Each year, millions of older adults in countries such as the United States, Canada, and Australia, develop health problems requiring hospitalization or specialized medical care. In most cases, it is the family members, including spouses and children, who face the responsibility of making health care decisions and acting as a liaison between medical professionals and their loved ones. And this is a burden that will continue to grow as more and more older adults require some form of medical treatment.
Though the stress this responsibility places on caregivers has been long recognized, a new study published in the Journal of Internal Medicine has found evidence of significant mental health problems in caregivers, including depression and posttraumatic stress. A team of researchers led by Alexia Torke of the Indiana Center for Aging Research examined 364 adults over the age of 65 and their surrogate decision-makers in Intensive Care Units (ICUs) at three major hospitals. Among the patients, the average age was 81.9 years and 62 percent were female with 67 percent of decision makers were adult children with an average age of 58.3 years (70.9 percent were female).
During the course of the study, family members made at least one difficult medical decision during the hospital stay and after their loved one was released. This could range from use of a ventilator, placement in a nursing home, or providing informed consent for surgeries or other invasive medical procedures. All decision-makers completed a battery of tests measuring depression, anxiety, and post-traumatic stress at the start of the study and six weeks after the patient left the hospital. They also completed surveys measuring their satisfaction with the quality of health care received as well as how responsive they felt hospital and support staff to be.
As you might expect, anxiety and depression levels remained high for decision-makers over the entire duration of the relative's hospital stay. Six weeks following release however, only 22.6 percent reported lingering anxiety with 11.3 percent reporting moderate to severe anxiety. When looking at depression, 29 percent reported depressive symptoms with 14 percent reporting moderate to severe depression. As well, around 14.6 percent reported symptoms of posttraumatic stress disorder (PTSD). This is consistent with previous research in family members of ICU patients and has even led to a new clinical term, post-intensive care syndrome—family, though the results of this study suggest that the psychological impact for decision makers can be high even with dealing with non-ICU patients.
Decision makers who reported receiving good emotional support from hospital workers were much less likely to have lingering anxiety and depression. The link between emotional support and anxiety in decision-makers were especially strong. Interestingly enough, decision makers who reported receiving good informational support (having hospital workers provide clear explanations of diagnosis and care) were more likely to develop PTSD symptoms, even when accounting for emotional support.
Though Torke and her co-authors recognize that this study cannot be used to prove causation, these results do highlight how critically important proper emotional support for decision-makers can be. It also highlights how vulnerable decision makers can be and the need for counseling to help prevent or reduce mental health problems that can arise afterward. With the rising number of older adults who will be needing medical care in future, the need for supportive counseling will certainly rise as well.