A surprise on caregivers' depression

Contrary to what researchers expected, placing a loved one with dementia in a nursing home does not make caregivers feel better.

In fact, most were just as depressed and anxious after their family member was in the nursing home, and some felt worse, said Richard Schulz, a University of Pittsburgh psychiatry professor who led a government-funded study published today. Anxiety abated after a year, but depression remained just as high as when the dementia patients were at home.

Caring for someone in the later stages of Alzheimer's disease is mentally and physically exhausting, so one might expect that caregivers would feel less stress once a relative with dementia is in a nursing home, Schulz said. Plus, earlier research by his team found that Alzheimer's caregivers quickly became less depressed after their loved one's death.

"We kind of were expecting similar effects in this group," he said.

Instead it seemed that caregivers were trading one kind of stress for another. Spouses in particular still visited frequently and were involved in the physical care of their disabled partners. They were still witnessing their loved ones' decline, and many felt guilty about the nursing-home placement. There were financial worries, and caregivers had to learn how to deal with the nursing-home bureaucracy.

Nearly half the caregivers were at risk for clinical depression.

Schulz said caregivers needed more counseling and treatment for depression and anxiety. "They could probably benefit from increased knowledge and understanding of how long-term-care facilities operate and what their role might be," he added. He said he believed that helping caregivers plan for the death of their relative also helped.

The study of 1,222 caregiver-patient pairs was published in the Journal of the American Medical Association. During the four-year study, 180 people with dementia were put in nursing homes. The researchers said the study was the first to examine what led to nursing-home placement, the nature of contact between caregivers and their relatives after placement, and how these factors affected caregiver health.

Schulz said nursing-home placement was "an act of last resort... . It's something you don't do lightly. You do it after you've run out of all your other options." He said he did not know if caregivers would have been even more depressed had they tried to keep their loved ones at home.

Spouses were the most distressed category of caregivers both before and after nursing-home placement. They visited the nursing home more frequently and were more involved in physical care.

Patients' functioning often declines abruptly when they enter nursing homes, because of the abrupt change in environment, Schulz said. "Often," he said, "caregivers will blame themselves for that."

And the guilt can be exacerbated by the patient's anger at being forced to leave home, said Carol Lippa, a Drexel University neurologist and board member of the Alzheimer's Association, Delaware Valley Chapter. "Almost no one wants to go in the nursing home," she said.

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