(see Poster Gallery) Role of Moderated Mediation of Older Adults' Ostomy-Related Problems and Community Resources in Burden and Depression Among Caregivers

Colorectal cancer is one of the most common cancers worldwide, with a continuous increase in numbers. With significant improvement in survival rates, the number of elderly undergoing ostomies has also increased. An ostomy often results in complex emotional, social, and physical concerns, which require continued care and support from health professionals, medical social workers, and family members. However, little is known about the most dominant types of family burden and mental health status among caregivers of older adults living with chronic illnesses such as ostomy. This study aimed to investigate the relationship between older adults’ ostomy-related problems and depression among caregivers. Family burden was set as a mediator between ostomy-related problems and depression among caregivers. We examined the moderated mediating effect of ostomy-related problems and the use of formal and informal community resources on family burden and depression among caregivers. A cross-sectional design was used for this study. Data from 125 family caregivers of older adults with ostomy were collected from a university hospital in Seoul, South Korea. Serial mediation, moderation, and moderated mediation were performed using SPSS 26.0 and PROCESS macro v.4.0 (model 6 and model 8) to assess the perceived severity of ostomy-related problems and the use of community resources. Economic burden scored the highest with an average of 3.11 (SD=1.02), followed by social burden (M=3.01, SD=1.21), physical burden (M=2.96, SD=1.12), and emotional burden (M=2.72, SD=.76). The direct effects of ostomy-related problems on depression were not significantly related to depression. However, the total indirect effect was significant (B=.22, SE=.10, CI [.04, .42]), indicating that family burden are fully mediated in the relationship between ostomy-related problems and depression. This relationship demonstrated that the severity of ostomy-related problems increased family burden, which was associated with higher level of depression. Subsequently, we examined whether the mediation was moderated using formal community resources. The index of moderated mediation was significant for the indirect effect of problems on depression related to burdens (B=−.54, SE=.18, CI [−.90, −.19]). Indirect effect decreased with the increase use of formal community resources. Therefore, for individuals who receive support and information from community-based organizations, such as health clinics, associations, and nonprofit organizations, the severity of depression is lower even if they handle more ostomy-related problems. The support and information received from friends and neighbors (informal resources) show no significant relationship. This study provides practical implications to social workers who mainly work with older adults with chronic illnesses. Our findings suggest that community-based organizations need to provide information on medical care and focus to reduce caregivers’ perceived levels of economic and psychological burdens. This approach would help reduce mental health problems in caring for older adults with chronic illnesses.