Caregiving Network Characteristics and Mental Health Care Utilization by Older Adults.

BACKGROUND

Rates of mental health service use are low among older adults. This study examined associations between mental health care utilization and caregiving network characteristics, including caregiving network size, caregiving intensity, the presence of formal helpers, and primary caregiver characteristics.

METHODS

Using a sample of 692 respondents in the health and retirement study (HRS) with linkage to veterans affairs healthcare records (mean age = 78.7, SD = 8.08; 97.1% male), logistic regression models tested caregiving network characteristics as predictors of mental health care utilization, adjusting for demographics and health conditions. Moderation effects of cognitive status (Langa-Weir HRS Classification) and depressive symptoms (CESD-8 Scale) were explored.

RESULTS

Mean network size was 1.6 helpers (SD 1.0), with 77.6% of networks comprising only family caregivers and 41.7% of care recipients reporting high-intensity caregiving. Primary caregiver was most often a spouse (61.1%) and female (89.4%, n = 49 (7.1%) missing data). In multivariable models, primary caregiver female gender was associated with a three-fold increase in likelihood of mental health service utilization (OR = 3.95, 95% CI 1.72-9.05), while other caregiving network characteristics were not associated. Having a primary caregiver who was female was most strongly associated with service utilization for care recipients with less severe depressive symptoms or impaired cognition.

CONCLUSIONS

Caregiver characteristics, particularly gender, may be important factors in facilitating greater mental health care use for older veterans. Targeted education and support may improve caregivers' effectiveness as a resource to help reduce age-related disparities in mental health access. This study contributes to the growing body of research examining the impact of caregivers on healthcare outcomes of older adults.