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Does Informal Care Break the Cycle of Functional Disability and Depressive Symptoms in Late Life?

Does Informal Care Break the Cycle of Functional Disability and Depressive Symptoms in Late Life?. I-Fen Lin (林一芬) Bowling Green State University Department of Sociology. Background. Functional disability and depressive symptoms increase with age

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Does Informal Care Break the Cycle of Functional Disability and Depressive Symptoms in Late Life?

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  1. Does Informal Care Break the Cycle of Functional Disability and Depressive Symptoms in Late Life? I-Fen Lin (林一芬) Bowling Green State University Department of Sociology

  2. Background • Functional disability and depressive symptoms increase with age • Disability: 9% young-old, 22% old-old, and 50% oldest-old • Depression: 8% young-old, 10% old-old, and 12% oldest-old • Both reduce quality of life and contribute to suicides among older adults

  3. Feedback Cycle + Disability Depression +

  4. Background • More than three quarters of disabled older adults reside in the community • Two thirds of community-dwelling older adults rely on informal care • Informal care is usually mobilized in a hierarchical order: spouses, adult children, other family members, and nonfamily members

  5. Breaking Feedback Cycle +- Disability Care Depression - +

  6. But Informal Care May Fail… • Caregiving strains (time, finance, health) • Interpersonal theory of depression • Negative interaction between caregiver and care recipient may exhaust informal care and increase older adults’ disability and depression

  7. Research Questions • Do disability and depression mobilize informal care? • Does informal care, once mobilized, reduce disability and depression? • How long does informal care maintain its intervening effect?

  8. Analytic Strategy: Cross-Sectional Data Time 1 Time 1 Disability Disability Care OR Care Depression Depression

  9. Concurrent Association • Disability + Depression (Black et al., 1998; Prince et al., 1997; West, 1998) • Depression + Disability (Barberger-Gateau et al., 1992; Grigsby et al., 1998; Guccione et al., 1994) • Disability/Depression + Informal care (McGarry, 1998, Wolff & Kasper, 2006) • Informal care - Disability/Depression (Greenglass et al., 2006) • Informal care + Disability/Depression (Lee et al., 1995; Liang et al., 2001; Seeman, et al., 1996)

  10. Analytic Strategy: Two-Wave Data Time 1 Time 2 Disability Disability Care Care Depression Depression

  11. Analytic Strategy: Two-Wave Data Time 1 Time 2 Disability Disability Care Care Depression Depression

  12. Autoregressive Effect • Disability + Disability (Gayman et al., 2008; Ormel et al., 2002) • Depression + Depression (Gayman et al., 2008; Ormel et al., 2002) • Informal care + Informal care (Silverstein et al., 2006)

  13. Cross-Lagged Effect • Disability/Depression + Informal care (Silverstein et al., 2006) • Informal care - Disability/Depression (Hays et al., 2001; Roberts et al., 1997; Wilcox et al., 1994) • Informal care + Disability/Depression (Davey & Eggebeen, 1998)

  14. Direct Effect • Disability | Informal care + Depression (Turner & Noh, 1988) • Depression | Informal care + Disability (Greemglass et al., 2006; Penninx et al., 1999)

  15. Analytic Strategy: Three-Wave Data Time 1 Time 2 Time 3 Disability Disability Disability Care Care Care Depression Depression Depression

  16. If More Waves of Data Are Used… Time 1 Time 2 Time 3 Time 4 Time 5 Disability Disability Disability Disability Disability Care Care Care Care Care Depression Depression Depression Depression Depression

  17. If More Waves of Data Are Used… Time 1 Time 2 Time 3 Time 4 Time 5 Disability Disability Disability Disability Disability Care Care Care Care Care Depression Depression Depression Depression Depression

  18. If More Waves of Data Are Used… Time 1 Time 2 Time 3 Time 4 Time 5 Disability Disability Disability Disability Disability Care Care Care Care Care Depression Depression Depression Depression Depression

  19. If More Waves of Data Are Used… Time 1 Time 2 Time 3 Time 4 Time 5 Disability Disability Disability Disability Disability Care Care Care Care Care Depression Depression Depression Depression Depression

  20. Data • 5 waves of Health and Retirement Study (1998, 2000, 2002, 2004, & 2006) • 65+ years old in 1998 • Exclude respondents who died, who were lost to follow up, and who moved into nursing homes during 1998-2006 • 6,359 older adults

  21. Functional Disability • Difficulty in walking, dressing, bathing, eating, getting in/out of bed, using toilet (ADL) for 3+ months • Difficulty in preparing meals, shopping for groceries, making phone calls, taking medicines, managing money (IADL) for 3+ months • Yes/No; KR-20 = 0.80 - 0.87; 0-11

  22. Depression • Feeling depressed, feeling that everything was an effort, having restless sleep, being unhappy, feeling lonely, not enjoying life, feeling sad, being unable to get going, not having a lot of energy • Yes/No; KR-20 = 0.74 – 0.76; 0-9

  23. Informal Care • Four sources of informal care • Spouse • Children • Other kin (grandchildren, parents, parents-in-law, siblings, other relatives) • Unrelated others • Yes/No, 0/1, 4 dichotomous variables (reference group: receiving no care)

  24. Control Variables Women 58.64% Age in 1998 72.26 Education 11.78 White 80.58% African American 11.84% Hispanic 7.58% Married in 1998 65.81% Widowed in 1998 24.47% Divorced in 1998 7.30% Never married in 1998 2.42% Health in 1998 (1:poor, 5:excellent) 3.22 Income in 1998 42,011.63 Number of children in 1998 3.28

  25. Analytic Strategy • Autoregressive, cross-lagged model using structural equation modeling framework • Model trimming approach • Final model: Comparative fit index (CFI) = 0.990 Tucker-Lewis index (TLI) = 0.989 Root mean square error of approximation (RMSEA) = 0.015 χ2 = 503.961, df = 214, p < 0.001

  26. Autoregressive, Cross-Lagged Model 1998 2000 2002 2004 2006 Disability Disability Disability Disability Disability Care Care Care Care Care Depression Depression Depression Depression Depression *Concurrent associations, higher-order autoregressive effects, and control variables are not shown in the graph.

  27. Spouse: Mobilizing Care? 1998 2000 2002 2004 2006 Disability Disability Disability Disability Disability .137 0 -.093 -.071 Spouse Spouse Spouse Spouse Spouse .043 0 -.048 0  Depression Depression Depression Depression Depression

  28. Spouse: Protective Effect of Care? 1998 2000 2002 2004 2006 Disability Disability Disability Disability Disability   .104 .113 .096 .165 Spouse Spouse Spouse Spouse Spouse   -.292 .114 .045 .086 Depression Depression Depression Depression Depression

  29. Spouse: Breaking Cycle 1? 1998 2000 2002 2004 2006 Disability Disability Disability Disability Disability .137 .113 Spouse Spouse Spouse Spouse Spouse .043 .114 Depression Depression Depression Depression Depression

  30. Spouse: Breaking Cycle 2? 1998 2000 2002 2004 2006 Disability Disability Disability Disability Disability 0 .096 Spouse Spouse Spouse Spouse Spouse 0 .045 Depression Depression Depression Depression Depression

  31. Spouse: Breaking Cycle 3? 1998 2000 2002 2004 2006 Disability Disability Disability Disability Disability -.093 .165 Spouse Spouse Spouse Spouse Spouse -.048 .086 Depression Depression Depression Depression Depression

  32. Children: Mobilizing Care? 1998 2000 2002 2004 2006 Disability Disability Disability Disability Disability .129 0 0 0 Child Child Child Child Child .041 0 0 0  Depression Depression Depression Depression Depression

  33. Children: Protective Effect of Care? 1998 2000 2002 2004 2006 Disability Disability Disability Disability Disability   .357 .096 .078 .114 Child Child Child Child Child   0 0 0 .088 Depression Depression Depression Depression Depression

  34. Children: Breaking Cycle 1? 1998 2000 2002 2004 2006 Disability Disability Disability Disability Disability .129 .096 Child Child Child Child Child .041 0 Depression Depression Depression Depression Depression

  35. Children: Breaking Cycle 2? 1998 2000 2002 2004 2006 Disability Disability Disability Disability Disability 0 .078 Child Child Child Child Child 0 0 Depression Depression Depression Depression Depression

  36. Children: Breaking Cycle 3? 1998 2000 2002 2004 2006 Disability Disability Disability Disability Disability 0 .114 Child Child Child Child Child 0 .088 Depression Depression Depression Depression Depression

  37. Other Kin: Mobilizing Care? 1998 2000 2002 2004 2006 Disability Disability Disability Disability Disability 0 0 0 0 Other Kin Other Kin Other Kin Other Kin Other Kin 0 0 0 0  Depression Depression Depression Depression Depression

  38. Other Kin: Protective Effect of Care? 1998 2000 2002 2004 2006 Disability Disability Disability Disability Disability   .839 0 0 .148 Other Kin Other Kin Other Kin Other Kin Other Kin   0 0 .125 0 Depression Depression Depression Depression Depression

  39. Other Kin: Breaking Cycle 1? 1998 2000 2002 2004 2006 Disability Disability Disability Disability Disability 0 0 Other Kin Other Kin Other Kin Other Kin Other Kin 0 0 Depression Depression Depression Depression Depression

  40. Other Kin: Breaking Cycle 2? 1998 2000 2002 2004 2006 Disability Disability Disability Disability Disability 0 0 Other Kin Other Kin Other Kin Other Kin Other Kin 0 .125 Depression Depression Depression Depression Depression

  41. Other Kin: Breaking Cycle 3? 1998 2000 2002 2004 2006 Disability Disability Disability Disability Disability 0 .148 Other Kin Other Kin Other Kin Other Kin Other Kin 0 0 Depression Depression Depression Depression Depression

  42. Unrelated Others: Mobilizing Care? 1998 2000 2002 2004 2006 Disability Disability Disability Disability Disability .150 0 .063 .061 Others Others Others Others Others 0 0 0 0  Depression Depression Depression Depression Depression

  43. Unrelated Others: Protective Effect of Care? 1998 2000 2002 2004 2006 Disability Disability Disability Disability Disability   .640 0 0 0 Others Others Others Others Others   0 .149 0 0 Depression Depression Depression Depression Depression

  44. Unrelated Others: Breaking Cycle 1? 1998 2000 2002 2004 2006 Disability Disability Disability Disability Disability 0 0 Others Others Others Others Others 0 .149 Depression Depression Depression Depression Depression

  45. Unrelated Others: Breaking Cycle 2? 1998 2000 2002 2004 2006 Disability Disability Disability Disability Disability .063 0 Others Others Others Others Others 0 0 Depression Depression Depression Depression Depression

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