title: End-of-life care: findings from a national survey of informal caregivers.
abstract: BACKGROUND
  Family and friends are thought to be the predominant providers of end-of-life care, although nationally representative data on this topic have been lacking.
  
  
  METHODS
  This study draws from the 1999 National Long-Term Care Survey and its Informal Caregivers Survey to characterize primary informal caregivers' experiences providing end-of-life care to chronically disabled community-dwelling older adults. Study participants were 1149 primary informal caregivers, stratified by care recipients' survival or death during the following 12 months.
  
  
  RESULTS
  An estimated 11.2% of the chronically disabled community-dwelling older adults died within 1 year of being interviewed. Among persons who died, 72.3% were receiving help from an informal caregiver at the time of the interview. End-of-life primary informal caregivers helped an average of 43 hours per week, 84.4% provided daily assistance, and caregiver support services were infrequently used (ie, respite care and support groups were used by less than 5% of caregivers). While end-of-life caregivers reported significant emotional (28.9%), physical (18.4%), and financial (14.0%) strains, more than two thirds endorsed personal rewards related to their helping role. Compared with primary informal caregivers of persons who survived the following 12 months, end-of-life caregivers provided significantly higher levels of assistance and reported more challenges and strains, but they were no less likely to endorse rewards related to their helping role.
  
  
  CONCLUSIONS
  End-of-life caregivers provide frequent and intense assistance with few supportive services. These data underscore the relevance of families to end-of-life care, and the potential benefit of better integrating families in patient care.
authors.affiliation: Department of Health Policy and Management, The Johns Hopkins Bloomberg School of Health, Baltimore, MD 21205, USA. jwolff@jhsph.edu
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Wolff
authors.forename: Sydney M
authors.initials: SM
authors.lastname: Dy
authors.forename: Kevin D
authors.initials: KD
authors.lastname: Frick
authors.forename: Judith D
authors.initials: JD
authors.lastname: Kasper
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D011159:Population Surveillance; D011785:Quality Assurance, Health Care; D012189:Retrospective Studies; D013727:Terminal Care / Q000592:standards*; D016526:Workload