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J Am Geriatr Soc. 2017 Oct;65(10):2220-2226. doi: 10.1111/jgs.15039. Epub 2017 Aug 24.

Association Between Spousal Caregiver Well-Being and Care Recipient Healthcare Expenditures.

Ankuda CK1,2,3, Maust DT3,4,5, Kabeto MU4,6, McCammon RJ6, Langa KM3,4,6,7, Levine DA3,4,6,8.

Author information

1
Robert Wood Johnson Clinical Scholars Program, University of Michigan, Ann Arbor, Michigan.
2
Department of Family Medicine, University of Michigan, Ann Arbor, Michigan.
3
Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan.
4
Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan.
5
Department of Psychiatry, University of Michigan, Ann Arbor, Michigan.
6
Department of Internal Medicine, Medical School, University of Michigan, Ann Arbor, Michigan.
7
Institute for Social Research, University of Michigan, Ann Arbor, Michigan.
8
Department of Neurology and Stroke Program, University of Michigan, Ann Arbor, Michigan.

Abstract

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.

KEYWORDS:

caregiving; depression; healthcare use; quality of life

PMID:
28836269
PMCID:
PMC5762126
DOI:
10.1111/jgs.15039
[Indexed for MEDLINE]
Free PMC Article

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