Hospice care appears
to alleviate depression amongst survivors even after a slow death, a new study
in the Journal of the American Medical
Association (JAMA) Internal Medicine
has found.
Caregiving poses mental and general health risks
(depression, heart disease) to a spouse both before and after a loved one dies,
according to the researchers who conducted the study.
“We are seeing that
hospice is providing a benefit for caregivers,” says Katherine Ornstein, lead
study author and epidemiologist in the Department of Geriatrics and Palliative
Medicine at the Icahn School of Medicine at Mount Sinai in New York City.
Hospice care focuses on palliative rather than curative care
and includes medical services, symptom management, spiritual counseling, social
services, and bereavement counseling delivered by an interdisciplinary team of
professionals (social workers, nurses, chaplains) for patients who are dying.
Most hospice care includes counseling services for family members before and
after a patient’s death; phone calls are made periodically to bereaved family
members, the researchers said.
While these results may seem expected, prior studies have
only been observational, involved low numbers of participants, and involved
mainly spouses of cancer patients.
Ornstein’s group collected data from the Health and
Retirement Study, a national telephone survey of community-dwelling adults 50
years or older, and linked it to Medicare claims, which is how hospice is
typically billed. They compared spouses of individuals enrolled in hospice for
at least three days before death with spouses of individuals who did not use
hospice by following both spousal sets for up to two years and measuring
depressive symptoms with questions from the Center for Epidemiologic Studies
Depression Scale.
Of the 1,106 spouses followed, 30 percent used hospice
services. Overall, 52 percent of the spouses experienced more depressive
symptoms over time—regardless of whether or not hospice care was used. A slight
but not statistically significant improvement of depression scores occurred in
28.2 percent of spouses of hospice users, compared with 21.7 percent of spouses
whose partners did not use hospice, the researchers found.
Similarly, among the 662 spouses who were primary
caregivers, 27.3 percent of the spouses of hospice users had improved (though
not by statistically relevant depression scores), compared with 20.7 percent whose
spouses didn’t use hospice.
Further statistical adjustment by the researchers that took
into account other patient and spousal characteristics revealed that spouses of
hospice users were significantly more likely than spouses of non-hospice users
to have their depression slightly lifted.
Not only are surviving spouses benefitting from hospice
care, but health care costs for seriously ill patients and, downstream, their
loved ones, in this country could be curtailed, the study concluded.
“Because most of these spouses are themselves Medicare
beneficiaries, caring for their well-being is not only important for individual
health but may also be fiscally prudent,” says Ornstein, whose group hopes to
eventually tease apart exactly which services that hospice provides contributes
to the lowered depression scores of widows and widowers.
In an accompanying commentary in the same journal, Holly
Prigerson and Kelly Trevino, of Cornell University and Weill Cornell Medical
College in New York City, wrote: “Should we conclude that hospice care is the
first-line treatment for depressions associated with widowhood? Probably not,
but it may well lighten the heavy load of caring for a terminally ill spouse
and may ease the trauma of watching and worrying while a loved one dies, as
well as the transition to widowhood.”