Older person behavioral and psychological symptoms (BPS) and functional limitations mediate the association between older person cognitive impairment and depressive symptoms in the caregiver.
Abstract
We assess for the mediation of the association between older person cognitive impairment
and caregiver depressive symptoms through older person BPS and functional limitations,
and whether the mediation varies by caregiver-older person relationship (spouse/adult
child). Data for 1111 older person (aged 75+ with activity of daily living (ADL) limitation)-caregiver
dyads from Singapore were used. The outcome variable was dichotomous (caregiver clinically
significant depressive symptoms [CSDS]: yes/no) in the primary analysis and continuous
(caregiver depressive symptoms score) in the sensitivity analysis. The causal steps
approach assessed for the mediation of the association between older person cognitive
impairment (yes/no) and the outcome variable through the two potential mediators.
A bootstrapping approach calculated point estimates and confidence intervals (CIs)
of the indirect (∼mediated) effects. Variation of the indirect effects by caregiver-older
person relationship was also assessed. In the primary analysis, the causal steps approach
supported older person BPS and functional limitations as mediators. The bootstrapping
approach confirmed both as significant mediators, though BPS (indirect effect odds
ratio (OR) 1.32 [95% bootstrap CI 1.19,1.48]; %mediation: 70.6%) was a stronger mediator
than functional limitations (1.04 [1.01,1.11]; %mediation: 11.5%). Variation of the
indirect effects by caregiver-older person relationship was not supported. Results
of the sensitivity analysis confirmed these results. We conclude that while caring
for an older person with cognitive impairment is detrimental for the caregiver's mood,
management of associated BPS and functional limitations, especially the former, among
such older persons may reduce depressive symptoms among their caregivers. Spouse as
well as adult child caregivers benefit.
Type
Journal articleSubject
HumansDementia
Disability Evaluation
Activities of Daily Living
Geriatric Assessment
Health Surveys
Prevalence
Depression
Stress, Psychological
Adult Children
Spouses
Cognition Disorders
Aged
Aged, 80 and over
Middle Aged
Caregivers
Singapore
Female
Male
Surveys and Questionnaires
Permalink
https://hdl.handle.net/10161/22881Published Version (Please cite this version)
10.1016/j.archger.2013.10.004Publication Info
Malhotra, Rahul; Chei, Choy-Lye; Østbye, Truls; Chan, Angelique; & Matchar, David
B (2014). Older person behavioral and psychological symptoms (BPS) and functional limitations
mediate the association between older person cognitive impairment and depressive symptoms
in the caregiver. Archives of gerontology and geriatrics, 58(2). pp. 269-277. 10.1016/j.archger.2013.10.004. Retrieved from https://hdl.handle.net/10161/22881.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
Collections
More Info
Show full item recordScholars@Duke
David Bruce Matchar
Professor of Medicine
My research relates to clinical practice improvement - from the development of clinical
policies to their implementation in real world clinical settings. Most recently my
major content focus has been cerebrovascular disease. Other major clinical areas in
which I work include the range of disabling neurological conditions, cardiovascular
disease, and cancer prevention. Notable features of my work are: (1) reliance on
analytic strategies such as meta-analysis, simulation, decision analy

Articles written by Duke faculty are made available through the campus open access policy. For more information see: Duke Open Access Policy
Rights for Collection: Scholarly Articles
Works are deposited here by their authors, and represent their research and opinions, not that of Duke University. Some materials and descriptions may include offensive content. More info