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Good Grief

Caring for dying loved one can lead to better health afterwards

TUESDAY, June 26, 2001 (HealthDayNews) -- While the strain of taking care of a dying loved one may seem unmanageable, your health may be better after your loss, a new study reveals.

Caregivers who were stressed during their spouse's illness took better care of themselves, took fewer antidepressants and did not lose as much weight as less involved spouses after a mate's death, researchers say. Also, older spouses who were stressed taking care of their significant others were not any more depressed afterward than less-involved spouses.

"The issue of those taking care of loved ones dying has been heavily researched, but caregivers are rarely followed through the experience of losing the person," says Richard Schulz, a professor of psychiatry and director of the Center for Social and Urban Research at the University of Pittsburgh.

To see if differences in caregiving prior to death influenced the health of the spouse after death, Schulz used information collected during the Center's Cardiovascular Health study of 819 older married men and women from 1993 to 1998. "Over the course of the study, about 129 individuals lost their spouses, and some had been caregivers prior to losing their spouses, and some were not."

"We also knew how these individuals were doing prior to the death -- their depression status, their medication use, their weight and their health behaviors, like going to the doctor, getting rest when they were tired, slowing down when they were sick," Schulz says.

The caregivers were divided into three groups. Forty people did not provide any care, while 52 "were heavy caregivers prior to the death and reported heavy strain," and 37 "provided some care but did not report stress," Schulz says.

"What we found was very different patterns of adaptation to bereavement among the three groups," Schulz says.

"For individuals heavily involved in caregiving, they were depressed before the death and continued to have high levels of depression after the death. However they showed improvement in health behaviors," he says. "They started taking better care of themselves after the death. They had no weight loss or increased medication use."

"Those people not involved in caregiving had lower levels of depression before death, as you would expect, but became much more depressed after the death," Schulz says. "They also had increased use of antidepressants and they had significant weight loss after the deaths."

For those who gave care but were not stressed, "they experienced an increase in depression [after the death] but did not show increased medication or weight loss and had no changes with health behaviors," he says.

The findings appear in the June 27 Journal of the American Medical Association.

More than 2.3 million people died in the United States in 1999, says the American Funeral Directors Association. Schulz says most deaths occur among older people who have one or more disabling conditions. "As a result, many deaths are preceded by an extended period during which family members provide care to the relative."

"Death brings an end to patients' suffering for the caregivers as well as an end to demanding caregiving tasks," Schulz says. "If you've been heavily involved in the caregiving, the death is probably more predictable. [The caregivers] are potentially more prepared, and the death of the spouse may allow a return to normal activities."

"For those less involved, the health outcomes could be due to the death being more unpredictable, and it may be more disruptive of normal routines," Schulz says.

The findings are not surprising, says Joan Hermann of Philadelphia, co-author of the book Social Work and Oncology: Supporting Survivors, Families and Caregivers .

"Someone who has spent a significant time taking care of somebody has had the time to sort out any relationship issues they have," Hermann says. "The level of caregiving involvement is very intimate, and I think as they anticipate losing someone, they are better able to get a sense of closure."

For those less involved, guilt may be an issue in how depressed they feel after a death. "You're stuck with the guilt yourself and there's no way to work it out until you forgive yourself," Hermann says.

"And that can take a long time," she says.

What To Do

For more on coping with death and finding your way through grief, try Good Grief or Grief Net.

SOURCES: Interviews with Richard Schulz, Ph.D., professor of psychiatry, director of the Center for Social and Urban Research, University of Pittsburgh; Joan Hermann, M.S.W., director of social work, Fox Chase Cancer Center, Philadelphia, Pa.; June 27, 2001, Journal of the American Medical Association
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