Home and Community Care Digest
Background: Research shows that being married is generally a protective characteristic in that married people have lower mortality rates than people who are widowed or never married. However, upon the death of a spouse, the surviving spouse is subject to an increased risk of death, known as the "widow effect". This effect appears to be higher for males and is thought to be due to the loss of emotional support from the deceased spouse. On the other hand, caregiver burden is used to describe the emotional and physical toll of providing care to a family member who is ill and is often more evident in females. Older adults whose spouses die from a terminal illness are likely to be negatively affected by both phenomena. The goal of hospice care is to help people who are terminally ill to die "good deaths". As such, the authors hypothesized that such care would benefit not only patients but their family members as well, by alleviating the likelihood of suffering from the widow effect or caregiver burden.
Methods: This large national study was based on a dataset created from Medicare claims data for patients who died during the period,1993-97. After adjusting for the use of hospice care, the study used matched cohorts to compare a group of older adults with terminally ill spouses who died after receiving hospice care with a group whose terminally ill spouses did not receive hospice care before they died. The study sample included 24,721 cases and 24,721 controls of bereaved wives and 6,177 cases and 6,177 controls of bereaved husbands.
Findings: The group of surviving spouses whose husbands or wives received hospice care had lower mortality rates 18 months after the death of their spouse compared to surviving spouses in the control group. The same relationship was found for both bereaved husbands and bereaved wives, but was larger for the bereaved wives.
Conclusions: Though the direct intent of hospice care is to benefit terminally ill patients, the use of hospice care - even for a period of three to four weeks - positively affected the mortality rate of the surviving spouses in the study sample. This study has implications not only for the use of hospice care, but also for how healthcare affects society in broader terms. The ability of the study to provide specific practical recommendations is limited, however, because it did not define the particular aspects of hospice care that produced the benefit to surviving spouses. Nevertheless it still offers evidence that the type of healthcare received by a patient impacts not only the patient but their family members as well, supporting a more global interpretation of healthcare as being broader than the doctor-patient dyad.
Reference: Ahrens J. "The Positive Impact of Hospice Care on Surviving Spouse". Home Healthcare Nurse, 2005; 23(1), 53-5.
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