Association Between Hospice Use and Depressive Symptoms in Surviving Spouses.

TitleAssociation Between Hospice Use and Depressive Symptoms in Surviving Spouses.
Publication TypeJournal Article
Year of Publication2015
AuthorsOrnstein, KA, Aldridge, MD, Garrido, MM, Gorges, RJ, Meier, DE, Kelley, AS
JournalJAMA Intern Med
Volume175
Issue7
Pagination1138-46
Date Published2015 Jul
ISSN Number2168-6114
KeywordsAged, Aged, 80 and over, Caregivers, depression, Female, Hospice Care, Hospices, Humans, Male, Prospective Studies, Spouses, Survivors
Abstract

IMPORTANCE: Family caregivers of individuals with serious illness are at risk for depressive symptoms and depression. Hospice includes the provision of support services for family caregivers, yet evidence is limited regarding the effect of hospice use on depressive symptoms among surviving caregivers.

OBJECTIVE: To determine the association between hospice use and depressive symptoms in surviving spouses.

DESIGN, SETTING, AND PARTICIPANTS: We linked data from the Health and Retirement Study, a nationally representative longitudinal survey of community-dwelling US adults 50 years or older, to Medicare claims. Participants included a propensity score-matched sample of 1016 Health and Retirement Study decedents with at least 1 serious illness and their surviving spouses interviewed between August 2002 and May 2011. We compared the spouses of individuals enrolled in hospice with the spouses of individuals who did not use hospice, performing our analysis between January 30, 2014, and January 16, 2015.

EXPOSURES: Hospice enrollment for at least 3 days in the year before death.

MAIN OUTCOMES AND MEASURES: Spousal depressive symptom scores measured 0 to 2 years after death with the Center for Epidemiologic Studies Depression Scale, which is scored from 0 (no symptoms) to 8 (severe symptoms).

RESULTS: Of the 1016 decedents in the matched sample, 305 patients (30.0%) used hospice services for 3 or more days in the year before death. Of the 1016 spouses, 51.9% had more depressive symptoms over time (mean [SD] change, 2.56 [1.65]), with no significant difference related to hospice use. A minority (28.2%) of spouses of hospice users had improved Center for Epidemiologic Studies Depression Scale scores compared with 21.7% of spouses of decedents who did not use hospice, although the difference was not statistically significant (P = .06). Among the 662 spouses who were the primary caregivers, 27.3% of spouses of hospice users had improved Center for Epidemiologic Studies Depression Scale scores compared with 20.7% of spouses of decedents who did not use hospice; the difference was not statistically significant (P = .10). In multivariate analysis, the odds ratio for the association of hospice enrollment with improved depressive symptoms after the spouse's death was 1.63 (95% CI, 1.00-2.65).

CONCLUSIONS AND RELEVANCE: After bereavement, depression symptoms increased overall for surviving spouses regardless of hospice use. A modest reduction in depressive symptoms was more likely among spouses of hospice users than among spouses of nonhospice users.

Notes

10.1001/jamainternmed.2015.1722

URLhttp://dx.doi.org/10.1001/jamainternmed.2015.1722
DOI10.1001/jamainternmed.2015.1722
User Guide Notes

http://www.ncbi.nlm.nih.gov/pubmed/26009859?dopt=Abstract

Endnote Keywords

caregiver burden/caregivers/Depressive Symptoms/depression/Hospice/CES Depression Scale/CES Depression Scale/spouses

Endnote ID

999999

Alternate JournalJAMA Intern Med
Citation Key8258
PubMed ID26009859
PubMed Central IDPMC4494882
Grant ListCDP 12-255 / HX / HSRD VA / United States
K23 AG040774 / AG / NIA NIH HHS / United States
IK2 HX000767 / HX / HSRD VA / United States
1K23AG040774-01A1 / AG / NIA NIH HHS / United States
K01 AG047923 / AG / NIA NIH HHS / United States
U01AG009740 / AG / NIA NIH HHS / United States
K01AG047923 / AG / NIA NIH HHS / United States