TY - JOUR T1 - Association between spousal caregiver well-being and care recipient healthcare expenditures JF - Journal of the American Geriatrics Society Y1 - 2017 A1 - Claire K. Ankuda A1 - Donovan T Maust A1 - Mohammed U Kabeto A1 - Ryan J McCammon A1 - Kenneth M. Langa A1 - Deborah A Levine KW - Caregiving KW - Marriage KW - Medical Expenses KW - Medicare/Medicaid/Health Insurance KW - Well-being AB - Objectives To measure the association between spousal depression, general health, fatigue and sleep, and future care recipient healthcare expenditures and emergency department (ED) use. Design Prospective cohort study. Setting Health and Retirement Study. Participants Home-dwelling spousal dyads in which one individual (care recipient) was aged 65 and older and had one or more activity of daily living or instrumental activity of daily living disabilities and was enrolled in Medicare Part B (N = 3,101). Exposure Caregiver sleep (Jenkins Sleep Scale), depressive symptoms (Center for Epidemiologic Studies Depression-8 Scale), and self-reported general health measures. Measurements Primary outcome was care recipient Medicare expenditures. Secondary outcome was care recipient ED use. Follow-up was 6 months. Results Caregiver depressive symptoms score and six of 17 caregiver well-being measures were prospectively associated with higher care recipient expenditures after minimal adjustment (P < .05). Higher care recipient expenditures remained significantly associated with caregiver fatigue (cost increase, $1,937, 95% confidence interval (CI) = $770–3,105) and caregiver sadness (cost increase, $1,323, 95% CI = $228–2,419) after full adjustment. Four of 17 caregiver well-being measures, including severe fatigue, were significantly associated with care recipient ED use after minimal adjustment (P < .05). Greater odds of care recipient ED use remained significantly associated with caregiver fatigue (odds ratio (OR) = 1.24, 95% CI = 1.01–1.52) and caregiver fair to poor health (OR = 1.23, 95% CI = 1.04–1.45) after full adjustment. Caregiver total sleep score was not associated with care recipient outcomes. Conclusion Poor caregiver well-being, particularly severe fatigue, is independently and prospectively associated with higher care recipient Medicare expenditures and ED use. VL - 65 UR - http://doi.wiley.com/10.1111/jgs.15039http://onlinelibrary.wiley.com/wol1/doi/10.1111/jgs.15039/fullpdfhttps://api.wiley.com/onlinelibrary/tdm/v1/articles/10.1111%2Fjgs.15039 IS - 10 JO - J Am Geriatr Soc ER - TY - JOUR T1 - Antidepressant Use and Cognitive Decline: The Health and Retirement Study. JF - Am J Med Y1 - 2015 A1 - Jane S Saczynski A1 - Allison B Rosen A1 - Ryan J McCammon A1 - Zivin, Kara A1 - Susan E. Andrade A1 - Kenneth M. Langa A1 - Sandeep Vijan A1 - Paul A Pirraglia A1 - Becky A. Briesacher KW - Age Distribution KW - Aged KW - Aged, 80 and over KW - Antidepressive Agents KW - Cognition KW - Cross-Sectional Studies KW - Depressive Disorder KW - Female KW - Follow-Up Studies KW - Geriatric Assessment KW - Humans KW - Incidence KW - Male KW - Middle Aged KW - Reference Values KW - Risk Assessment KW - Sex Distribution KW - Surveys and Questionnaires KW - United States AB -

BACKGROUND: Depression is associated with cognitive impairment and dementia, but whether treatment for depression with antidepressants reduces the risk for cognitive decline is unclear. We assessed the association between antidepressant use and cognitive decline over 6 years.

METHODS: Participants were 3714 adults aged 50 years or more who were enrolled in the nationally representative Health and Retirement Study and had self-reported antidepressant use. Depressive symptoms were assessed using the 8-item Center for Epidemiologic Studies Depression Scale. Cognitive function was assessed at 4 time points (2004, 2006, 2008, 2010) using a validated 27-point scale. Change in cognitive function over the 6-year follow-up period was examined using linear growth models, adjusted for demographics, depressive symptoms, comorbidities, functional limitations, and antidepressant anticholinergic activity load.

RESULTS: At baseline, cognitive function did not differ significantly between the 445 (12.1%) participants taking antidepressants and those not taking antidepressants (mean, 14.9%; 95% confidence interval, 14.3-15.4 vs mean, 15.1%; 95% confidence interval, 14.9-15.3). During the 6-year follow up period, cognition declined in both users and nonusers of antidepressants, ranging from -1.4 change in mean score in those with high depressive symptoms and taking antidepressants to -0.5 change in mean score in those with high depressive symptoms and not taking antidepressants. In adjusted models, cognition declined in people taking antidepressants at the same rate as those not taking antidepressants. Results remained consistent across different levels of baseline cognitive function, age, and duration of antidepressant use (prolonged vs short-term).

CONCLUSIONS: Antidepressant use did not modify the course of 6-year cognitive change in this nationally representative sample.

PB - 128 VL - 128 IS - 7 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25644319?dopt=Abstract U2 - PMC4618694 U4 - Antidepressants/Cognition/Depression/CES Depression Scale/CES Depression Scale/COMORBIDITY/Depressive Symptoms ER -