Depression and Anxiety of Care Partners During the Emergency Department Visit of Older Adults with Cognitive Impairment

Abstract

Introduction: Older adults with cognitive impairment (CI) are more likely to visit the emergency department (ED) than those without CI. They are also more likely to suffer poor outcomes after an ED visit. Family and friends who serve as care partners contribute significant time and resources to the care of these patients and may need particular attention to their emotional needs during and after the ED encounter. In this study, we examined the association between patient and care partner characteristics on care partner depression and anxiety at the time of the ED visit. Methods: Baseline data from 640 patient-care partner dyads who were enrolled in a two-site randomized controlled trial at New York University Lagone Health and Indiana University. The goal of the trial was to evaluate a tailored collabotative care management program to reduce readmissions of ED patients older than 75 years with CI and reduce care partner burden. Eligible patients were ED patients aged ≥75 years with CI as measured by the Mini-Cog or the proxy-reported Short Informant Questionnaire on Cognitive Decline in the Elderly and a planned dicharge home. Eligble care partners were self-identified or identified by the patient. We collected patient and care partner demographics, care partner-reported patient medical and psychiatric history, daily needs of the patient, and patient-care partner relationship. We used descriptive statistics and logistic regression to identify factors associated with symptoms of depression or anxiety in care partners, as assessed by Patient Health Questionnaire (PHQ-9) and General Anxiety Disorder (GAD-7) scores, respectively. Results: Depression and anxiety data were available on all 640 care partners. In total, 251 (39.2%) had depression as measured by a score of ≥5 on the PHQ-9 and 299 (46.7%) had anxiety based on a score ≥5 on the GAD-7. Patient functional impairment (OR 1.04, 95% CI 1.01, 1.07), behavioral and psychological symptoms (OR 1.08, 95% CI 1.04, 1.13) and care partner social support (OR 0.91, CI 0.88, 0.95) were significantly associated with care partner depression. Similarly, patient functional impairment (OR 1.04, 95% CI 1.01, 1.07), behavioral and psychological symptoms (OR 1.11, 95% CI 1.07, 1.16) and care partner social support (OR 0.94, CI 0.90, 0.97) were also significantly associated with care partner anxiety as was patient race (p=0.041). Conclusion: Care partners of older adults with CI who present to the ED demonstrate depression and anxiety, but discharge from the ED represents an opportunity to focus on integration of care partners into aftercare in a well-informed, supportive fashion.