FACILITATING OLDER SPOUSES' ADJUSTMENT TO SPOUSAL DEATH

研究结果有可能作出重要贡献 预防性心理健康服务，以服务不足的人口-老年人 失去亲人的成年人本研究的进一步意义主要在于其 有可能证明可复制的短期 预防性干预，以促进老年配偶适应 减少丧亲之痛的病态后果及其相关的 在一个样本中的医疗保健成本在高风险的穷人丧亲之痛的结果。 配偶死亡是一个巨大的压力事件， 死亡和发病的风险增加。我们建议评估 预防性干预措施对已婚老年人的有效性 即将去世的配偶谁是绝症与癌症。的 干预的目标是促进丧偶配偶的心理社会 调整和过渡到守寡，从而减少她们 精神病理学和其他病态的结果在丧亲后时期。 预防性干预将在最后6个月内开始， 死亡配偶的疾病，并继续五/六个月到死后 期 使用真正的实验设计，绝症患者的配偶 随机分配到预防性干预（n=110）或 对照组（n=110）。将进行死亡前基线访谈 与井配偶在应计后不久。组间差异 丧偶配偶的发病率水平将在发病后7个月进行评估， 死亡，在极度悲痛之后，死亡后14个月， 在短期解决方案之后。为了评估 我们将选择一个人群， 精神病理学和其他病态丧亲结局的高风险 由于他们拥有所有这些诱发因素： 晚期配偶的疾病，延长，6个月以上的应计;很快- 将被剥夺配偶的抚养责任，平均超过 每周8小时与疾病有关的实际或工具性援助; 未亡配偶的年龄，年龄在55-75岁之间的老年人; 配偶的健康状况，患有慢性疾病或活动受限的健康状况 条件为6个月以上的应计费用。这项研究的具体目标是： (1)确定预防性干预措施在以下方面的有效性： 协助丧偶配偶（55岁以上）适应社会心理， 丧失和转变为寡妇的情况， 心理健康指标的发病率较低， 身体健康和社会功能。 (2)评估其他风险因素对 在这个预先选定的高风险样本中，最差的丧亲结局。 (3)评价预防性干预的相对有效性， 根据这些额外的风险因素， 最有可能出现病态的丧亲之痛 这项研究还将证明使用高风险 标准的目标交付的计划，以那些个人与 最大的需求，降低服务提供成本。拟议 干预是短暂的（8个死亡前和8个死亡后会议）， 在各种卫生保健中可以容易地实施干预， 设置.

The study findings have the potential to make an important contribution to preventive mental health services to an underserved population--older bereaved adults. This study's further significance lies largely in its potential to demonstrate the efficacy of a replicable short-term preventive intervention for facilitating older spouse's adjustment to widowhood and reducing morbid bereavement outcomes and their associated health care costs in a sample at high risk for poor bereavement outcomes. Spousal death is a profoundly stressful event that places the individual at increased risk for mortality and morbidity. We propose to assess the efficacy of a preventive intervention for older married adults facing the impending death of their spouse who is terminally-ill with cancer. The goal of the intervention is to facilitate bereaved spouses' psychosocial adjustment and transition to widowhood, thereby reducing their risk of psychopathology and other morbid outcomes in the post-bereavement period. The preventive intervention will begin during the last 6 months of the dying spouse's illness and continue five/six months into the postdeath period. Using a true experimental design, spouses of terminally-ill patients are randomly assigned to either the preventive intervention (n=110) or to a control group (n=110). Pre-death baseline interviews will be conducted with the well spouses shortly after accrual. Group differences in the bereaved spouses' morbidity levels will be assessed at 7 months post- death, following the period of acute grief, and 14 months post-death, following the period of short-term resolution. In order to assess the efficacy of the preventive intervention we will be selecting a population at high risk for psychopathology and other morbid bereavement outcomes due to their possessing all of these predisposing factors: duration of terminally-ill spouse's illness, prolonged, 6+ months by accrual; soon- to-be-bereaved spouse's caregiving responsibilities, average of more than 8 hours of illness-related practical or instrumental assistance per week; surviving spouse's own age, older adult--aged 55-75; and surviving spouse's health status, has a chronic illness or activity-limiting health condition for 6+ months at accrual. The study's specific aims are: (1) To determine the efficacy of a preventive intervention in facilitating bereaved spouses (aged 55+) psychosocial adjustment to their loss and transition to widowhood, as evidenced by decreased psychopathology and lower morbidity on indicators of psychological well- being, physical health and social functioning. (2) To evaluate the predictive value of additional risk factors for the poorest bereavement outcomes within this pre-selected high risk sample. (3) To evaluate the relative efficacy of the preventive intervention for those bereaved spouses who, on the basis of these additional risk factors are at highest risk for morbid bereavement outcomes. The study will also demonstrate the feasibility of using high risk criteria to target the delivery of the program to those individuals with the greatest need, keeping the service delivery costs down. The proposed intervention is brief (8 pre- and 8 post-death sessions) and the intervention can be readily implemented in a variety of health care settings.