Long-Term Effect of End-of-Life Care among Spouses Who Dealt with Death at Home: Results from the Health and Retirement Study = 사망한 노인을 개호한 배우자의 장기간 영향에 관한 연구

국문 초록 (Abstract)

연구목적 : 이 연구는 생애말기 개호 전 후에 돌봄 서비스를 제공해 온 배우자의 우울증상을 연구하고 이 이후의 여파를 조사하고자 한다. 연구방법 : 이 연구는 미국 건강과 은퇴 연구 (Health and Retirement Study, HRS)내의 사망자에 대한 설문데이터 (EXIT)을 이용하여 1996년부터 2004년까지 사망한 가족을 개호한 배우자의 데이터를 이용하여 배우자의 우울증상 변화를 연구하였다. 본 HRS 설문데이터는 간략한 형식의 Center for Epidemiologic Studies Depression scale (CES-D)를 우울척도로 사용하였다. 본 연구는 CES-D 점수가 3점 이상을 우울 증상이 있다고 보았다. 다변수분석을 위해 로지스틱 모형을 이용하여 생애말기 개호 전과 후에 배우자의 우울 증상에 영향을 미치는 요인을 조사하였다. 연구결과 : 지난 10여 년 동안 생애 말기 돌봄 서비스를 제공한 1,335 명의 배우자 중, 78.95%가 백인이었고, 69.44%가 여성이었다. 그들의 평균연령은 79.11 세였다. 배우자의 우울 정도는 가족의 사망 2년 전에 비해, CES-D척도를 통해 보면(2.13), 가족의 사망을 겪을 당시에 매우 유의하게 증가하였다 (2.80) (p<0.001). 절반 이상의 배우자들이 (60.00%) 가족의 사망을 맞이할 당시에 임상적인 우울 증상을 보고 하였다. 그러나, 배우 개호자들의 우울 증상은 가족의 사망 2년 이후는 급격이 감소하는 것으로 나타났다 (40.75%). 로지스틱모형 분석결과, 배우자가 주요한 간호자였거나, 기억력 손상이 심했던 배우자나, 정신상의 문제가 있었던 배우자, 또는 당뇨를 앓고 있었던 배우자들은 가족의 사망 이후에도 임상적 우울증상을 보고 할 가능성이 높은 것으로 나타났다. 결론 : 본 연구의 결과는 생애말기 심각성과 배우자의 우울 증상에 장기간 영향을 미치는 것을 증명하고 있다.

다국어 초록 (Multilingual Abstract)

Objectives : This study examines spouses’ depressive symptoms before and after end-of- life-care and its long-term effects. Methods : Health and Retirement Study (HRS), EXIT surveys were used to identify spouses of decedents who lived at homes before death from 1996 to 2004. The HRS measures depressive symptoms with a short version of the standard Center for Epidemiologic Studies Depression scale (CES-D). We identified active depression (CES-D>= 3). Logistic regression for multivariate analyses was used to examine the factors of depressive symptoms prior and post EOL care. Results : Among 1,335 spouses providing end-of-life care for the past ten years, 69.44 % were female and 78.95% were white. The average age was 79.12 years. The average CES-D scores significantly increased from two years before their spouses’ death (2.13) and at the time period of their spouses’ death (2.80) (p<0.001). Over half (60.00%) had active depressive symptoms at the time of their spouses’ death. The rate decreased 2 years later (40.75%). Primary caregiver, spouses who had memory problem, psychiatric problems, diabetes were more likely to suffer from depressive symptoms post to EOL care period. Conclusion : This study provides evidence of the intensity of end-of-life care and long- term effect on spouse caregivers` depressive symptoms.

참고문헌 (Reference)

1 Emanuel EJM, "Understanding Economic and Other Burdens of Terminal Illness : The Experiences of Patients and Their Caregivers" 32 (32): 451-459, 2000

2 Visser G, "The end of life : informal care for dying older people and its relationship to place of death" 18 (18): 468-477, 2004

3 "The Healthcare Effectiveness Data and Information Set (HEDIS) 2007"

4 "The Health and Retirement Study"

5 Grabowski DC, "The Costs And Potential Savings Associated With Nursing Home Hospitalizations" 26 (26): 1753-1761, 2007

6 Mittelman MS, "Sustained Benefit of Supportive Intervention for Depressive Symptoms in Caregivers of Patients With Alzheimer’s Disease" 161 : 850-856, 2004

7 Rabow M, "Supporting family caregivers at the end of life : "they don't know what they don't know"" 291 (291): 483-491, 2004

8 Blazer D, "Subjective social support and depressive symptoms in major depression : separate phenomena or epiphenomena" 25 (25): 191-203, 1991

9 Aneshensel CS, "Stress, role captivity, and the cessation of caregiving" 34 (34): 45-60, 1993

10 Pearlin LI, "Stress, health, and the life course : some conceptual perspectives" 46 (46): 205-219, 2005

11 SAS, "SAS 2002"

12 Cannuscio C, "Reverberations of family illness : a longitudinal assessment of informal caregiving and mental health status in the Nurses' Health Study" 92 (92): 1305-1311, 2002

13 Hebert RS, "Religious beliefs and practices are associated with better mental health in family caregivers of patients with dementia : findings from the REACH study" 15 (15): 292-300, 2007

14 Prigerson, H, "Prolonged grief disorder: Psychometric validation of criteria proposed for DSM-V and ICD-11" 6 (6): 1000121-, 2000

15 Rhee Y, "Muramatsu N End-of-life and formal and informal care use of community-dwelling older adults with different levels of physical disability" 59 (59): 1983-1984, 2011

16 Schulz R, "Long-term Care Placement of Dementia Patients and Caregiver Health and Well-being" 292 : 961-967, 2004

17 Schulz R, "Involvement in caregiving and adjustment to death of a spouse : findings from the caregiver health effects study" 285 (285): 3123-3129, 2001

18 Schulz R, "Involvement in caregiving and adjustment to death of a spouse : findings from the caregiver health effects study" 285 (285): 3123-3129, 2001

19 Tennstedt SL, "Informal care for frail elders : the role of secondary caregivers" 29 (29): 677-683, 1989

20 Langa KM, "Informal Caregiving Time and Costs for Urinary Incontinence in Older Individuals in the United States" 50 (50): 733-737, 2002

21 Hebert R, "Improving well-being in caregivers of terminally ill patients. Making the case for patient suffering as a focus for intervention research" 34 (34): 539-546, 2007

22 Haley W, "Family caregiving in hospice : effects on psychological and health functioning among spousal caregivers of hospice patients with lung cancer or dementia" 15 (15): 1-18, 2001

23 Langa KM, "Extent and Cost of Informal Caregiving for Older Americans With Symptoms of Depression" 161 : 857-863, 2004

24 Schulz R, "End-of-life care and the effects of bereavement on family caregivers of persons with dementia" 349 (349): 1936-1942, 2003

25 Redinbaugh EM, "End-of-Life Caregiving : What Helps Family Caregivers Cope?" 6 (6): 901-909, 2003

26 Williams SW, "Emotional and Physical Health of Informal Caregivers of Residents at the End of Life:The Role of Social Support" 63 (63): 171-183, 2008

27 Kim JH Knight BG, "Effects of caregiver status, coping styles, and social support on the physical health of Korean American caregivers" GERONTOLOGICAL SOC AMER 48 : 287-299, 2008

28 Steffick DE, "Documentation of Affective Functioning Measures in the Health and Retirement Study, in HRS/AHEAD Documentation Report" Ann Arbor MI 2000

29 Lustman, PJ, "Depression and poor glycemic control : a meta-analytic review of the literature" 23 (23): 934-942, 2000

30 Jiang W, "Depression and heart disease : evidence of a link, and its therapeutic implications" 16 (16): 111-127, 2002

31 Doshi JA, "Depression and Retirement in Late Middle-Aged U.S. Workers" 43 (43): 693-713, 2008

32 Smith, M. A., "Characterizing Hospice Services in the United States Gerontologis" 48 : 25-41, 2008

33 Hebert R, "Caregiving at the end of life" 9 (9): 1174-1187, 2006

34 Schulz R, "Caregiving as a risk factor for mortality : the Caregiver Health Effects Study" 282 (282): 2215-2219, 1999

35 Pearlin L, "Caregiving and the stress process : an overview of concepts and their measures" 30 : 583-594, 1990

36 Lee S, "Caregiving and risk of coronary heart disease in U.S. women: A prospective study" 24 (24): 113-208, 2002

37 Chappell N, "Burden and well-being among caregivers : examining the distinction" 42 (42): 772-780, 2002

38 Syren SM, "Being a family in the midst of living and dying" 22 (22): 26-32, 2006

39 Pinquart M, "Associations of caregiver stressors and uplifts with subjective well-being and depressive mood : a meta-analytic comparison" 8 (8): 438-449, 2004

40 Emanuel E, "Assistance from family members, friends, paid care givers, and volunteers in the care of terminally ill patients" 341 (341): 956-963, 1999

41 King AC, "Ambulatory blood pressure and heart rate responses to the stress of work and caregiving in older women" 49 (49): 239-245, 1994

42 Max W, "Alzheimer's disease. The unpaid burden of caring" 7 (7): 179-199, 1995

43 Pruchno R, "Aberrant behaviors and Alzheimer's disease : mental health effects on spouse caregivers" 44 (44): 177-182, 1989

44 Choi, D., "A study on effect of a mutual support group program for women who lost spouses" Sogang University 2010