title: The Use of Life-Sustaining Procedures in the Last Month of Life Is Associated With More Depressive Symptoms in Surviving Spouses.
abstract: Family caregivers of individuals with serious illness who undergo intensive life-sustaining medical procedures at the end of life may be at risk of negative consequences including depression.
  
  
  
  The objective of this study was to determine the association between patients' use of life-sustaining procedures at the end of life and depressive symptoms in their surviving spouses.
  
  
  
  We used data from the Health and Retirement Study, a longitudinal survey of U.S. residents, linked to Medicare claims data. We included married Medicare beneficiaries aged 65 years and older who died between 2000 and 2011 (n = 1258) and their surviving spouses. The use of life-sustaining procedures (i.e., intubation/mechanical ventilation, tracheostomy, gastrostomy tube insertion, enteral/parenteral nutrition, and cardiopulmonary resuscitation) in the last month of life was measured via claims data. Using propensity score matching, we compared change in depressive symptoms of surviving spouses.
  
  
  
  Eighteen percent of decedents underwent one or more life-sustaining procedures in the last month of life. Those whose spouses underwent life-sustaining procedures had a 0.32-point increase in depressive symptoms after death (scale range = 0-8) and a greater likelihood of clinically significant depression (odds ratio = 1.51) compared with a matched sample of spouses of those who did not have procedures (P < 0.05).
  
  
  
  Surviving spouses of those who undergo intensive life-sustaining procedures at the end of life experience a greater magnitude of increase in depressive symptoms than those whose spouses do not undergo such procedures. Further study of the circumstances and decision making surrounding these procedures is needed to understand their relationship with survivors' negative mental health consequences and how best to provide appropriate support.
authors.affiliation: Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York; Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, New York. Electronic address: katherine.ornstein@mssm.edu.
authors.forename: Katherine A
authors.initials: KA
authors.lastname: Ornstein
authors.affiliation: Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York; James J. Peters Veterans Affairs Medical Center, Bronx, New York.
authors.forename: Melissa D
authors.initials: MD
authors.lastname: Aldridge
authors.affiliation: Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York; James J. Peters Veterans Affairs Medical Center, Bronx, New York.
authors.forename: Melissa M
authors.initials: MM
authors.lastname: Garrido
authors.affiliation: Harris School of Public Policy, University of Chicago, Chicago, Illinois.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Gorges
authors.affiliation: Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Evan
authors.initials: E
authors.lastname: Bollens-Lund
authors.affiliation: Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York; James J. Peters Veterans Affairs Medical Center, Bronx, New York.
authors.forename: Albert L
authors.initials: AL
authors.lastname: Siu
authors.affiliation: Department of Internal Medicine, Veterans Affairs Center for Clinical Management Research, Institute for Social Research, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: Kenneth M
authors.initials: KM
authors.lastname: Langa
authors.affiliation: Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York; James J. Peters Veterans Affairs Medical Center, Bronx, New York.
authors.forename: Amy S
authors.initials: AS
authors.lastname: Kelley
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers / Q000523:psychology*; D003863:Depression / Q000523:psychology*; D005260:Female; D006801:Humans; D007440:Intubation / Q000523:psychology; D008137:Longitudinal Studies; D008297:Male; D008603:Mental Health; D012121:Respiration, Artificial / Q000523:psychology; D018454:Spouses / Q000523:psychology*; D017741:Survivors / Q000523:psychology*; D013727:Terminal Care / Q000523:psychology*
keywords: Caregiving; bereavement; end-of-life care; life-sustaining procedures