Involvement in caregiving and adjustment to death of a spouse - Findings from the caregiver health effects study

Context Most deaths in the United States occur among older persons who have 1 or more disabling conditions. As a result, many deaths are preceded by a n extended period during which family members provide care to their disable d relative. Objective To better understand the effect of bereavement on family caregive rs by examining predeath vs postdeath changes in self-reported and objectiv e health outcomes among elderly persons providing varying levels of care pr ior to their spouse's death. Design and Setting Prospective, population-based cohort study conducted in 4 US communities between 1993 and 1998. Participants One hundred twenty-nine individuals aged 66 to 96 years whose spouse died during an average 4-year follow-up. Individuals were classified as noncaregivers (n=40), caregivers who reported no strain (n=37), or stra ined caregivers (n=52). Main Outcome Measures Changes in depression symptoms (assessed by the 10-it em Center for Epidemiological Studies-Depression [CES-D] scale), antidepres sant medication use, 6 health risk behaviors, and weight among the 3 groups of participants. Results Controlling for age, sex, race, education, prevalent cardiovascular disease at baseline, and interval between predeath and postdeath assessmen ts, CES-D scores remained high but did not change among strained caregivers (9.44 vs 9.19; P=.76), while these scores increased for both noncaregivers (4.74 vs 8.25; F-1,F-116=14.33; P<.001) and nonstrained caregivers (4.94 v s 7.13; F-1,F-116=4.35; P= .04) Noncaregivers were significantly more likel y to be using nontricyclic antidepressant medications following the death t han the nonstrained caregiver group (odds ratio [OR], 12.85; 95% confidence interval [Cl], 1.02-162.13; P=.05). The strained caregiver group experienc ed significant improvement in health risk behaviors following the death of their spouse (1.47 vs 0.66 behaviors; F-1,F-118=20.23; P<.001), while the n oncaregiver and nonstrained caregiver groups showed little change (0.27 vs 0.27 [P=.99] and 0.46 vs 0.27 [P=.39] behaviors, respectively). Noncaregive rs experienced significant weight loss following the death (149.1 vs 145.3 lb [67.1 vs 65.4 kg]; F-1,F-101=8.12; P=.005), while the strained and nonst rained caregiving groups did not show significant weight change (156.2 vs 1 55.2 lb [70.3 vs 69.8 kg] [P= 41] and 156.2 vs 154.0 lb [70.3 vs 69.3 kg] [ P=.12], respectively). Conclusions These data indicate that the impact of losing one's spouse amon g older persons Varies as a function of the caregiving experiences that pre cede the death. Among individuals who are already strained prior to the dea th of their spouse, the death itself does not increase their level of distr ess. Instead, they show reductions in health risk behaviors. Among noncareg ivers, losing one's spouse results in increased depression and weight loss.