Late-Life Depression Care: Individual and Collective Perspectives of Family Members

Purpose: Most treatment for older adults with major depression is either funded or provided by government programs, yet policy decisions about how to treat late-life depression have largely ignored social factors that affect treatment outcomes. With family systems theory and a family resilience framework providing the theoretical infrastructure, and a convergent parallel design, this mixed methods study sought to characterize family members who are involved with older adults with depression, and asked how the involvement affects family functioning and relationships.

Methods: Twenty community-dwelling adults age 60 and over diagnosed with major depression were recruited. The older adults identified family members involved in their care; family members were then invited to participate. Thirty-eight family members completed in-depth face-to-face semi-structured interviews. Subscales from the Family Experiences Interview Schedule (FEIS) were used to collect quantitative information such as family enumeration, respondents’ involvement with the older relative, benefits and gratifications, and affective response. The General Functioning (GF) subscale from the Family Assessment Device (FAD)—which classifies family functioning as healthy (scores below 2.00) or unhealthy (scores 2.00 and above)—was used to assess individual family members’ perceptions of overall family functioning. Statistical evaluation of responses to the FEIS and the FAD-GF was used to describe individual and collective perspectives of family members.  Quantitative descriptive data was also used to shape and validate the themes used to code the textual qualitative data.

Results: Family members included primary and secondary kin and other individuals identified as family by the older adult. Participant perception of family functioning did not concur among family members in eight of the ten families represented by more than one participant.  Most participants who perceived family functioning as healthy looked positively on their relationship with the older adult. Ninety-two percent enjoyed being with and were happy to do things for the older adult. None reported that they were embarrassed by the older adult, but all worried about the older adult’s treatment. Eighty-three percent reported LDS as their religious preference. Those who perceived family functioning as unhealthy still acknowledged benefits.  Sixty percent enjoyed being with the older adult and 73% were happy to do things for the older adult, but a substantial minority also reported burdens. For example, 40% acknowledged that they were embarrassed by the older adult.  Fifty-four percent seldom or never worried about the older adult’s treatment (compared with 17% in the healthy functioning group).  A minority (42%) of those perceiving family functioning as unhealthy reported LDS as their religious preference.

Implications: Outcomes suggest that family members are heavily involved in providing care for older adults with depression, that members in the same family view family functioning differently from one another, and that most family members caring for older adults with depression experience both benefits and burdens. The complex factors identified in this study should be considered when shaping public policy and when developing evidence-based interventions for older adults and family members who are involved in their care. Social worker researchers can lead the way in this endeavor.