A "good death" for whom? Quality of spouse's death and psychological distress among older widowed persons.

Ethicists, policy makers, and care providers are increasingly concerned with helping the dying elderly to experience a "good death." A "good death" is characterized by physical comfort, social support, acceptance, and appropriate medical care, and it should minimize psychological distress for the dying and their families. I identify the predictors of death quality and evaluate how the quality of an older adult's death affects the surviving spouse's psychological adjustment six months after the loss. Analyses use Changing Lives of Older Couples (CLOC) data, a prospective study of married persons ages 65 and older. Positive spousal relationships during the final days increase survivors' yearning yet reduce their anger. Having a spouse die a painful death is associated with elevated anxiety, yearning, and intrusive thoughts. The perception of physician negligence is associated with elevated anger. These findings suggest that improved end-of-life care and pain management will benefit both the dying and their bereaved spouses.