Katherine A. Ornstein (
Jennifer L. Wolff is a professor of public health at Johns Hopkins University, in Baltimore, Maryland.
Health Aff (Millwood). 2019 Jun;38(6):964-972. doi: 10.1377/hlthaff.2019.00087.
Caregiving in the last years of life is associated with increased depression and negative health outcomes for surviving spouses, many of whom are themselves in poor health. Yet it is unclear how often spouses are caregiving alone, how they differ from supported spouses, and whether lack of support affects postbereavement outcomes. We hypothesized that spouses who were solo caregivers-that is, the only caregivers (paid or unpaid) who provided assistance with a spouse's self-care or household activities-would experience more depression after bereavement than supported spouses would. Using information from the Health and Retirement Study, we found that 55 percent of the spouses of community-dwelling married people with disability were solo caregivers. Solo caregiving was even common among people who cared for spouses with dementia and those with adult children living close by. Bereavement outcomes did not differ between solo and supported caregiving spouses. Caregiving spouses are often isolated and may benefit from greater support, particularly during the final years before bereavement. While some state and federal policy proposals aim to systematically recognize and assess caregivers, further innovations in care delivery and reimbursement are needed to adequately support seriously ill older adults and their caregivers. Ultimately, the focus of serious illness care must be expanded from the patient to the family unit.
在生命的最后几年，照顾者会感到更加沮丧，并且健康状况也会恶化，尤其是那些本身健康状况不佳的配偶。然而，目前尚不清楚有多少配偶是独自照顾者，他们与得到支持的配偶有何不同，以及缺乏支持是否会影响丧偶后的结果。我们假设，那些独自照顾者——即仅提供配偶自理或家务活动帮助的照顾者（有偿或无偿）——在丧偶后会比得到支持的配偶经历更多的抑郁。我们利用健康与退休研究的数据发现，在有残疾的社区居住的已婚人群中，有 55%的配偶是独自照顾者。在照顾有痴呆症的配偶以及与成年子女同住的配偶的人中，独自照顾的情况更为普遍。丧偶后，独自照顾和得到支持的照顾配偶的结果没有差异。照顾配偶的人通常很孤立，可能需要更多的支持，尤其是在丧偶前的最后几年。虽然一些州和联邦政策提案旨在系统地承认和评估照顾者，但在护理提供和报销方面还需要进一步创新，以充分支持重病老年人及其照顾者。最终，严重疾病护理的重点必须从患者扩展到家庭单位。
