities of Daily Living10aAged10aAged, 80 and over10aCaregivers10aDisabled Persons10aFemale10aHealth Status10aHome Nursing10aHumans10aMale10aMortality10aProportional Hazards Models10aProspective Studies10aRisk Factors10aSocioeconomic Factors10aSpouses10aStress, Psychological10aUnited States1 aSchulz, R1 aBeach, S, R uhttps://chs-nhlbi.org/node/60502940nas a2200373 4500008004100000022001400041245009900055210006900154260001600223300001100239490000800250520194800258653000902206653002102215653001502236653002402251653001102275653002902286653001102315653000902326653001502335653001502350653001702365653001202382653002602394653001802420100001402438700001602452700001502468700001802483700001602501700001402517856003502531 2000 eng d a0003-992600aAssociation between depression and mortality in older adults: the Cardiovascular Health Study.0 aAssociation between depression and mortality in older adults the c2000 Jun 26 a1761-80 v1603 a

BACKGROUND: Studies of the association between depressive symptoms and mortality in elderly populations have yielded contradictory findings. To address these discrepancies, we test this association using the most extensive array of sociodemographic and physical health control variables ever studied, to our knowledge, in a large population-based sample of elderly individuals.

OBJECTIVE: To examine the relation between baseline depressive symptoms and 6-year all-cause mortality in older persons, systematically controlling for sociodemographic factors, clinical disease, subclinical disease, and health risk factors.

METHODS: A total of 5201 men and women aged 65 years and older from 4 US communities participated in the study. Depressive symptoms and 4 categories of covariates were assessed at baseline. The primary outcome measure was 6-year mortality.

RESULTS: Of the 5201 participants, 984 (18.9%) died within 6 years. High baseline depressive symptoms were associated with a higher mortality rate (23.9%) than low baseline depression scores (17.7%) (unadjusted relative risk [RR], 1.41; 95% confidence interval [CI], 1.22-1.63). Depression was also an independent predictor of mortality when controlling for sociodemographic factors (RR, 1.43; 95% CI, 1.23-1.66), prevalent clinical disease (RR, 1.25; 95% CI, 1.07-1.45), subclinical disease indicators (RR, 1.35; 95% CI, 1.15-1.58), or biological or behavioral risk factors (RR, 1.42; 95% CI, 1.22-1.65). When the best predictors from all 4 classes of variables were included as covariates, high depressive symptoms remained an independent predictor of mortality (RR, 1.24; 95% CI, 1.06-1.46).

CONCLUSIONS: High levels of depressive symptoms are an independent risk factor for mortality in community-residing older adults. Motivational depletion may be a key underlying mechanism for the depression-mortality effect.

10aAged10aAlcohol Drinking10aDepression10aDepressive Disorder10aFemale10aHealth Status Indicators10aHumans10aMale10aMotivation10aPrevalence10aRisk Factors10aSmoking10aSocioeconomic Factors10aUnited States1 aSchulz, R1 aBeach, S, R1 aIves, D, G1 aMartire, L, M1 aAriyo, A, A1 aKop, W, J uhttps://chs-nhlbi.org/node/61801932nas a2200349 4500008004100000022001400041245013700055210006900192260001300261300001100274490000700285520098400292653000901276653001201285653001501297653001501312653002101327653001101348653002001359653001801379653001101397653002501408653000901433653001801442653001601460653001201476100001601488700001401504700001401518700001501532856003501547 2000 eng d a0882-797400aNegative and positive health effects of caring for a disabled spouse: longitudinal findings from the caregiver health effects study.0 aNegative and positive health effects of caring for a disabled sp c2000 Jun a259-710 v153 a

Data from the first 2 waves of the Caregiver Health Effects Study (n = 680) were analyzed to examine the effects of changes in caregiving involvement on changes in caregiver health-related outcomes in a population-based sample of elders caring for a disabled spouse. Caregiving involvement was indexed by levels of (a) spouse physical impairment, (b) help provided to the spouse, and (c) strain associated with providing help. Health-related outcomes included perceived health, health-risk behaviors, anxiety symptoms, and depression symptoms. Increases in spouse impairment and caregiver strain were generally related to poorer outcomes over time (poorer perceived health, increased health-risk behaviors, and increased anxiety and depression), whereas increased helping was related to better outcomes (decreased anxiety and depression). Results suggest that caring for a disabled spouse is a complex phenomenon that can have both deleterious and beneficial consequences.

10aAged10aAnxiety10aCaregivers10aDepression10aDisabled Persons10aFemale10aHealth Behavior10aHealth Status10aHumans10aLongitudinal Studies10aMale10aMental Health10aRisk-Taking10aSpouses1 aBeach, S, R1 aSchulz, R1 aYee, J, L1 aJackson, S uhttps://chs-nhlbi.org/node/61904047nas a2200409 4500008004100000022001400041245011700055210006900172260001600241300001100257490000800268520296800276653000903244653002203253653002603275653001603301653001503317653001003332653001503342653001103357653002203368653002003390653001103410653000903421653002603430653001203456653001603468100001403484700001603498700001203514700001803526700001503544700001403559700001503573700001403588856003503602 2001 eng d a0098-748400aInvolvement in caregiving and adjustment to death of a spouse: findings from the caregiver health effects study.0 aInvolvement in caregiving and adjustment to death of a spouse fi c2001 Jun 27 a3123-90 v2853 a

CONTEXT: Most deaths in the United States occur among older persons who have 1 or more disabling conditions. As a result, many deaths are preceded by an extended period during which family members provide care to their disabled relative.

OBJECTIVE: To better understand the effect of bereavement on family caregivers by examining predeath vs postdeath changes in self-reported and objective health outcomes among elderly persons providing varying levels of care prior to their spouse's death.

DESIGN AND SETTING: Prospective, population-based cohort study conducted in 4 US communities between 1993 and 1998.

PARTICIPANTS: One hundred twenty-nine individuals aged 66 to 96 years whose spouse died during an average 4-year follow-up. Individuals were classified as noncaregivers (n = 40), caregivers who reported no strain (n = 37), or strained caregivers (n = 52).

MAIN OUTCOME MEASURES: Changes in depression symptoms (assessed by the 10-item Center for Epidemiological Studies-Depression [CES-D] scale), antidepressant medication use, 6 health risk behaviors, and weight among the 3 groups of participants.

RESULTS: Controlling for age, sex, race, education, prevalent cardiovascular disease at baseline, and interval between predeath and postdeath assessments, CES-D scores remained high but did not change among strained caregivers (9.44 vs 9.19; P =.76), while these scores increased for both noncaregivers (4.74 vs 8.25; F(1,116) = 14.33; P<.001) and nonstrained caregivers (4.94 vs 7.13; F(1,116) = 4.35; P =.04). Noncaregivers were significantly more likely to be using nontricyclic antidepressant medications following the death than the nonstrained caregiver group (odds ratio [OR], 12.85; 95% confidence interval [CI], 1.02-162.13; P =.05). The strained caregiver group experienced significant improvement in health risk behaviors following the death of their spouse (1.47 vs 0.66 behaviors; F(1,118) = 20.23; P<.001), while the noncaregiver and nonstrained caregiver groups showed little change (0.27 vs 0.27 [P =.99] and 0.46 vs 0.27 [P =.39] behaviors, respectively). Noncaregivers experienced significant weight loss following the death (149.1 vs 145.3 lb [67.1 vs 65.4 kg]; F(1,101) = 8.12; P =.005), while the strained and nonstrained caregiving groups did not show significant weight change (156.2 vs 155.2 lb [70.3 vs 69.8 kg] [P =.41] and 156.2 vs 154.0 lb [70.3 vs 69.3 kg] [P =.12], respectively).

CONCLUSIONS: These data indicate that the impact of losing one's spouse among older persons varies as a function of the caregiving experiences that precede the death. Among individuals who are already strained prior to the death of their spouse, the death itself does not increase their level of distress. Instead, they show reductions in health risk behaviors. Among noncaregivers, losing one's spouse results in increased depression and weight loss.

10aAged10aAged, 80 and over10aAntidepressive Agents10aBereavement10aCaregivers10aDeath10aDepression10aFemale10aFollow-Up Studies10aHealth Behavior10aHumans10aMale10aSocioeconomic Factors10aSpouses10aWeight Loss1 aSchulz, R1 aBeach, S, R1 aLind, B1 aMartire, L, M1 aZdaniuk, B1 aHirsch, C1 aJackson, S1 aBurton, L uhttps://chs-nhlbi.org/node/653