COVID-19 weighs down family caregivers of the elderly

Depressive and anxiety symptoms are prevalent among family caregivers of community-dwelling older adults during the coronavirus disease 2019 (COVID-19) pandemic in Hong Kong, according to a study by the City University of Hong Kong.

In the cross-sectional study, 236 family caregivers of community-dwelling older adults (mean age, 62.7 years; female, 74.2 percent; mean caregiving year, 7.4 years) were recruited. Data collection was through a self-administered survey or telephone interview. The mental health status of the caregivers and pandemic-related factors associated with depression and anxiety were investigated. [BMC Geriatr 2022;22:125]

“The prevalence of mental health symptoms [among the caregivers] was alarming: 56 percent and 25 percent of the respondents can be considered cases of depression and anxiety, respectively [ie, Hospital Anxiety and Depression Scale-Depression or Anxiety Scale (HAD-D or HAD-A) score ≥8],” reported the researchers.

Of note, there was a moderate to strong correlation between anxiety and depression (r=0.69; p<0.001), indicating that respondents with anxiety symptoms were also likely to have depressive symptoms.

About 60 percent of respondents had a full-time or part-time job. “Working caregivers were significantly more depressed than non-working caregivers [p=0.04], while young caregivers reported more anxiety [p=0.01] and depressive symptoms [p=0.02] than older caregivers,” highlighted the researchers.

During the COVID-19 pandemic, non-emergency healthcare services (ie, geriatric day hospitals, day-care centres and outreach rehabilitation services) were suspended, and access to medications was impeded. “Healthcare systems in Hong Kong and other countries depend on family caregivers in taking care of community-dwelling older adults more than ever,” the researchers noted. “These changes in the COVID-19 pandemic are putting increasing demands on family caregivers in providing daily care and support beyond their usual caregiving responsibility, with deprived social support, which are detrimental to mental health.”

In the study, positive predictors of depression and anxiety included getting drugs from hospitals (depression: p<0.01; anxiety: p<0.01) and hand hygiene (depression: p<0.05; anxiety: p<0.01). Positive predictors of anxiety included perceived risk (p<0.01), perceived severity (p<0.05) and home infection risk (p<0.05).

“Family caregivers have to protect themselves and the older adults from COVID-19, making them reluctant to expose themselves to risky healthcare settings,” noted the researchers. “The pragmatic challenges place dilemmas on family caregivers on whether to expose themselves and the older adults to the risk of infection or to delay treatment and services, which may lead to deteriorations in the older adults’ physical and mental conditions.”

“Our results reveal the need to provide mental health care support to younger family caregivers, those with less caregiving experience, and those family caregivers who are challenged on both ends [work and family caregiving] during the pandemic,” emphasized the researchers. “Tailor-made interventions by age and working status of the family caregivers are recommended.”

“Telemedicine practice, including online pharmaceutical services and the Internet Hospital plus Drug Delivery platform, could be a solution in alleviating the burden and worry of infection of family caregivers,” the researchers suggested.