Elderly people with depression require a significant and costly amount of
regular care and assistance provided by family
The additional hours of "informal care" attributable to
depressive symptoms—over and above the amount of informal care typically
provided for elderly people—represents a significant time commitment for
family members and societal economic cost, according to the May American
Journal of Psychiatry.
Study author Kenneth M. Langa, M.D., Ph.D., told Psychiatric News
that based on similar studies of other conditions in the elderly (including
cancer, diabetes, urinary incontinence, among others), depression ranked
second only to dementia in the amount of additional care required by family
and other informal caregivers.
"Most psychiatrists have a sense that depressed people will need to
depend on the people around them," he said. "What is significant
is that this is the first study that quantifies the amount of care associated
with depression in older people."
Langa is an assistant professor of medicine at the University of Michigan
School of Medicine.
He said that while the amount of time spent on a per-person basis
(approximately three extra hours a week) may not seem significant, the
prevalence of depression in the elderly makes the cumulative amount of
required informal caregiving enormous at a national level. Caregiving
associated with depressive symptoms in elderly Americans represented a yearly
cost of about $9 billion, according to the study.
Elderly women were more likely than elderly men to report depressive
symptoms. Seventy-three percent of women, compared with 23 percent of men,
reported four to eight depressive symptoms in a week. Sixtyfive percent of
women, compared with 35 percent of men, reported one to three depressive
symptoms in a week.
In a previous study by Langa and colleagues, women with functional
limitations received significantly fewer hours of informal care than men with
similar levels of impairment The study, "Gender Disparities in the
Receipt of Home Care for Elderly People With Disability in the United
States," appeared in the December 20, 2000, Journal of the American
"It is important for psychiatrists and other clinicians to know that
older women who live alone may be at heightened risk for depression, yet may
receive significantly less care than men," he said. "They are much
more likely to be living alone, and even when they are married, they receive
about half as much help as their spouse."
Langa said the study has important implications for policymakers. Though
informal care can be considered "off the books" of public and
private insurance ledgers, it nevertheless represents a significant hidden
cost to society.
"The costs of depression are not confined to the direct costs of
treating the condition or of suicide," he said. "There is a
significant cost that spreads out to the family. That's important to consider
in policy debates."
In the study, data from the 1993 "Asset and Health Dynamics Among the
Oldest Old Study," a nationally representative survey of people age 70
years or older, were used to determine weekly hours and cost of informal
caregiving for 6,649 respondents. Forty-four percent of the respondents
reported one to three depressive symptoms, and 18 percent reported four to
eight depressive symptoms.
Adjusting for sociodemographics, caregiver network, and coexisting chronic
health conditions, people with no depressive symptoms received an average of
2.9 hours a week of informal care, compared with 4.3 hours a week for those
with one to three symptoms, and 6.0 hours a week for those with four to eight
Costs of informal care were estimated by using a range of costs associated
with buying home health care for their depression and other chronic
conditions. The annual cost nationally of $9 billion for informal care for
depression compares with $6 billion each for stroke, urinary tract infection,
and diabetes. For dementia, costs of informal care are $18 billion, according
"Clearly, the brain is important," he said. "Dementia,
depression, and stroke are the most costly in terms of informal
Langa said the specific pathways by which depression leads to increased
requirements for informal caregiving are deserving of further study.
"The most likely hypothesis is the anhedonia associated with
depression," he said. "People with depression are not really
interested in things and have trouble getting up. Family members are required
to get the depressed individual up and going.
"There is also the issue of the interaction with other chronic
conditions. Someone with severe diabetes who is also depressed is going to put
more of a burden on family members to make sure they take their