Preparedness for Death and

 

Adjustment to Bereavement among

 

Caregivers of Recently Placed Nursing 

Home Residents

Journal of Palliative Medicine

To cite this article:
Schulz Richard, Boerner Kathrin, Klinger Julie, and Rosen Jules. Journal of Palliative Medicine. February 2015, 18(2): 127-133. doi:10.1089/jpm.2014.0309.

Published in Volume: 18 Issue 2: December 3, 2014
Online Ahead of Print: December 3, 2014

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Author information

Richard Schulz, PhD,¹ Kathrin Boerner, PhD,² Julie Klinger, MA,³ and Jules Rosen, MD⁴

¹Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania.

²University of Massachusetts, Boston, Massachusetts.

³UCSUR, University of Pittsburgh, Pittsburgh, Pennsylvania.

⁴Mind Springs Health, Frisco, Colorado.

Address correspondence to:

Richard Schulz, PhD

University Center for Social and Urban Research

University of Pittsburgh

3343 Forbes Avenue

Pittsburgh, PA 15260

E-mail: schulz@pitt.edu

Accepted October 21, 2014

ABSTRACT

Background: Preparedness for death as a predictor of post-bereavement adjustment has not been studied prospectively. Little is known about pre-death factors associated with feeling prepared prior to the death of a loved one.

Objective: Our aim was to prospectively assess the role of preparedness for death as a predictor of post-bereavement adjustment in informal caregivers (CGs) who experienced the death of their loved one and to identify predictors and correlates of complicated grief, depression, and preparedness for death among informal CGs.

Methods: We conducted a prospective, longitudinal study using data collected for a randomized trial testing the efficacy of an intervention for CGs of recently placed care recipients (CRs). Subjects were 217 informal CGs of care recipients recently placed in nursing homes, and they were followed for 18 months. CGs were assessed in person by certified interviewers at 6-month intervals. Eighty-nine CGs experienced the death of their loved one in the course of the study. Measurements used included preparedness for death, advance care planning (ACP), complicated grief, depression, and sociodemographic characteristics.

Results: CGs who reported feeling more prepared for the death experienced lower levels of complicated grief post-bereavement. A multivariate ordinal logistic regression model showed that spouses as opposed to adult child CGs were less prepared for the death, depressed CGs were less prepared, and patients who engaged in ACP had CGs who felt more prepared. CR overt expressions about wanting to die was also related to higher levels of preparedness in the CG.

Conclusions: We show prospectively that preparedness for death facilitates post-bereavement adjustment and identify factors associated with preparedness. ACP can be an effective means for preparing informal CGs for the death of their CRs.

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