Involvement in caregiving and adjustment to death of a spouse

Findings from the caregiver health effects study

Richard Schulz, Scott R. Beach, Bonnie Lind, Lynn M. Martire, Bozena Zdaniuk, Calvin H Hirsch, Sharon Jackson, Lynda Burton

Research output: Contribution to journalArticle

186 Citations (Scopus)

Abstract

Context: 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. Design and Setting: Prospective, population-based cohort study conducted in 4 US communities between 1993 and 1998. Participants: 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). Main Outcome Measures: 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.

Original languageEnglish (US)
Pages (from-to)3123-3129
Number of pages7
JournalJournal of the American Medical Association
Volume285
Issue number24
StatePublished - Jun 27 2001

Fingerprint

Social Adjustment
Caregivers
Spouses
Health
Risk-Taking
Depression
Antidepressive Agents
Weight Loss
Epidemiologic Studies
Weights and Measures
Bereavement
Sex Education
Cohort Studies
Cardiovascular Diseases
Odds Ratio
Outcome Assessment (Health Care)
Confidence Intervals

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Involvement in caregiving and adjustment to death of a spouse : Findings from the caregiver health effects study. / Schulz, Richard; Beach, Scott R.; Lind, Bonnie; Martire, Lynn M.; Zdaniuk, Bozena; Hirsch, Calvin H; Jackson, Sharon; Burton, Lynda.

In: Journal of the American Medical Association, Vol. 285, No. 24, 27.06.2001, p. 3123-3129.

Research output: Contribution to journalArticle

Schulz, R, Beach, SR, Lind, B, Martire, LM, Zdaniuk, B, Hirsch, CH, Jackson, S & Burton, L 2001, 'Involvement in caregiving and adjustment to death of a spouse: Findings from the caregiver health effects study', Journal of the American Medical Association, vol. 285, no. 24, pp. 3123-3129.
Schulz, Richard ; Beach, Scott R. ; Lind, Bonnie ; Martire, Lynn M. ; Zdaniuk, Bozena ; Hirsch, Calvin H ; Jackson, Sharon ; Burton, Lynda. / Involvement in caregiving and adjustment to death of a spouse : Findings from the caregiver health effects study. In: Journal of the American Medical Association. 2001 ; Vol. 285, No. 24. pp. 3123-3129.
@article{9a0b6f079cad492dbd16d1424b48d9d7,
title = "Involvement in caregiving and adjustment to death of a spouse: Findings from the caregiver health effects study",
abstract = "Context: 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. Design and Setting: Prospective, population-based cohort study conducted in 4 US communities between 1993 and 1998. Participants: 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). Main Outcome Measures: 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.",
author = "Richard Schulz and Beach, {Scott R.} and Bonnie Lind and Martire, {Lynn M.} and Bozena Zdaniuk and Hirsch, {Calvin H} and Sharon Jackson and Lynda Burton",
year = "2001",
month = "6",
day = "27",
language = "English (US)",
volume = "285",
pages = "3123--3129",
journal = "JAMA - Journal of the American Medical Association",
issn = "0002-9955",
publisher = "American Medical Association",
number = "24",

}

TY - JOUR

T1 - Involvement in caregiving and adjustment to death of a spouse

T2 - Findings from the caregiver health effects study

AU - Schulz, Richard

AU - Beach, Scott R.

AU - Lind, Bonnie

AU - Martire, Lynn M.

AU - Zdaniuk, Bozena

AU - Hirsch, Calvin H

AU - Jackson, Sharon

AU - Burton, Lynda

PY - 2001/6/27

Y1 - 2001/6/27

N2 - Context: 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. Design and Setting: Prospective, population-based cohort study conducted in 4 US communities between 1993 and 1998. Participants: 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). Main Outcome Measures: 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.

AB - Context: 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. Design and Setting: Prospective, population-based cohort study conducted in 4 US communities between 1993 and 1998. Participants: 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). Main Outcome Measures: 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.

UR - http://www.scopus.com/inward/record.url?scp=0035958317&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0035958317&partnerID=8YFLogxK

M3 - Article

VL - 285

SP - 3123

EP - 3129

JO - JAMA - Journal of the American Medical Association

JF - JAMA - Journal of the American Medical Association

SN - 0002-9955

IS - 24

ER -