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Strategies That Teach A Caregiver To Manage A Loved One's Illness Also Helps In

Coping With Death

Main Category: Caregivers / Homecare News

Article Date: 06 Aug 2006 - 9:00am (PDT)

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Depression

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 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.; 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 N. Gitlin, Ph.D.,

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.

Contact: Jocelyn Uhl Duffy

University of Pittsburgh Medical Center

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