Death with and without Dementia: Impact on Family Antidepressant Prescriptions (RP220)

Outcomes 1. Participants will be able to identify differences in antidepressant prescriptions in family members of patients with and without dementia before and after death.2. Participants will be able to identify additional caregiver and patient factors associated with antidepressant prescriptions including demographics, caregiver-patient relationship, nursing home status, and family size. Key Message Persons with dementia often have more protracted long-term care and end-of-life caregiving needs, compared to those with other chronic illnesses with caregiving typically managed by spouses and adult children. Dementia-related responsibilities are particularly stressful, with high rates of depression before death and more intense grief reactions following death. Importance Little is known, however, about how the emotional stress of caregiving may differ before and after the death of persons with and without dementia. Given that antidepressant prescriptions are a strong indicator of clinically relevant levels of caregiver stress and bereavement outcomes, we explored the rates of antidepressant prescriptions among family members of decedents with and without dementia, during the one year prior and one year following a family member's death. Objective(s) To examine antidepressant prescriptions in kin of decedents with and without dementia before and after death. Scientific Methods Utilized This retrospective cohort study used data from the novel Utah Caregiving Population Science (Utah C-PopS) dataset and focused on the widows/widowers (n=47,117) and sons/daughters (n=210,572) of decedents who died in Utah between 1998-2016 with dementia (n=29,401) or without dementia (n=98,017). Descriptive statistics were used to describe the study sample and multivariable logistic regressions were used to predict whether someone had an antidepressant prescription during the one-year prior and one-year post death by dementia status, controlling for decedent age, kin age, co-residence status, presence/type/number of other kin, prior antidepressant use, and other variables. Results Multivariable logistic regression models revealed spouses of dementia decedents had higher odds of an antidepressant prescription compared to spouses of non-dementia decedents during pre-death (End of life caregiving) [OR = 1.22 (1.01, 1.46)], including higher odds of prescriptions in female spouses [OR =1.64 (1.39, 1.96)]. Adult children of dementia decedents had higher odds of an antidepressant prescription compared to adult children of non-dementia decedents during pre-death (End of life (EOL) caregiving) [OR = 1.36 (95% 1.17, 1.58)], including higher odds of prescriptions in daughters [OR=1.74 (1.51, 2.00)]. Conversely, there was no difference in odds of antidepressant prescription 1 year after death in either spouses or adult children of decedents with and without dementia [OR = 1.12 (0.93, 1.33); OR = 1.12 (0.96, 1.31) respectively]. Conclusion(s) Differences in antidepressant prescriptions during pre-death periods suggests that caregiving and bereavement may be more intense for spouses and adult children of persons with dementia and for females compared to males. Dementia status did not have a significant effect on the odds of post-death grief antidepressant prescriptions. Impact These results underscore the need for pre-death support for caregivers of persons with dementia, particularly female caregivers. Furthermore, these results demonstrate the utility of population-based datasets to investigate associations between dementia kin and medical outcomes including antidepressant prescriptions. Further analysis should examine if larger family sizes and multiple available caregivers impact antidepressant prescriptions an indicator that other family members may be more likely to share the caregiving responsibilities and provide grief support. Keywords Family caregivers/Psychosocial support