Karen A. Zurlo

Diagnosis and Treatment of Depression in Older Community-Dwelling Adults: 1992–2005

OBJECTIVE: To examine evolving patterns of depression diagnosis and treatment in older U.S. adults in the era of newer‐generation antidepressants.

Racial and Ethnic Disparities in Depression Care in Community-Dwelling Elderly in the United States

OBJECTIVES We investigated racial/ethnic disparities in the diagnosis and treatment of depression among community-dwelling elderly. METHODS We performed a secondary analysis of Medicare Current Beneficiary Survey data (n = 33,708) for 2001 through 2005. We estimated logistic regression models to assess the association of race/ethnicity with the probability of being diagnosed and treated for depression with either antidepressant medication or psychotherapy. RESULTS Depression diagnosis rates were 6.4% for non-Hispanic Whites, 4.2% for African Americans, 7.2% for Hispanics, and 3.8% for others. After we adjusted for a range of covariates including a 2-item depression screener, we found that African Americans were significantly less likely to receive a depression diagnosis from a health care provider (adjusted odds ratio [AOR] = 0.53; 95% confidence interval [CI] = 0.41, 0.69) than were non-Hispanic Whites; those diagnosed were less likely to be treated for depression (AOR = 0.45; 95% CI = 0.30, 0.66). CONCLUSIONS Among elderly Medicare beneficiaries, significant racial/ethnic differences exist in the diagnosis and treatment of depression. Vigorous clinical and public health initiatives are needed to address this persisting disparity in care.

Sequential Patterns of Health Conditions and Financial Outcomes in Late Life: Evidence From the Health and Retirement Study

The cost and prevalence of chronic health conditions increase in late life and can negatively impact accumulated wealth. Based on the financial challenges midaged and older adults face, we sought to understand the evolution of distinctive sequences of chronic health conditions and how these sequences affect retirement savings. We used 10 waves of the Health and Retirement Study and tracked the health states and changes in wealth of 5,540 individuals. We identified five typical sequences of chronic health conditions, which are defined as follows: Multimorbidity, Comorbidity, Mild Disease, Late Event, and No Disease. Wealth accumulation differed across the five sequences. Multimorbidity and Comorbidity were the most costly sequences. Individuals with these health patterns, respectively, had

Spousal Caregiving and Financial Strain Among Middle-Aged and Older Adults

91,205 and

Do Financial Constraints Affect Depressive Symptomatology Among Mid-Aged and Older Adults?

95,140, less net worth than respondents identified with No Disease. Our findings suggest policy makers consider sequential disease patterns when planning for the health-care needs and expenditures of older Americans.

The Economic Burden of Out-of-Pocket Medical Expenditures Before and after Implementation of the Medicare Prescription Drug Program

We examine whether spousal caregivers face difficulties in meeting their basic household expenses compared to nonspousal caregivers and whether social support mechanisms ameliorate any financial strain from caregiving responsibilities. We use data for caregivers aged 45 and over drawn from a nationally representative, cross-sectional Canadian Community Health Survey—Healthy Aging (N = 5,067). Spousal caregiving is associated with a 35% increase in the likelihood of experiencing difficulties in meeting basic expenses compared to other types of caregiving. Each of social support mechanisms (affectionate, emotional/informational, and positive social interaction), singularly and combined, lessens financial strain from caregiving. Our findings suggest that spousal caregivers are particularly vulnerable because they have fewer resources to draw on for support and perform much more intensive care. Our results highlight the importance of developing appropriate policies and programs to support caregivers.

Racial Disparities in Depression Care among Older Adults: Can the Perspectives of Clinicians and Patients be Reconciled?

The relationship between financial constraints and depressive symptomatology among adults aged 50 and greater was examined. The mediating effect of perceived control over one’s financial circumstances on this relationship was assessed. Ordinary least square hierarchical regression models were estimated using data from the Health and Retirement Study. As an aggregated measure, financial constraints were positively associated with depression in mid-age and late life, and this relationship was partially accounted for by the pathway of perceived control over one’s financial circumstances. When disaggregated as a measure, financial constraints at the individual level had a significant effect on depression, while financial constraints at the family and public levels did not have a significant effect. When added to the model, perceived control over one’s financial circumstances had a significant effect on depressive symptomatology, financial constraints remained significant at the individual level.

Financial Literacy: Building Economic Empowerment with Survivors of Violence

Older Americans, although covered by Medicare, bear a large economic burden of medical expenses in the form of premiums for Medicare and supplemental plans, as well as the cost of uncovered or under-covered medical services. This study compares the patterns of this economic burden in 2010 with the baseline year of 2005. The period covered was marked by economic shocks, health care technology innovations and major Medicare reforms, including implementation of the prescription drug (Part D) program and changes in premium rules. Consequently, we present a description of the economic burden and do not attempt to make causal inferences. The definition of expenditures is limited to three components of out-of-pocket (OOP) medical spending: premiums, prescription drugs costs, and health services. While this definition is a limitation of the study, it also allows the researchers to focus on the costs most likely to be affected by improved access to prescription drugs and premium reforms.

Health Shocks, Out-of-Pocket Medical Expenses and Consumer Debt Among Middle-Aged and Older Americans

Depression is highly prevalent and debilitating in late life. It affected 3.8 million older Americans in 2005, and its prevalence is expected to increase to 6.6 million in 2025. Despite its prevalence and associated negative health outcomes, depression is not diagnosed and treated equally among older Americans. An under-recognition and under-treatment of depression in minority elders exists, which has lead to significant disparities between Whites and non-Whites. These disparities challenge our principles of equality, equity and adequacy and, in their most extreme form, become human rights issues. As a result, eliminating health disparities has become a priority of the US Federal government. Practitioners must address differences in the diagnosis and treatment of depression among clients served. Increased levels of cultural competency and educating clients will help reconcile differences between clinicians and their patients and lead to increased understanding of client needs, while decreasing disparities in depression care and diagnosis.