Who uses bereavement services? An examination of service use by bereaved dementia caregivers.

OBJECTIVES: The purpose of this study was to examine factors associated with the bereavement service utilization of bereaved dementia caregivers. Grounded in Andersen's behavioral model of health service use, this study examined predisposing, enabling, and need factors as potential predictors of bereavement service use. METHOD: Data were drawn from the Resources for Enhancing Alzheimer's Caregiver Health Study. Hierarchical logistic regression analyses were conducted for bereaved dementia caregivers (N = 224). RESULTS: Approximately one in three participants utilized bereavement services. Support groups, counseling, and psychotropic medications were used in similar proportions. Depressive symptomatology, anxiety, and complicated grief served as need factors, with higher levels resulting in higher probability of service utilization. CONCLUSION: The results highlight the importance of need factors in the utilization of bereavement services. Future research should focus on interventions designed to assure timely access to those bereaved family caregivers who are most in need.

The role of grief, anxiety, and depressive symptoms in the use of bereavement services.

This study examined the role of psychological distress in the use of bereavement services at six months post-loss by 250 bereaved spouses in the Changing Lives of Older Couples study. Approximately 52% (129) used services, commonly provided by physicians and clergy. Hierarchical logistic regression analyses indicated that Black race, higher educational level, elevated depressive symptoms, anxiety, and grief were related to greater service use. Other predisposing, enabling, and need variables were not related to service use. Findings suggest the need for outreach and education with physicians and clergy and the importance of an accessible, comprehensive range of community-based bereavement services.

Depressive symptoms, social network, and bereavement service utilization and preferences among spouses of former hospice patients.

BACKGROUND: Bereavement services are an important part of comprehensive end-of-life care with potential to ameliorate physical, psychological, and spiritual distress. We studied bereaved spouses of hospice patients to examine bereavement service utilization, barriers, and preferences regarding content, structure, and delivery of potential bereavement services. We also examined the impact of depressive symptoms and social network. METHODS: Retrospective cohort study of bereaved spousal caregivers of patients of three hospices in Tampa Bay, Florida. Descriptive and univariate analyses assessed demographics, depressive symptoms, social network, service utilization, barriers, and preferences. RESULTS: Nearly half utilized at least one type of specialized professional bereavement intervention to aid in coping with their loss. The most frequently used services were provided by clergy members and physicians. Primarily attitudinal in nature, barriers included the finding that more than one third felt available services did not fit their needs or interests. Individual and spiritually-based services were highly endorsed, as were services designed to provide tools to reframe the loss and cope with accompanying changes and emotions. Lower social network was associated with higher content preferences for services consistent primarily with restoration-oriented coping. CONCLUSION: Clinicians and service providers may facilitate coping by routinely screening for depressive symptoms and social network and tailoring interventions to those identified as experiencing elevated distress or lacking social resources. Attitudinal barriers and preferences suggest that even in the service-rich environment of hospice some modification of bereavement services might reach more bereaved spouses. Future studies might address whether preferences lead individuals to services of the greatest benefit.

Long-term effects of bereavement and caregiver intervention on dementia caregiver depressive symptoms.

PURPOSE: The purpose of this study was to examine the joint effects of bereavement and caregiver intervention on caregiver depressive symptoms. DESIGN AND METHODS: Alzheimer's caregivers from a randomized trial of an enhanced caregiver support intervention versus usual care who had experienced the death of their spouse (n = 254) were repeatedly assessed with the Geriatric Depression Scale prior to and following bereavement. Random effects regression growth curve analyses examined the effects of treatment group and bereavement while controlling for other variables. RESULTS: The death of the care recipient led to reductions in depressive symptoms for both caregiving groups. Enhanced support intervention led to lower depressive symptoms compared with controls both before and after bereavement. Post-bereavement group differences were stronger for caregivers of spouses who did not previously experience a nursing home placement. These caregivers maintained these differences for more than 1 year after bereavement. Caregivers who received the enhanced support intervention were more likely to show long-term patterns of fewer depressive symptoms before and after bereavement, suggesting resilience, whereas control caregivers were more likely to show chronic depressive symptoms before and after the death of their spouse. IMPLICATIONS: Caregiver intervention has the potential to alter the long-term course of the caregiving career. Such clinical strategies may also protect caregivers against chronic depressive symptoms that would otherwise persist long after caregiving ends.