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Involvement in Caregiving and Adjustment to Death of a Spouse
Findings From the Caregiver Health Effects Study
Richard Schulz, PhD;
Scott R. Beach, PhD;
Bonnie Lind, MS;
Lynn M. Martire, PhD;
Bozena Zdaniuk, PhD;
Calvin Hirsch, MD;
Sharon Jackson, PhD;
Lynda Burton, ScD
JAMA. 2001;285:3123-3129.
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 an extended period during which family members provide care to their disabled relative.
Objective To better understand the effect of bereavement on family caregivers by examining predeath vs postdeath changes in self-reported and objective health outcomes among elderly persons providing varying levels of care prior 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 strained caregivers (n = 52).
Main Outcome Measures Changes in depression symptoms (assessed by the 10-item Center for Epidemiological Studies–Depression [CES-D] scale), antidepressant 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 assessments, 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; F1,116 = 14.33; P<.001) and nonstrained caregivers (4.94 vs 7.13; F1,116 = 4.35; P = .04). Noncaregivers were significantly more likely to be using nontricyclic antidepressant medications following the death than the nonstrained caregiver group (odds ratio [OR], 12.85; 95% confidence interval [CI], 1.02-162.13; P = .05). The strained caregiver group experienced significant improvement in health risk behaviors following the death of their spouse (1.47 vs 0.66 behaviors; F1,118 = 20.23; P<.001), while the noncaregiver and nonstrained caregiver groups showed little change (0.27 vs 0.27 [P = .99] and 0.46 vs 0.27 [P = .39] behaviors, respectively). Noncaregivers experienced significant weight loss following the death (149.1 vs 145.3 lb [67.1 vs 65.4 kg]; F1,101 = 8.12; P = .005), while the strained and nonstrained caregiving groups did not show significant weight change (156.2 vs 155.2 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 among older persons varies as a function of the caregiving experiences that precede the death. Among individuals who are already strained prior to the death of their spouse, the death itself does not increase their level of distress. Instead, they show reductions in health risk behaviors. Among noncaregivers, losing one's spouse results in increased depression and weight loss.
Author Affiliations: Department of Psychiatry (Drs Schulz and Martire) and University Center for Social and Urban Research (Drs Schulz, Martire, Beach, and Zdaniuk), University of Pittsburgh, Pittsburgh, Pa; Department of Biostatistics, University of Washington, Seattle (Ms Lind); Division of General Medicine, University of California, Davis Medical Center (Dr Hirsch); Department of Public Health Sciences, Section on Epidemiology, Wake Forest School of Medicine, Winston-Salem, NC (Dr Jackson); and Health Services Research and Development Center, Johns Hopkins University, School of Hygiene and Public Health, Baltimore, Md (Dr Burton). A list of the participating institutions and principal staff of the Cardiovascular Health Study was published previously (J Am Geriatr Soc. 1997;45:1423-1433).
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