FACILITATING OLDER SPOUSES' ADJUSTMENT TO SPOUSAL DEATH

这项研究结果有可能做出重要贡献。 为服务不足的人群提供预防性心理健康服务--老年人 失去亲人的成年人。这项研究的进一步意义很大程度上在于 有可能证明可复制的短期 促进年长配偶适应的预防性干预 丧偶和减少病态丧亲的后果及其相关 在丧亲结局不佳的高风险样本中，医疗保健费用。 配偶死亡是一件令人深感压力的事件，它使个人 死亡和发病风险增加。我们建议评估 预防性干预对老年已婚老年人的疗效观察 身患癌症的绝症配偶即将离世。这个 干预的目标是促进丧偶的心理社会 调整和过渡到寡妇，从而降低他们患上 丧亲后的精神病理学和其他病态后果。 预防性干预将在2005年的最后6个月开始 临终配偶的疾病，并在去世后持续5/6个月 句号。 使用真实的实验设计，绝症患者的配偶 随机分配到预防性干预组(n=110)或 对照组(n=110)。将进行生前基线访谈 在应计后不久与井上的配偶一起。不同群体之间的差异 丧偶的发病率水平将在7个月后进行评估- 在急性悲痛期之后死亡，在死亡后14个月， 在短期解决阶段之后。为了评估 预防干预的效果我们将选择一个人群 有很高的精神病和其他病态丧亲后果的风险 由于他们拥有所有这些诱因：持续时间 绝症配偶患病时间延长，按累算计算，超过6个月；很快- 丧偶的照看责任，平均超过 每周8小时与疾病有关的实际或辅助援助； 尚存配偶的年龄，年龄较大的成年人--55-75岁；以及 配偶的健康状况，患有慢性病或限制活动的健康 在应计条件下6个月以上。这项研究的具体目标是： (1)确定预防性干预的效果 协助丧失亲人的配偶(55岁以上)适应其 丧失和转变为寡妇，从以下方面可以看出 心理病理学和较低的心理健康指标发病率- 生存、身体健康和社会功能。 (2)评估额外风险因素对 在这个预先选定的高风险样本中，最糟糕的丧亲结果。 (3)评价预防干预的相对效果。 那些丧失亲人的配偶，根据这些额外的风险因素 是病态丧亲后果的最高风险。 这项研究还将证明使用高风险 将计划交付给符合以下条件的个人的标准 最大的需求，降低服务交付成本。建议数 干预是简短的(8次临终和8次临终)， 干预可以很容易地在各种医疗保健中实施 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.