By Lisa Rapaport
Dementia patients may go to the emergency room more often when their caregivers are depressed, a recent study suggests.
Researchers observed 663 dementia patients and their family caregivers - typically spouses, domestic partners or other relatives - for six months. At the start of the study, 84 caregivers, or almost 13%, had depression.
Caregiver depression was associated with a 73% increase in emergency room use among dementia patients, researchers reported July 8 online in JAMA Neurology.
Based on six months of observation, the researchers calculated that dementia patients who had a caregiver with depression were on track to visit the emergency room 1.5 times a year, compared with 0.8 annual visits for patients without a depressed caregiver.
In absolute terms, caregiver depression was associated with an additional 0.7 emergency room visits per dementia patient per year.
"Caregiver depression and feelings of high caregiver burden are incredibly common among those who care for family members with dementia," said Dr. Elan Guterman, lead author of the study and a neurology researcher at the University of California, San Francisco
"We know that this impacts the quality of life of these caregivers and now we have evidence that this may impact emergency department use for patients with dementia as well, which likely raises the overall cost of care," Guterman said by email.
Caregivers in the study were 64 years old on average and most were female. Dementia patients were 77 years old on average and slightly more than half were female.
Depression was more common among younger caregivers, and it was also more common when dementia patients were younger or had more severe disease.
Going to the emergency room also wasn't good for caregivers' mental health.
Each additional emergency room visit was associated with 1.26 times the odds of caregiver depression after six months.
The study wasn't designed to prove whether or how caregiver depression directly causes additional emergency room visits for dementia patients.
It also focused only on caregivers and dementia patients at academic medical centers in three states, and it's possible that results would be different in other care settings or in other parts of the country.
Even so, the results offer fresh evidence that dementia care should encompass support for family caregivers, said Charles Given, professor emeritus at the college of nursing at Michigan State University in East Lansing.
"Family members are confronted with observing the physical and cognitive decline of one of their own, they are unprepared to recognize changes that are significant health threats and thus tend to over compensate by seeking care when it may not be needed," Given, who wasn't involved in the study, said by email.
"Family caregivers need access to primary ongoing care for their patients where they can describe the problem and be offered advice as to what to do, what symptoms to observe and possibly address at home," Given added. "The health care system needs to be alert to the signs of depression in caregivers and help them get the support and counseling that they need."
JAMA Neurol 2019.
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