Major Abdominal Cerrahi Sonrası Yaşlı Hastalarda Bakıcı Depresyonu ve Yükü, Kötü Fonksiyonel Sonuçlarla İlişkilidir

Öz

Giriş: Bu çalışma, major abdominal cerrahi geçiren yaşlı hastaların bakıcılarında bakıcı yükü ile depresyon arasındaki ilişkiyi araştırmayı ve bunun hastanın ameliyat sonrası fonksiyonel durumu ile ilişkisini değerlendirmeyi amaçlamıştır. Gereç ve Yöntemler: Tek merkezli olarak yürütülen bu kesitsel çalışmada, 65 hasta-bakıcı çifti dâhil edildi. Hasta fonksiyonel durumu Katz İndeksi ve Lawton-Brody Enstrümantal Günlük Yaşam Aktiviteleri (IADL) Ölçeği kullanılarak değerlendirildi. Bakıcı yükü Zarit Bakıcı Yükü Ölçeği ile, depresyon ise Beck Depresyon Envanteri (BDI) kullanılarak ölçüldü. Olayın etkisi (IES-R) ve yaşam kalitesi (SF-36) verileri de toplandı. Değişkenler arasındaki korelasyonlar Spearman'ın sıra korelasyon katsayısı kullanılarak değerlendirildi. Sonuç: Çalışmaya yaş ortalaması 58.9 ± 13.8 yıl olan bakıcılar ve yaş ortalaması 70.4 ± 5.8 yıl olan hastalar dâhil edildi. Bakıcıların yarısından fazlası (%50.8) BDI'ye göre şiddetli depresyon sergiledi. Bakım yükü ile depresyon arasında güçlü bir pozitif korelasyon bulundu (r = 0.53, p < 0.001). Orta veya şiddetli depresyonu olan bakıcılara sahip hastaların, depresyonu olmayan veya hafif depresyonu olan bakıcılara sahip hastalara kıyasla fonksiyonel durum skorları (Katz İndeksi, p < 0.001) anlamlı derecede düşüktü. Tartışma: Bulgularımız, bakıcı yükü ile depresyon arasında anlamlı bir pozitif ilişki olduğunu ve bunun da hastanın daha kötü fonksiyonel sonuçlarıyla ilişkili olduğunu ortaya koymaktadır. Bu sonuçlar, hem bakıcı hem de hasta sonuçlarını iyileştirmek için bu kırılgan bakıcı popülasyonu için kapsamlı psikolojik destek sistemlerinin uygulanmasının kritik ihtiyacının altını çizmektedir.

Anahtar Kelimeler

• Bakıcı yükü
• depresyon
• genel cerrahi
• yaşam kalitesi

Caregiver Depression and Burden are Associated with Poor Functional Outcomes in Elderly Patients Following Major Abdominal Surgery

Abstract

Aim: This study aimed to investigate the relationship between caregiver burden and depression in caregivers of elderly patients undergoing major abdominal surgery and to evaluate its association with the patient's postoperative functional status. Methods: In this cross-sectional study conducted at a single center, we enrolled 65 patient-caregiver dyads. Patient functional status was assessed using the Katz Index and the Lawton-Brody Instrumental Activities of Daily Living Scale (IADL). Caregiver burden was measured with the Zarit Caregiver Burden Scale, and depression was assessed using the Beck Depression Inventory (BDI). Data on event impact (IES-R) and quality of life (SF-36) were also collected. Correlations between variables were evaluated using Spearman's rank correlation coefficient. Results: The study included caregivers with a mean age of 58.9 ± 13.8 years and patients with a mean age of 70.4 ± 5.8 years. More than half of the caregivers (50.8%) exhibited severe depression according to the BDI. A strong positive correlation was found between caregiving burden and depression (r = 0.53, p < 0.001). Patients with moderately or severely depressed caregivers had significantly lower functional status scores (Katz Index, p < 0.001) compared to patients with non-depressed or mildly depressed caregivers. Conclusions: Our findings reveal a significant positive relationship between caregiver burden and depression, which in turn is associated with poorer patient functional outcomes. These results underscore the critical need for implementing comprehensive psychological support systems for this vulnerable caregiver population to improve both caregiver and patient outcomes.

Keywords

• Caregiver burden
• depression
• general surgery
• quality of life

References

1. 1. Li LT, Barden GM, Balentine CJ, et al. Postoperative transitional care needs in the elderly: an outcome of recovery associated with worse long-term survival. Ann Surg. 2015;261(4):695-701.
2. 2. Balentine CJ, Naik AD, Berger DH, Chen H, Anaya DA, Kennedy GD. Postacute Care After Major Abdominal Surgery in Elderly Patients. JAMA Surg. 2016;151(8):759-766.
3. 3. Sacks GD, Lawson EH, Dawes AJ, Gibbons MM, Zingmond DS, Ko CY. Which patients require more care after hospital discharge? an analysis of post-acute care use among elderly patients undergoing elective surgery. J Am Coll Surg. 2015;220(6):1113-1121, e2.
4. 4. Bednarek A, Mojs E, Krawczyk-Wasielewska A, et al. Correlation between depression and burden observed in informal caregivers of people suffering from dementia with time spent on caregiving and dementia severity. Eur Rev Med Pharmacol Sci. 2016;20(1):59-63.
5. 5. Collins RN, Kishita N. Prevalence of depression and burden among informal care-givers of people with dementia: a meta-analysis. Ageing and Society. 2020;40(11):2355-2392.
6. 6. Lwi SJ, Ford BQ, Casey JJ, Miller BL, Levenson RW. Poor caregiver mental health predicts mortality of patients with neurodegenerative disease. Proc Natl Acad Sci USA.2017;114(28):7319-7324.
7. 7. Pristavec T. The caregiving dyad: Do caregivers’ appraisals of caregiving matter for care recipients’ health?. Arch Gerontol Geriatr. 2019;82:50-60.
8. 8. Segrin C, Badger TA, Sikorskii A, et al. Longitudinal dyadic interdependence in psychological distress among Latinas with breast cancer and their caregivers. Support Care Cancer. 2020;28(6):2735-2743.

9. 9. Ageing and health. Available from: https://www.who.int/news-room/fact-sheets/detail/ageing-and-health. Accessed July 30, 2025.
10. 10. Janssen T, Steyerberg E, Faes M, et al. Risk factors for postoperative delirium after elective major abdominal surgery in elderly patients: A cohort study. Int J Surg. 2019;71:29-35.
11. 11. Virches A, Miyazaki ET, dos Santos Junior R, et al. Burden, Stress, and Depression in Informal Caregivers of Patients Pre and Post Liver Transplant. Transplant Proc. 2021;53(1):233-238.
12. 12. Arik G, Varan HD, Yavuz BB, et al. Validation of Katz index of independence in activities of daily living in Turkish older adults. Arch Gerontol Geriatr. 2015;61(3):344-350.
13. 13. Wei L, Hodgson C. Clinimetrics: The Lawton-Brody Instrumental Activities of Daily Living Scale. J Physiother. 2023;69(1):57.
14. 14. Weiss DS, Marmar CR. The impact of event scale – revised. In:Wilson JP, Keane TM, eds. Assessing psychological trauma and PTSD. New York, Guilford Press, 1997:399–411
15. 15. Arai Y, Kudo K, Hosokawa T, Washio M, Miura H, Hisamichi S. Reliability and validity of the Japanese version of the Zarit Caregiver Burden interview. Psychiatry Clin Neurosci. 1997;51(5):281-287.
16. 16. Ware JE, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992;30(6):473-483
17. 17. Beck JG, Grant DM, Read JP, et al. The impact of event scale-revised: psychometric properties in a sample of motor vehicle accident survivors. J Anxiety Disord. 2008;22(2):187-198.
18. 18. Borges EL, Franceschini J, Costa LHD, Fernandes ALG, Jamnik S, Santoro IL. Family caregiver burden: the burden of caring for lung cancer patients according to the cancer stage and patient quality of life. J Bras Pneumol. 2017;43(1):18-23.
19. 19. Camargo R.C.V.F. Implications on the mental health of elderly caregivers: an urgent need for formal support. SMAD. Revista eletrônica saúde mental álcool e drogas. 2010;6(2):231-254.
20. 20. Balentine CJ, Naik AD, Berger DH, Chen H, Anaya DA, Kennedy GD. Postacute Care After Major Abdominal Surgery in Elderly Patients. JAMA Surg. 2016;151(8):759.
21. 21. Teo JYK, Turner R, Self M. Effect of exercise prehabilitation on functional status of patients undergoing bowel resection: a systematic review. ANZ Journal of Surgery. 2020;90(5):693-701.
22. 22. Ringle ML, Wernovsky G. Functional, quality of life, and neurodevelopmental outcomes after congenital cardiac surgery. Seminars in Perinatology. 2016;40(8):556-70.
23. 23. Yang X, Zeng Q, Tan S, Zhou H, Qiu X, Yan J. Psychosocial situation, burden, and unmet needs among informal caregivers prior to hematopoietic stem cell transplantation: a systematic review of quantitative and qualitative data. Support Care Cancer. 2025;33(2):119.
24. 24. Singh Solorzano C, Leigh E, Steptoe A, et al. The Impact of Caregiving Burden on Mental Well-Being in Coronary Artery Bypass Graft Surgery Caregivers: The Mediatory Role of Perceived Social Support. IJERPH. 2021;18(10):5447.
25. 25. Cucciare MA, Gray H, Azar A, Jimenez D, Gallagher-Thompson D. Exploring the relationship between physical health, depressive symptoms, and depression diagnoses in Hispanic dementia caregivers. Aging Ment Health. 2010;14(3):274-282.
26. 26. O'Dwyer ST, Moyle W, Zimmer-Gembeck M, De Leo D. Suicidal ideation in family carers of people with dementia. Aging Ment Health. 2016;20(2):222-230.
27. 27. Geng H, Chuang D, Yang F, et al. Prevalence and determinants of depression in caregivers of cancer patients. Medicine (Baltimore). 2018;97(39):e11863.
28. 28. Bryson GL, Mercer C, Varpio L. Patient and caregiver experience following ambulatory surgery: qualitative analysis in a cohort of patients 65 yr and older. Can J Anaesth. 2014;61(11):986-994.
29. 29. Janssen TL, Lodder P, de Vries J, et al. Caregiver strain on informal caregivers when providing care for older patients undergoing major abdominal surgery: a longitudinal prospective cohort study. BMC Geriatr. 2020;20(1):178.
30. 30. Navab E, Legacy N, Haase KR, et al. Interventions to support caregivers of older adults undergoing surgery: A systematic review. Am J Surg. 2025;242:116226.