Main Category: Caregivers / Homecare News
Article Date: 06 Aug 2010 - 9:00am (PDT)
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.
University of Pittsburgh Medical Center
