An increase in caregiving hours and depressive symptoms are detectable in caregivers at least 10 years before their partner is diagnosed with cognitive impairment, a new study finds. Clinicians should note the need for earlier detection and family support, investigators say.
The researchers analyzed household survey data from the 2000-2016 waves of the Health and Retirement Study. Caregivers’ depressive symptoms and weekly caregiving hours were evaluated for the 10 years before and after the partners’ dementia diagnosis.
Depressive symptoms were measured using the shortened Center for Epidemiologic Studies Depression Scale. Weekly caregiving hours were self-reported.
Before the onset of a partner’s dementia, each measure increased every two years by 3% and 9%, respectively. Both measures then fell — by 2% and 1% — every two years after the partner’s clinical diagnosis, reported Melissa Harris, PhD, RN, of Duke University, and colleagues.
Cognitive changes and related disabilities happen over years and even decades before they reach a threshold at which dementia is diagnosed, said Harris. She and her colleagues were surprised, however, to find that caregivers’ depressive symptoms and caregiving hours fell after the onset of a partner’s dementia.
“It may be that caregivers are accessing support and services as the level of disability reaches this onset threshold,” or they may be reaching a point in their caregiving journey where they have adapted to the changes, she said.
The results counter the prevailing wisdom that received care spikes just after dementia onset, according to senior investigator Geoffrey Hoffman, PhD, MPH, of the University of Michigan School of Nursing. Instead, it appears that early referral to specialty services is critical to easing the emotional burden and high care demands experienced by caregivers, the authors said.
Clinicians may want to think of dementia as a journey that begins before diagnosis in order to best identify needs and solutions, Harris concluded.
The study was published in the journal Medical Care.