Schulz Richard, Boerner Kathrin, Klinger Julie, Rosen Jules
1 Department of Psychiatry, University of Pittsburgh , Pittsburgh, Pennsylvania.
J Palliat Med. 2015 Feb;18(2):127-33. doi: 10.1089/jpm.2014.0309. Epub 2014 Dec 3.
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.
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.
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.
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.
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.
将对死亡的准备程度作为丧亲后适应情况的预测指标尚未进行前瞻性研究。对于与在亲人去世前感到有心理准备相关的临终前因素，我们知之甚少。
我们的目的是前瞻性评估对死亡的准备程度在经历亲人死亡的非正式照料者（CGs）丧亲后适应情况中的预测作用，并确定非正式照料者中复杂悲伤、抑郁及对死亡的准备程度的预测因素和相关因素。
我们进行了一项前瞻性纵向研究，使用为一项随机试验收集的数据，该试验测试了一项针对近期安置的护理接受者（CRs）的照料者的干预措施的效果。研究对象为217名近期将护理接受者安置在养老院的非正式照料者，对他们进行了18个月的随访。由经过认证的访谈者每隔6个月对照料者进行一次面对面评估。在研究过程中，有89名照料者经历了亲人的死亡。所使用的测量指标包括对死亡的准备程度、预先护理计划（ACP）、复杂悲伤、抑郁以及社会人口学特征。
报告对死亡有更多心理准备的照料者在丧亲后复杂悲伤的程度较低。多变量有序逻辑回归模型显示，与成年子女照料者相比，配偶对死亡的准备程度较低，抑郁的照料者准备程度较低，而参与预先护理计划的患者的照料者感觉准备更充分。护理接受者公开表达想死的意愿也与照料者更高的准备程度相关。
我们前瞻性地表明，对死亡的准备程度有助于丧亲后的适应，并确定了与准备程度相关的因素。预先护理计划可以成为让非正式照料者为其护理接受者的死亡做好准备的有效手段。
