title: Involvement in caregiving and adjustment to death of a spouse: findings from the caregiver health effects study.
abstract: BACKGROUND
  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.
  
  
  METHODS
  Prospective, population-based cohort study conducted in 4 US communities between 1993 and 1998.
  
  
  METHODS
  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).
  
  
  METHODS
  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; F(1,116) = 14.33; P<.001) and nonstrained caregivers (4.94 vs 7.13; F(1,116) = 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; F(1,118) = 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]; F(1,101) = 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.
authors: Department of Psychiatry and University Center for Social and Urban Research, University of Pittsburgh, 121 University Place, Pittsburgh, PA 15260, USA. schulz@pitt.edu
authors: R
authors: R
authors: Schulz
authors: S R
authors: SR
authors: Beach
authors: B
authors: B
authors: Lind
authors: L M
authors: LM
authors: Martire
authors: B
authors: B
authors: Zdaniuk
authors: C
authors: C
authors: Hirsch
authors: S
authors: S
authors: Jackson
authors: L
authors: L
authors: Burton
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000928:Antidepressive Agents / Q000627:therapeutic use; D001601:Bereavement; D017028:Caregivers / Q000523:psychology*; D003643:Death; D003863:Depression / Q000453:epidemiology / Q000208:ethnology; D005260:Female; D005500:Follow-Up Studies; D015438:Health Behavior; D006801:Humans; D008297:Male; D012959:Socioeconomic Factors; D018454:Spouses; D015431:Weight Loss
chemical_list: D000928:Antidepressive Agents