title: Preparedness for the death of a loved one and mental health in bereaved caregivers of patients with dementia: findings from the REACH study.
abstract: BACKGROUND
  Although it has been suggested that family and friends who are prepared for the death of a loved one have less distress, the relationship between preparedness and bereavement mental health is inconclusive.
  
  
  OBJECTIVE
  To determine the relationship between preparedness for the death and mental health in bereaved caregivers of dementia patients and explore predictors of preparedness.
  
  
  METHODS
  A prospective study of family caregivers of persons with dementia. Standardized assessment instruments and structured questions were used to collect data at study entry and at 6, 12, and 18 months. Multiple caregiving-related variables were collected. Bereaved caregivers reported whether they were "not at all" prepared or prepared for the death of their loved one.
  
  
  METHODS
  Two hundred twenty-two bereaved caregivers
  
  
  RESULTS
  Twenty-three percent of caregivers were not prepared for the death. These caregivers had more depression, anxiety, and complicated grief symptoms. Black caregivers, caregivers with less education, those with less income, and those with more depressive symptoms prior to the death were more likely to perceive themselves as "not at all" prepared. In contrast, the amount of pain the care recipient was in prior to death was positively associated with preparedness.
  
  
  CONCLUSIONS
  Despite providing high-intensity care, often for years, many bereaved caregivers perceived themselves as unprepared for the death. These caregivers had more depression, anxiety, and complicated grief symptoms. Future work should be directed to confirming these findings and determining how best to intervene with high-risk caregivers.
authors.affiliation: Division of General Internal Medicine, Section of Palliative Care and Medical Ethics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213, USA. herberts@msx.upmc.edu
authors.forename: Randy S
authors.initials: RS
authors.lastname: Hebert
authors.forename: Qianyu
authors.initials: Q
authors.lastname: Dang
authors.forename: Richard
authors.initials: R
authors.lastname: Schulz
mesh_terms: D000368:Aged; D001293:Attitude to Death; D001601:Bereavement; D017028:Caregivers; D003704:Dementia; D006801:Humans; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D011446:Prospective Studies