Spousal Caregivers Are Caregiving Alone In The Last Years Of Life
Spousal Caregivers Are Caregiving Alone In The Last Years Of Life
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DOI：
10.1377/hlthaff.2019.00087
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发表时间：
2019-06-01
期刊：
影响因子：
9.7
通讯作者：
Kelley, Amy S.
中科院分区：
文献类型：
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作者：
Ornstein, Katherine A.;Wolff, Jennifer L.;Kelley, Amy S.
在生命的最后几年照顾与增加抑郁症和对幸存配偶的负面健康结果有关，其中许多人本身健康状况不佳。然而，目前还不清楚配偶独自生活的频率，他们与受支持的配偶有何不同，以及缺乏支持是否会影响丧亲后的结果。我们假设，单身的配偶，也就是说，唯一的照顾者（有偿或无偿）谁提供了帮助配偶的自我照顾或家庭活动，将经历更多的抑郁症后丧亲之痛比支持的配偶会。利用健康和退休研究的信息，我们发现，社区居住的已婚残疾人的配偶中有55%是单身照顾者。独居甚至在照顾痴呆症配偶和附近有成年子女的人中也很常见。丧亲的结果并没有不同的单身和支持离婚的配偶。提供照料的配偶往往是孤立的，可能会受益于更多的支持，特别是在丧亲前的最后几年。虽然一些州和联邦政策提案旨在系统地认识和评估照顾者，但需要在护理提供和报销方面进一步创新，以充分支持重病老年人及其照顾者。最终，重病护理的重点必须从病人扩大到家庭单位。
Caregiving in the last years of life is associated with increased depression and negative health outcomes for surviving spouses, many of whom are themselves in poor health. Yet it is unclear how often spouses are caregiving alone, how they differ from supported spouses, and whether lack of support affects postbereavement outcomes. We hypothesized that spouses who were solo caregivers-that is, the only caregivers (paid or unpaid) who provided assistance with a spouse's selfcare or household activities-would experience more depression after bereavement than supported spouses would. Using information from the Health and Retirement Study, we found that 55 percent of the spouses of community-dwelling married people with disability were solo caregivers. Solo caregiving was even common among people who cared for spouses with dementia and those with adult children living close by. Bereavement outcomes did not differ between solo and supported caregiving spouses. Caregiving spouses are often isolated and may benefit from greater support, particularly during the final years before bereavement. While some state and federal policy proposals aim to systematically recognize and assess caregivers, further innovations in care delivery and reimbursement are needed to adequately support seriously ill older adults and their caregivers. Ultimately, the focus of serious illness care must be expanded from the patient to the family unit.