A new U-M study reveals that depression among senior citizens carries a huge unrecognized cost: many extra hours of unpaid help with everyday activities, delivered by the depressed seniors' spouses, adult children, and friends.

Even moderately depressed seniors, a new University of Michigan study finds, require far more hours of care than those without any symptoms of depression, regardless of other health problems they may have.

The findings, published in the May issue of the American Journal of Psychiatry, are based on data from the U-M’s Health and Retirement Study, a long-term survey of older Americans conducted by the U-M Institute for Social Research. The study’s authors, from the U-M Health System’s departments of Internal Medicine and Psychiatry and the VA Ann Arbor Healthcare System, analyzed data from 6,651 people over the age of 70 from around the nation.

In all, 18 percent of the seniors reported having had four to eight depressive symptoms in the last week on a standardized survey. Another 44 percent had one to three symptoms. The survey showed that 38 percent of seniors who had many depressive symptoms, and 23 percent of those with a few symptoms, reported receiving informal care from family or friends — but only 11 percent of those without depressive symptoms did.

"People with many depressive symptoms also had a significantly higher likelihood than others of needing help with tasks such as dressing, bathing, eating, grocery shopping, taking medicines, paying bills and using the telephone," says lead author Ken Langa, M.D., Ph.D., an assistant professor of general medicine and faculty associate of ISR. "Even those with just a few depressive symptoms were more likely to need help with these everyday activities than those without signs of depression."

In all, the seniors with many depressive symptoms required six hours a week, on average, of help from unpaid caregivers — more than twice as much as the 2.9 hours for those with no symptoms. Those with few symptoms got 4.3 hours of care a week.

Even when the researchers took into account the other chronic health problems that the seniors faced — from heart disease and diabetes to arthritis and vision problems — those with depressive symptoms still needed more care than those without.

As Langa says, "It’s a sort of chicken-and-egg problem: the symptoms of depression make it harder to care for yourself, and those with illnesses that make them less independent often become depressed. But no matter which came first, better recognition and treatment of depression among the elderly could improve a patient’s outlook and probably reduce the burden on the family. This is especially true for those with other health problems that require complex self-management."

Senior author Sandeep Vijan, M.D., M.S., adds, "Chronic diseases such as depression have an effect on society that extends beyond the patient. This study shows that the impact on families and caregivers is significant in terms of time and cost. The medical community often overlooks these factors when considering the best way to care for patients, but it is vitally important to consider the broad picture when making decisions on treatment and health policy."

The researchers found that older women, especially those without spouses, were more likely to have many symptoms of depression. "This increased risk, combined with less social support and fewer financial means to pay for help, means they are especially likely to go without necessary care and assistance in everyday tasks," explains Langa. He and his colleagues hope their study alerts physicians to the importance of paying extra attention to the depressive symptoms and caregiving needs of older women living alone.

All the data are from the Asset and Health Dynamics among the Oldest Old, or AHEAD, cohort of the Health and Retirement study. The study was funded by the National Institute on Aging and the Alzheimer’s Association.

For more information:

U-M Institute for Social Research
http://www.isr.umich.edu

U-M Health and Retirement Study
http://hrsonline.isr.umich.edu

U-M Depression Center — information for older adults
http://www.med.umich.edu/depression/geriatric.htm

UMHS Health Minute — elderly depression -
http://www.med.umich.edu/opm/newspage/2002/elderlydep.htm

National Institute of Mental Health - depression in older adults
http://www.nimh.nih.gov/HealthInformation/depoldermenu.cfm