Long-Term Care Service Usage Mediates the Relationship between Cognitive Decline and Depression

Background and Purpose:

Life changes due to cognitive decline among older adults can lead to loss of confidence, a decline in self-respect and negative emotional states including depression, resulting in a deterioration in life’s quality. However, based on Stress-Process model and previous empirical findings, some older adults with cognitive decline remain psychologically healthy and do not experience depression. With the appropriate use of internal and environmental coping resources, it can mediate the above mentioned relationship. Since the literature shows inconsistent results regarding the relationship between cognitive function/decline and depression, and fewer studies have analyzed the mediating effect of long-term service care usage in the context of the Korean insurance system, this study examines the relationship between cognitive function and depression using data from representative samples and further verifies the impact of long-term care service usage as a mediator in this relationship.

Methods: This study used data from the 2017 National Survey of Older Koreans and to be a participant in this study, those who did not respond to the Mini-Mental State Examination for Dementia Screening (MMSE-DS) (240), responded through proxy respondents (226) or were within the normal category (7,038) were excluded, conferring a final sample of 3,020 participants. Cognitive Function was measured using the Korean version of the Mini-Mental State Examination for Dementia Screening (MMSE-DS) and depression was measured using the Korean version of the Short Geriatric Depression Scale (SGDS). Long-term care service usage was measured by one question, which asked whether participants used such services in 2017 (0 = not using and 1 = using). Covariates included demographic (sex, age, and marital status), socioeconomic (education, annual household income, and economic status), health status variables (ADL, Instrumental Activities of Daily Living (IADL), and the number of chronic diseases) and use of other social services. Given the nature of the outcome variable as continuous variables and this study sought to examine their relationship, multiple regression was employed for analysis. Further, hierarchical regression was used to divide the dimensions of the significant control, independent, and mediating variable.

Results:

Cognitive scores were distributed from 5 to 23, with an average of 20.1 and 17.5% had symptoms of depression with an average score of 5.5. Also, 7.4% of the participants used long-term care services. We found that, the adverse effects of cognitive function on depression were statistically significant(-3.070,p<.01) and long-term care service usage influenced older adults’ depression levels depending on their cognitive function(1.984, p<.05).

Conclusion and implications:

This study revealed that different cognitive functioning levels resulted in different long-term care service usage effects on depression in Korean older adults. In particular, alike older adults with moderate cognitive impairment, older adults with mild cognitive impairment who used long-term care services had significantly higher depression levels than those who did not. Thus, although long-term care services are currently focused on satisfying older adults’ basic physical needs, in the future, they should include psychological programs that can neutralize negative interpretations toward age-related cognitive decline. This is particularly important for older adults with mild cognitive impairment.