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Abstract
This dissertation includes three manuscripts, all of which examine the relationship between informal caregiver depressive symptoms and care-recipient use of medical care in a sample of community-dwelling, elderly, veterans with dementia. A secondary aim of this dissertation was to elucidate other potentially important predisposing, enabling, and need variables related to use of medical care. The first manuscript examined the relationship between caregiver depressive symptoms and care-recipient's vaccination against influenza. The second manuscript examined the relationship between caregiver depressive symptoms and care-recipients' utilization of dementia and non-dementia outpatient care. The third manuscript explored caregiver and care-recipient risk factors for care-recipient hospital admissions for ambulatory care-sensitive conditions---conditions where hospital-based care is potentially avoidable with access to high-quality outpatient care.
The sample and study independent variables were drawn from the 1998 National Longitudinal Caregiver Survey. The final sample consisted of 1,813 community-dwelling older male veterans with dementia, and their co-residing female informal caregivers. Study dependent variables (i.e., veteran utilization of VA medical care) were drawn from Veteran Affairs inpatient and outpatient claims. To establish the correct temporal order of variables, all independent variables were measured before medical care occurred. The findings of these manuscripts are as follows:
Manuscript 1: Greater caregiver depressive symptoms were associated with a decreased likelihood of care-recipient vaccination. Adjusted for other variables, the predicted probability of vaccine receipt for the care-recipient was 41% for care-recipients with caregivers in the lowest quartile of depressive symptoms compared to only 26% for care-recipients with caregivers in the highest quartile.
Manuscript 2: Whereas caregiver depressive symptoms were significantly associated with the likelihood of care-recipient vaccination, the results presented in Manuscript 2 suggest that depressive symptoms are not a major determinant of outpatient utilization more generally. With the exception of the likelihood of having a non-dementia outpatient visit, caregiver depressive symptoms were not significantly associated with other outpatient utilization measures.
Manuscript 3: Greater depressive symptoms was associated with a significant increase in risk of care-recipient hospitalization for ambulatory care-sensitive conditions (ACSC); these are medical conditions typically manageable with access to high-quality outpatient care and adherence to treatment regimens prescribed as part of this high-quality care. (Abstract shortened by UMI.)
