Hospice support services may decrease depressive symptoms in spouses

1. Depression symptoms are common in surviving spouses, and increase following bereavement regardless of participation in hospice care.

2. Hospice use was associated with a modest reduction in depressive symptoms overall.

Evidence Rating Level: 2 (Good)       

Study Rundown: Hospice care represents a comprehensive system designed to assist patients and their family members during end of life. Caregivers and relatives play a crucial role in supporting their loved ones during this time, though if they are not in turn supported, they are more vulnerable to depression and diminished self-care behaviors. Hospice care typically includes counseling, symptom management, and social services. This study sought to quantify the effects, if any, of high-quality hospice care on the vulnerability to depressive symptoms of patients’ spouses.

Hospice use was associated with improved depressive symptoms in patient spouses. One of the strengths of this study was that analyses were conducted at two-year intervals regardless of the time of death, which yielded the ability to assess the impact of hospice care at various time points following bereavement. A significant limitation is that the actual use of hospice-related counseling and services by the spouse of the decedent was not recorded, so it is not clear what frequency, duration, or type of support has the most impact on supporting their emotional health.

Click to read the study, published today in JAMA Internal Medicine

Relevant Reading: Hospice Care: What Services Do Patients and Their Families Receive?

In-Depth [prospective cohort]: The study cohort was obtained through the Health and Retirement Study (HRS), a nationally-based ongoing survey of American adults over the age of 50, during which telephone-based questionnaires are conducted at two-year intervals. A total of 1025 decedents were identified as having spouses with Medicare fee-for-service, married at the time of death, with cause of death being limited to non-acute causes. When spouses were interviewed, symptoms of feeling sad, lonely, or fatigued were assessed with an 8-item version of the Center for Epidemiologic Studies Depression Scale (CES-D), which is scored as 0 (no symptoms) to 8 (severe) with a cutoff of 3 identifying depression. Statistical analysis was performed using propensity score matching and multivariable regression adjustment.

After propensity score matching, there were 1016 spouses identified. With a hospice enrollment cutoff of at least 7 days in the year before death, hospice was associated with improved depressive symptoms in patient spouses that identified themselves as their loved one’s primary caregiver (OR 1.65; 95%CI 1.02-2.65). Conversely there was no association with a cutoff of only one day of hospice use (OR 1.31; 95%CI 0.91-1.90), as might be expected as counseling and support services can rarely be fully deployed in a 24 hour span. The length of hospice enrollment was identified via individual Medicare hospice claims.

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