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Caregivers / Homecare News
Article Date: 06 Aug 2006 - 9:00am (PDT)
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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, which
are published in the August issue of the American
Journal of Geriatric Psychiatry, 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.
The study, 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.
###
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.
Contact: Jocelyn Uhl Duffy
University of Pittsburgh Medical Center
