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 Hospice Care Helps Relieve Survivors' Depression, Study Finds

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.”
 
Jackie Oberst is Provider’s managing editor. Email her at joberst@providermagazine.com or follow her on Twitter, @ProviderMag.
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