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Predictors of well-being in bereaved former hospice caregivers: The role of caregiving stressors, appraisals, and social resources

Published online by Cambridge University Press:  23 May 2008

Allison M. Burton*
Affiliation:
Center for Health Services Research in Primary Care, Durham VAMC/Duke University Medical Center, Durham, North Carolina
William E. Haley
Affiliation:
School of Aging Studies, University of South Florida, Tampa, Florida
Brent J. Small
Affiliation:
School of Aging Studies, University of South Florida, Tampa, Florida
Margaret R. Finley
Affiliation:
School of Aging Studies, University of South Florida, Tampa, Florida
Marie Dillinger-Vasille
Affiliation:
School of Aging Studies, University of South Florida, Tampa, Florida
Ronald Schonwetter
Affiliation:
LifePath Hospice and Palliative Care, Inc., Tampa, Florida
*
Address correspondence and reprint requests to: Allison M. Burton, Center for Health Services Research in Primary Care, Durham VAMC/Duke University Medical Center, Hock Plaza, Suite 1105, Box 2720, 2424 Erwin Rd., Durham, NC 27705. E-mail: [email protected]

Abstract

Objective:

The current literature on caregiving and bereavement indicates that the relationship between these two common life events is complex and needs to be further studied in order to gain a more comprehensive understanding of their interaction.

Methods:

In the current project, 50 spouses of hospice patients with end-stage lung cancer or dementia were assessed while caregiving and at an average of 4 months after the death on a variety of measures, including caregiving stressors, appraisals, social resources, and well-being. A stress process model was utilized in order to examine which preloss factors were associated with postloss depression, life satisfaction, and grief.

Results:

Our results indicated that patient diagnosis (cancer or dementia) and caregiver appraisals (stressfulness of functional impairment and positive aspects of caregiving) were not predictors on any of our well-being outcomes. However, fewer months caregiving was a significant predictor of both higher depression and grief postloss. Additionally, lower levels of social activities, smaller social networks, and lower satisfaction with social support were significantly associated with higher postloss depression.

Significance of results:

Results support both the resource depletion and anticipatory grief hypotheses and suggest that short-term bereavement outcomes are different than factors that predict well-being while caregiving. Future studies should address whether long-term bereavement outcomes differ by baseline caregiving characteristics to guide intervention research.

Type
Original Articles
Copyright
Copyright © Cambridge University Press 2008

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References

REFERENCES

Aneshensel, C.S., Pearlin, L.I., Mullan, J.T., et al. (1995). Profiles in caregiving: The unexpected career. San Diego: Academic Press.Google Scholar
Bass, D.M. & Bowman, K. (1990). The transition from caregiving to bereavement: The relationship of care-related strain and adjustment to death. The Gerontologist, 30, 3542.CrossRefGoogle ScholarPubMed
Boerner, K., Schulz, R., & Horowitz, A. (2004). Positive aspects of caregiving and adaptation to bereavement. Psychology and Aging, 19, 668675.CrossRefGoogle ScholarPubMed
Bonanno, G.A., Wortman, C.B., Lehman, D.R., et al. (2002). Resilience to loss and chronic grief: A prospective study from pre-loss to 18 months post-loss. Journal of Personality and Social Psychology, 83, 11501164.CrossRefGoogle Scholar
Carr, D. (2004). Black/White differences in psychological adjustment to spousal loss among older adults. Research on Aging, 26, 591622.CrossRefGoogle Scholar
Carr, D., House, J.S., Wortman, C., et al. (2001). Psychological adjustment to sudden and anticipated spousal death among the older widowed. Journal of Gerontology: Social Sciences, 56B, S237S248.CrossRefGoogle Scholar
Cleiren, M.P.H.D., van der Wal, J., & Diekstra, R.F.W. (1988). Death after a long term disease: Anticipation and outcome in the bereaved. Pharos International Autumn-Winter, 112–114, 136139.Google Scholar
Davis, C.G. & Nolen-Hoeksema, S. (2001). Loss and meaning: How do people make sense of loss? American Behavioral Scientist, 44, 726741.Google Scholar
Faschingbauer, T.R., Zisook, S., & DeVaul, R.A. (1987). The Texas Revised Inventory of Grief. In Biopsychosocial Aspects of Bereavement, Zisook, S. (ed.), pp. 111124. Washington, DC: American Psychiatric Association.Google Scholar
George, L.K. (1990). Caregiver stress studies—There really is more to learn. The Gerontologist, 30, 580581.CrossRefGoogle ScholarPubMed
Goode, K.T., Haley, W.E., Roth, D.L., et al. (1998). Predicting longitudinal changes in caregiver physical and mental health: A stress process model. Health Psychology, 17, 190198.CrossRefGoogle ScholarPubMed
Haley, W.E., LaMonde, L.A., Han, B., et al. (2001). Family caregiving in hospice: Effects on psychosocial and health functioning among spousal caregivers of hospice patients with lung cancer or dementia. The Hospice Journal, 15, 118.CrossRefGoogle ScholarPubMed
Haley, W.E., LaMonde, L.A., Han, B., et al. (2003). Predictors of depression and life satisfaction among spousal caregivers in hospice: Application of a stress process model. Journal of Palliative Medicine, 6, 215224.CrossRefGoogle ScholarPubMed
Haley, W.E., Roth, D.L., Coleton, M.I., et al. (1996). Appraisal, coping, and social support as mediators of well-being in Black and White Alzheimer's family caregivers. Journal of Consulting and Clinical Psychology, 64, 121129.CrossRefGoogle Scholar
Katz, S., Ford, A.B., Moskowitz, R.W., et al. (1963). Studies of illness in the aged. The index of ADL: A standardized measure of biological and psychological function. Journal of the American Medical Association, 185, 914919.CrossRefGoogle Scholar
Krause, N. & Borawski-Clark, E. (1995). Social class differences in social support among older adults. The Gerontologist, 35, 498508.CrossRefGoogle ScholarPubMed
Kwak, J. & Haley, W.E. (2005). Current research findings on end-of-life decision making among racially/ethnically diverse groups. The Gerontologist, 45, 634641.CrossRefGoogle ScholarPubMed
Lawton, M.P. & Brody, E. (1969). Assessment of older people: Self-maintaining and instrumental activities of daily living. The Gerontologist, 9, 179186.CrossRefGoogle ScholarPubMed
Lawton, M.P., Moss, M., Fulcomer, M., et al. (1982). A research and service oriented multilevel assessment instrument. Journal of Gerontology, 37, 9199.CrossRefGoogle Scholar
Lubben, J.E. (1988). Assessing social networks among elderly populations. Family and Community Health, 11, 4252.CrossRefGoogle Scholar
McHorney, C.A. & Mor, V. (1988). Predictors of bereavement depression and its health services consequences. Medical Care, 26, 882893.CrossRefGoogle ScholarPubMed
Minino, A.M. & Smith, B.L. (2001). Deaths: Preliminary data for 2000. National Vital Statistics Reports, 49 (12). Hyattsville, MD: National Center for Health Statistics.Google Scholar
Mullan, J.T. (1992). The bereaved caregiver: A prospective study of changes in well-being. The Gerontologist, 32, 673683.CrossRefGoogle Scholar
Owen, J.E., Goode, K.T., & Haley, W.E. (2001). End of life care and reactions to death in African American and White family caregivers of relatives with Alzheimer's disease. Omega, 43, 349361.CrossRefGoogle ScholarPubMed
Pearlin, L.I., Mullan, J.T., Semple, S.J., et al. (1990). Caregiving and the stress process: An overview of concepts and their measures. The Gerontologist, 30, 583594.CrossRefGoogle ScholarPubMed
Phipps, E., Braitman, L.E., True, G., et al. (2003). Family care giving for patients at life's end: Report from the Cultural Variations Study (CVAS). Palliative & Supportive Care, 1, 165170.CrossRefGoogle ScholarPubMed
Prigerson, H.G. & Jacobs, S.C. (2001). Traumatic grief as a distinct disorder: A rationale, consensus criteria, and a preliminary empirical test. In Handbook of Bereavement Research: Consequences, Coping, and Care, Stroebe, M.S., Hansson, R.O., Stroebe, W., et al. (eds.), pp. 563584. Cambridge, UK: Cambridge University Press.Google Scholar
Radloff, L.S. (1977). The CES-D scale: A self report depression scale for research in the general population. Applied Psychological Measurements, 1, 385401.CrossRefGoogle Scholar
Raphael, B., Minkov, C., & Dobson, M. (2001). Psychotherapeutic and pharmacological intervention for bereaved persons. In Handbook of Bereavement Research: Consequences, Coping, and Care, Stroebe, M.S., Hansson, R.O., Stroebe, W., et al. (eds.), pp. 563584. Cambridge, UK: Cambridge University Press.Google Scholar
Sankar, A. (1991). Ritual and dying: A cultural analysis of social support for caregivers. The Gerontologist, 31, 4350.CrossRefGoogle ScholarPubMed
Schulz, R. & Beach, S.R. (1999). Caregiving as a risk factor for mortality: The Caregiver Health Effects Study. Journal of the American Medical Association, 282, 22152219.CrossRefGoogle ScholarPubMed
Schulz, R., Mendelsohn, A.B., Haley, W.E., et al. (2003). End of life care and the effects of bereavement among family caregivers of persons with dementia. New England Journal of Medicine, 349, 19361942.CrossRefGoogle ScholarPubMed
Schulz, R., Newsom, J.T., Fleissner, K., et al. (1997a). The effects of bereavement after family caregiving. Aging & Mental Health, 1, 269282.CrossRefGoogle Scholar
Schulz, R., Newsom, J.T., Mittelmark, M., et al. (1997b). Health effects of caregiving: The Caregiver Health Effects Study. Annals of Behavioral Medicine, 19, 110116.CrossRefGoogle ScholarPubMed
Schulz, R., O'Brien, A.T., Bookwala, J., et al. (1995). Psychiatric and physical morbidity effects of dementia caregiving: Prevalence, correlates, and causes. The Gerontologist, 35, 771791.CrossRefGoogle ScholarPubMed
Stroebe, W. & Schut, H. (1999). The dual process model of coping with bereavement: Rationale and description. Death Studies, 23, 197224.Google ScholarPubMed
Stroebe, W. & Stroebe, M.S. (1987). Bereavement and health: The psychological and physical consequences of partner loss. New York: Cambridge University Press.CrossRefGoogle Scholar
Wood, V., Wylie, M.L., & Sheafor, B. (1969). An analysis of a short self-report measure of life satisfaction: Correlation with rater judgements. Journal of Gerontology, 24, 465469.CrossRefGoogle Scholar