S144

Posters: P-142

Background: Researchers cited depression significantly being the major

declining element associated with caregiver morbidity (Whelan 2001;
Burton, Zdaniu, Schulz, Jackson, Hirsch). Providing daily care to demented family members is a physically and emotionally exhausting task.
Among the consequences is depression which is alarmingly common
among these caregivers and is often severe (Ferris 2002). Objective: To
examine depression knowledge, attitude and help seeking behaviors among
older African Americans caring for their loved ones with Alzheimers
disease. Methods: With a representative sample, we developed a 12-item
qualitative survey from a focus group structured with open-ended questions
relative to depression and caregiving. The survey was self-administered
during a 2005 Live Healthy Georgia health fair in a multi-purpose senior
center. Results: Thirty-three African Americans aged 50-90 responded to
this survey, of which twenty-five were caregivers. Of the twenty-five,
fourteen were caring for a loved one with Alzheimers disease and eleven
were non-AD caregivers. Of the total sample population, 59% indicated
that African American AD caregivers had no understanding of depression.
Additionally, 69% of all caregivers indicated African American AD caregivers did not know how to seek help if they were depressed. Among
fourteen African American AD caregivers, 69% agreed in strong association with age (Somers d0.583, p0.048). Additionally, 58% of non-AD
caregivers answered that African American AD caregivers did not know
how to seek help if they were depressed which was associated with age
(lambda1.0, p0.003). Of all respondents, 87% indicated that African
American AD caregivers grieve during the care of their loved one. There
was a significant difference between the responses of AD and non-AD
caregivers to this question (t-value2.309; df13; p0.038). Of AD
caregivers, 71% indicated African American AD caregivers grieve caring
for their loved one; 100% of non-AD caregivers agreed. Conclusions: We
may need further research in depression counseling intervention strategies
among AD caregivers during and after the caring experience (Mittelman
2004). In 1999 the Surgeon General of the United States, David Satcher,
MD, issued a report on mental health. His conclusions are our conclusions:
mental illnesses such as depression are real; treatment works; get help
(Satcher 2001).
ACKNOWLEDGMENTS: Lorraine Cook, MSW, Emma Darnell MultiPurpose Senior Center; Rosalene King, MSW, Helene Mills Multi-Purpose
Senior Center; Arnisha Norman, MS, RD, LD, Atlanta Regional Center.
REFERENCES:
Burton Lynda C, Zdaniu Bozena K, Schulz Richard, Jackson Sharon, and
Hirsch Calvin. The Gerontologist 2003; 43:230-241.
Ferris Mara, MS, RN, C, CS, CPHQ, CRRN, EMT (President AGE, Inc. /
Association for Gerontologic Education) Reducing the Caregivers Depression, January 3, 2000, (Reviewed: November 1, 2002).
Mittelman MS, Roth DL, Coon DW, Haley WE. Sustained benefit of
supportive intervention for depressive symptoms in caregivers of patients
with Alzheimers disease, Am J Psychiatry. 2004 May; 161(5):850-6.
Neundorfer Marcia M., McClendon McKee J., Smyth Kathleen A.,
Stuckey Jon C., Strauss Milton E., and Patterson Marian B. A Longitudinal
Study of the Relationship Between Levels of Depression Among Persons
With Alzheimers Disease and Levels of Depression Among Their Family
Caregivers, J. Gerontol. B. Psychol. Sci. Soc. Sci. 2001; 56:P301-P313.
Satcher, David. Surgeon Generals Report on Childrens Mental Health,
2001.
Schulz, R., G. Williamson, R. Morycz, and D. Biegel. Changes in Depression Among Men and Women Caring for an Alzheimers Patient. In:
Caregiving Systems: Informal and Formal Helpers, edited by S. H. Zarit,
L. Pearlin, and K. Schaie, pp. 119-40, 1993.
Whelen Robinson- Susan, PhD, Caregiving negative effects can last years:
study: depression rate didnt drop, Journal of Abnormal Psychology, December 2001.

P-142

ADVANCE CARE PLANNING AND DEMENTIA

Karen B. Hirschman, Sarahlena Panzer, Jason H.T. Karlawish,

University of Pennsylvania, Philadelphia, PA, USA. Contact e-mail:
hirschk@nursing.upenn.edu
Background: A person with dementia progressively loses his or her ability
to make decisions. Over time, other people, usually family members, make
decisions for the patient. However, we know little about whether older
adults are having advance care planning (ACP) discussions and what
factors older adults think are important if their family has to make medical
decisions on their behalf. Objective: This study was designed to assess
whether older adults are having discussions about health care preferences
and to identify the factors that are important to ACP, the process of having
discussions and creating formal written directives. Methods: In-depth
interviews with 43 older adults: 22 Alzheimers Disease Center (ADC)
patients with Mild Cognitive Impairment (MCI) or early stage Alzheimers
Disease (AD) and 21 ADC control subjects (without dementia). Results:
Fifty percent of the AD patients and 69% of controls have had a discussion
about their health care preferences with their relatives, while 100% of the
subjects expressed that they should discuss their preferences with their
family. Sixty-eight percent of dementia patients and 100% of controls felt
that it was more important to put their health care preferences in writing
versus having only a conversation. Although 100% of the controls felt
written directives were important, 24% reported not having a living will or
durable power of attorney. When asked if it would be helpful to talk about
ACP with a lawyer, only 59% of dementia patients said it would be helpful
while 86% of controls said it would be helpful. Approximately two-thirds
of both subject groups felt that talking with their physicians would be
helpful. Dementia patients said educational materials would be helpful
(73%) but fewer controls felt educational materials would be helpful
(52%). Conclusions: While the majority of older adults, regardless of MCI
or dementia, are having ACP discussions, 100% think that these discussions should take place. For patients with dementia these conversations will
provide their family decision makers with information on which to base
decisions in the future. Further research into the barriers and facilitators to
ACP and medical decision making are necessary.
P-143

FAMILY MEMBERS PERCEPTIONS OF

PALLIATIVE CARE SERVICE NEEDS OF
ADVANCED DEMENTIA PATIENTS

Karen B. Hirschman, Jennifer M. Kapo, Sarahlena Panzer,

David J. Casarett, University of Pennsylvania, Philadelphia, PA, USA.
Contact e-mail: hirschk@nursing.upenn.edu
Background: Despite advances in therapeutics, Alzheimers Disease remains a progressive and terminal illness that will require palliative care. An
increased understanding of the needs and preferences for palliative care
services for persons with advanced dementia is essential to address the
unique and complex needs of the growing population of elders and their
family members. Objective: To identify the palliative care services that
family members of nursing home residents with advanced dementia believe
to be most helpful. Methods: In-depth telephone interviews with family
members (n35) of nursing home residents with advanced dementia (Cognitive Performance Scale score 5 and a diagnosis of dementia as
reported on the Minimum Data Set). Subjects were recruited from both
inner city and suburban nursing home facilities in two large nursing home
and continuing care communities. Results: There were no differences
between black (n17) and white (n18) family members perceptions of
palliative care needs. Over 60% of family members thought it would be
helpful to learn more about how to detect when their relative is in pain.
Forty-three percent of family members indicated that they felt their relative
needed more visitors. In addition, 43% of family members said they were
emotionally exhausted in coping with their relatives illness. Thirty-eight
percent of family members felt their relative could use more spiritual
support and 36% felt it would be helpful to have more information on their