Does Informal Care Break the Cycle of Functional Disability and Depressive Symptoms in Late Life?

1. Does Informal Care Break the Cycle of Functional Disability and Depressive Symptoms in Late Life? I-Fen Lin (林一芬) Bowling Green State University Department of Sociology

4. Background • Functional disability and depressive symptoms increase with age • Disability: 9% young-old, 22% old-old, and 50% oldest-old • Depression: 8% young-old, 10% old-old, and 12% oldest-old • Both reduce quality of life and contribute to suicides among older adults

5. Feedback Cycle + Disability Depression +

6. Background • More than three quarters of disabled older adults reside in the community • Two thirds of community-dwelling older adults rely on informal care • Informal care is usually mobilized in a hierarchical order: spouses, adult children, other family members, and nonfamily members

7. Breaking Feedback Cycle +- Disability Care Depression - +

8. But Informal Care May Fail… • Caregiving strains (time, finance, health) • Interpersonal theory of depression • Negative interaction between caregiver and care recipient may exhaust informal care and increase older adults’ disability and depression

9. Research Questions • Do disability and depression mobilize informal care? • Does informal care, once mobilized, reduce disability and depression? • How long does informal care maintain its intervening effect?

10. Analytic Strategy: Cross-Sectional Data Time 1 Time 1 Disability Disability Care OR Care Depression Depression

11. Concurrent Association • Disability + Depression (Black et al., 1998; Prince et al., 1997; West, 1998) • Depression + Disability (Barberger-Gateau et al., 1992; Grigsby et al., 1998; Guccione et al., 1994) • Disability/Depression + Informal care (McGarry, 1998, Wolff & Kasper, 2006) • Informal care - Disability/Depression (Greenglass et al., 2006) • Informal care + Disability/Depression (Lee et al., 1995; Liang et al., 2001; Seeman, et al., 1996)

12. Analytic Strategy: Two-Wave Data Time 1 Time 2 Disability Disability Care Care Depression Depression

13. Analytic Strategy: Two-Wave Data Time 1 Time 2 Disability Disability Care Care Depression Depression

14. Autoregressive Effect • Disability + Disability (Gayman et al., 2008; Ormel et al., 2002) • Depression + Depression (Gayman et al., 2008; Ormel et al., 2002) • Informal care + Informal care (Silverstein et al., 2006)

15. Cross-Lagged Effect • Disability/Depression + Informal care (Silverstein et al., 2006) • Informal care - Disability/Depression (Hays et al., 2001; Roberts et al., 1997; Wilcox et al., 1994) • Informal care + Disability/Depression (Davey & Eggebeen, 1998)

16. Direct Effect • Disability | Informal care + Depression (Turner & Noh, 1988) • Depression | Informal care + Disability (Greemglass et al., 2006; Penninx et al., 1999)

17. Analytic Strategy: Three-Wave Data Time 1 Time 2 Time 3 Disability Disability Disability Care Care Care Depression Depression Depression

18. If More Waves of Data Are Used… Time 1 Time 2 Time 3 Time 4 Time 5 Disability Disability Disability Disability Disability Care Care Care Care Care Depression Depression Depression Depression Depression

19. If More Waves of Data Are Used… Time 1 Time 2 Time 3 Time 4 Time 5 Disability Disability Disability Disability Disability Care Care Care Care Care Depression Depression Depression Depression Depression

20. If More Waves of Data Are Used… Time 1 Time 2 Time 3 Time 4 Time 5 Disability Disability Disability Disability Disability Care Care Care Care Care Depression Depression Depression Depression Depression

21. If More Waves of Data Are Used… Time 1 Time 2 Time 3 Time 4 Time 5 Disability Disability Disability Disability Disability Care Care Care Care Care Depression Depression Depression Depression Depression

22. Data • 5 waves of Health and Retirement Study (1998, 2000, 2002, 2004, & 2006) • 65+ years old in 1998 • Exclude respondents who died, who were lost to follow up, and who moved into nursing homes during 1998-2006 • 6,359 older adults

23. Functional Disability • Difficulty in walking, dressing, bathing, eating, getting in/out of bed, using toilet (ADL) for 3+ months • Difficulty in preparing meals, shopping for groceries, making phone calls, taking medicines, managing money (IADL) for 3+ months • Yes/No; KR-20 = 0.80 - 0.87; 0-11

25. Depression • Feeling depressed, feeling that everything was an effort, having restless sleep, being unhappy, feeling lonely, not enjoying life, feeling sad, being unable to get going, not having a lot of energy • Yes/No; KR-20 = 0.74 – 0.76; 0-9

27. Informal Care • Four sources of informal care • Spouse • Children • Other kin (grandchildren, parents, parents-in-law, siblings, other relatives) • Unrelated others • Yes/No, 0/1, 4 dichotomous variables (reference group: receiving no care)

29. Control Variables Women 58.64% Age in 1998 72.26 Education 11.78 White 80.58% African American 11.84% Hispanic 7.58% Married in 1998 65.81% Widowed in 1998 24.47% Divorced in 1998 7.30% Never married in 1998 2.42% Health in 1998 (1:poor, 5:excellent) 3.22 Income in 1998 42,011.63 Number of children in 1998 3.28

30. Analytic Strategy • Autoregressive, cross-lagged model using structural equation modeling framework • Model trimming approach • Final model: Comparative fit index (CFI) = 0.990 Tucker-Lewis index (TLI) = 0.989 Root mean square error of approximation (RMSEA) = 0.015 χ2 = 503.961, df = 214, p < 0.001

31. Autoregressive, Cross-Lagged Model 1998 2000 2002 2004 2006 Disability Disability Disability Disability Disability Care Care Care Care Care Depression Depression Depression Depression Depression *Concurrent associations, higher-order autoregressive effects, and control variables are not shown in the graph.

32. Spouse: Mobilizing Care? 1998 2000 2002 2004 2006 Disability Disability Disability Disability Disability .137 0 -.093 -.071 Spouse Spouse Spouse Spouse Spouse .043 0 -.048 0  Depression Depression Depression Depression Depression

33. Spouse: Protective Effect of Care? 1998 2000 2002 2004 2006 Disability Disability Disability Disability Disability   .104 .113 .096 .165 Spouse Spouse Spouse Spouse Spouse   -.292 .114 .045 .086 Depression Depression Depression Depression Depression

34. Spouse: Breaking Cycle 1? 1998 2000 2002 2004 2006 Disability Disability Disability Disability Disability .137 .113 Spouse Spouse Spouse Spouse Spouse .043 .114 Depression Depression Depression Depression Depression

35. Spouse: Breaking Cycle 2? 1998 2000 2002 2004 2006 Disability Disability Disability Disability Disability 0 .096 Spouse Spouse Spouse Spouse Spouse 0 .045 Depression Depression Depression Depression Depression

36. Spouse: Breaking Cycle 3? 1998 2000 2002 2004 2006 Disability Disability Disability Disability Disability -.093 .165 Spouse Spouse Spouse Spouse Spouse -.048 .086 Depression Depression Depression Depression Depression

37. Children: Mobilizing Care? 1998 2000 2002 2004 2006 Disability Disability Disability Disability Disability .129 0 0 0 Child Child Child Child Child .041 0 0 0  Depression Depression Depression Depression Depression

38. Children: Protective Effect of Care? 1998 2000 2002 2004 2006 Disability Disability Disability Disability Disability   .357 .096 .078 .114 Child Child Child Child Child   0 0 0 .088 Depression Depression Depression Depression Depression

39. Children: Breaking Cycle 1? 1998 2000 2002 2004 2006 Disability Disability Disability Disability Disability .129 .096 Child Child Child Child Child .041 0 Depression Depression Depression Depression Depression

40. Children: Breaking Cycle 2? 1998 2000 2002 2004 2006 Disability Disability Disability Disability Disability 0 .078 Child Child Child Child Child 0 0 Depression Depression Depression Depression Depression

41. Children: Breaking Cycle 3? 1998 2000 2002 2004 2006 Disability Disability Disability Disability Disability 0 .114 Child Child Child Child Child 0 .088 Depression Depression Depression Depression Depression

42. Other Kin: Mobilizing Care? 1998 2000 2002 2004 2006 Disability Disability Disability Disability Disability 0 0 0 0 Other Kin Other Kin Other Kin Other Kin Other Kin 0 0 0 0  Depression Depression Depression Depression Depression

43. Other Kin: Protective Effect of Care? 1998 2000 2002 2004 2006 Disability Disability Disability Disability Disability   .839 0 0 .148 Other Kin Other Kin Other Kin Other Kin Other Kin   0 0 .125 0 Depression Depression Depression Depression Depression

44. Other Kin: Breaking Cycle 1? 1998 2000 2002 2004 2006 Disability Disability Disability Disability Disability 0 0 Other Kin Other Kin Other Kin Other Kin Other Kin 0 0 Depression Depression Depression Depression Depression

45. Other Kin: Breaking Cycle 2? 1998 2000 2002 2004 2006 Disability Disability Disability Disability Disability 0 0 Other Kin Other Kin Other Kin Other Kin Other Kin 0 .125 Depression Depression Depression Depression Depression

46. Other Kin: Breaking Cycle 3? 1998 2000 2002 2004 2006 Disability Disability Disability Disability Disability 0 .148 Other Kin Other Kin Other Kin Other Kin Other Kin 0 0 Depression Depression Depression Depression Depression

47. Unrelated Others: Mobilizing Care? 1998 2000 2002 2004 2006 Disability Disability Disability Disability Disability .150 0 .063 .061 Others Others Others Others Others 0 0 0 0  Depression Depression Depression Depression Depression

48. Unrelated Others: Protective Effect of Care? 1998 2000 2002 2004 2006 Disability Disability Disability Disability Disability   .640 0 0 0 Others Others Others Others Others   0 .149 0 0 Depression Depression Depression Depression Depression

49. Unrelated Others: Breaking Cycle 1? 1998 2000 2002 2004 2006 Disability Disability Disability Disability Disability 0 0 Others Others Others Others Others 0 .149 Depression Depression Depression Depression Depression

50. Unrelated Others: Breaking Cycle 2? 1998 2000 2002 2004 2006 Disability Disability Disability Disability Disability .063 0 Others Others Others Others Others 0 0 Depression Depression Depression Depression Depression