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Elder Care News
Caregivers Learning to Manage Illness also Helped in
Coping with Death
Original goal was
easing burden of caring for relative with dementia
 August 3, 2006 - An intervention aimed at
preventing depression and easing the burden of caring for a relative
with dementia also helps to prevent complicated grief and depression
following the death of the loved one, according to a University of
Pittsburgh-led study. The findings could help the
millions of American families caring for relatives with dementia.
Approximately 4.5 million Americans with Alzheimer's disease live at
home with 75 percent cared for by family members.
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Geriatric Care Mangers Emerging as Important
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years ago, are emerging into an important piece of the network for the
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Elder Care News |
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The study, published in the August issue of the
American Journal of Geriatric Psychiatry, was initially designed to establish methods
for preventing depression and increasing coping skills during the caregiving process, sought to determine who among caregivers were at
risk for complicated grief and depression after their care-recipients
died.
Surprisingly, the interventions aimed at helping
the caregiver cope while the care-recipient was living also helped the
caregiver cope with the recipient's death, preventing complicated grief
and depression. According to principal investigator and lead author
Richard Schulz, Ph.D., professor of psychiatry at the University of
Pittsburgh, the finding was totally unexpected.
Complicated grief most often occurs following the
death of someone in a very close and loving relationship. Key features
include:
● a sense of disbelief regarding the death,
● anger and bitterness over the death,
● recurrent pangs of painful emotions with intense yearning and
longing for the deceased,
● avoidance of situations and activities that are reminders of the
loss, and a preoccupation with thoughts of the loved one, often
including distressing, intrusive thoughts related to the death.
Since it is a newly characterized condition, not
yet included in the American Psychiatric Association's Diagnostic and
Statistical Manual, little is known about how to treat and prevent
complicated grief. In fact, report the authors, the results of this
study are the first to demonstrate the effectiveness of such
interventions -- which include education, skills training and group
support -- on preventing complicated grief and depression after death.
Twenty percent of the caregivers in the study
experienced symptoms of complicated grief after their loved ones died.
Most of these did not receive the interventions, had depressive symptoms
and/or saw the caregiving process as positive, usually because they
derived a sense of purpose from the situation, and were most likely to
experience severe depression and complicated grief post-death.
"Taking care of a relative with dementia can be
very stressful. Most caregivers respond well to their loved one's death,
seeing it as a relief for the patient, which is why we focused on
helping during the caregiving process, rather than after," said Dr.
Schulz, who is associate director of the University of Pittsburgh
Institute on Aging and director of the Center for Social and Urban
Research. "Given that in our previous studies we have found that a large
number, some 30 percent of caregivers, are still at risk for severe
depression after the death of their loved one, it's encouraging to know
that these interventions can help both before and after death."
The Resources for Enhancing Alzheimer's Caregiver
Health (REACH) study followed 1,222 caregivers and their loved ones in
Boston; Birmingham, Ala.; Memphis, Tenn.; Miami; Philadelphia; and Palo
Alto, Calif., between 1996 and 2000. During the course of the study, 265
of the care-recipients died; 217 of their caregivers were followed for
this study.
According to the authors, the caregivers were
generally representative of individuals who provide in-home care for
relatives with Alzheimer's disease. They were an average of 64 years
old; 84 percent were women; and nearly half were caring for a spouse.
Care-recipients were on average 81 years old and 54 percent were men.
Caregivers were initially randomized to receive
either six months of an active intervention or a control intervention,
and were assessed at the onset of the study and at six, 12 and 18
months. The caregivers whose loved ones died during the study were
assessed following the death, around 15 weeks post-death, and at six, 12
and 18 months.
The researchers found that reducing caregiver
burden, treating depression prior to death and providing supportive
psychosocial or skills training caregiver interventions helped the
caregivers to better manage with their loved one's deaths.
"Our findings show that caregiving is closely
intertwined with the bereavement experience that follows. Family members
caring for relatives with advanced disease would not only benefit from
traditional caregiving interventions designed to ease the burden of care
but also from pre-bereavement treatments that would better prepare them
for the impending death of their loved one," said Dr. Schulz.
Notes on study:
Co-authors of the study include: Kathrin Boerner,
Ph.D., Lighthouse International, N.Y.; Katherine Shear, M.D., formerly
of the University of Pittsburgh and now at the Columbia School of Social
Work, New York City; Song Zang, M.S., University of Pittsburgh; and
Laura N. Gitlin, Ph.D., Thomas Jefferson University, Philadelphia.
The study was supported by grants from the
National Institute on Aging, the National Institute of Nursing Research,
the National Institute of Mental Health and the National Heart, Lung and
Blood Institute, all of the National Institutes of Health.
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