(Press-News.org) While most surviving spouses had more depression symptoms following the death of their partner regardless of hospice use, researchers found a modest reduction in depressive symptoms among some surviving spouses of hospice users compared with nonhospice users, according to an article published online by JAMA Internal Medicine.
The Institute of Medicine's report on improving the quality of care near the end of life highlights the need for supporting family caregivers. Core components of high-quality hospice care include counseling services for family members before and after the patient's death, according to study background.
Katherine A. Ornstein, Ph.D., M.P.H., of the Icahn School of Medicine at Mount Sinai, New York, and coauthors used data from a national sample to examine the effect of hospice use on depressive symptoms in surviving spouses, especially those spouses identified as primary caregivers. The authors linked data from the Health and Retirement Study to Medicare claims. Participants included 1,016 decedents and their surviving spouses. Depression scores reflecting symptom severity were measured up to two years after death.
Of the 1,016 decedents, 305 patients (30 percent) used hospice services for more than three days in the year before their deaths. Overall 51.9% of the 1016 spouses had more depressive symptoms over time. There were no significant differences across groups based on hospice use.
Study results show that 28.2 percent of spouses of hospice users had improved depression scores compared with 21.7 percent of spouses whose partners didn't use hospice, although the difference was not statistically significant. Among the 662 spouses who were primary caregivers, 27.3 percent of the spouses of hospice users had improved depression scores compared with 20.7 percent whose spouses didn't use hospice, although the difference was not statistically significant. After further adjustment based on patient and spousal characteristics, spouses of hospice users were significantly more likely than spouses of non-hospice users to have reduction in symptoms.
"Although overall depression scores increase following death in spouses regardless of hospice use, our work suggests that hospice use is associated with a modest reduction in depressive symptoms for a subgroup of surviving spouses. Because most of these spouses are themselves Medicare beneficiaries, caring for their well-being is not only important for individual health but may also be fiscally prudent. Although there has been significant attention to the current unsustainable level of spending on health care for seriously ill persons in the United States, these analyses do not even begin to factor in the downstream effects of caregiving for a seriously ill relative on spouses and other family members. Maximizing the use of hospice for appropriate patients is a high-value intervention that can benefit both the patients and their families. Attention to the quality of caregiver support and bereavement services within hospice will be necessary to increase its benefits for families," the study concludes.
(JAMA Intern Med. Published online May 26, 2015. doi:10.1001/jamainternmed.2015.1722. Available pre-embargo to the media at http://media.jamanetwork.com.)
Editor's Note: The authors made funding/support disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
Commentary: The Antidepressant Effect of Hospice
In a related commentary, Holly G. Prigerson, Ph.D., and Kelly Trevino, Ph.D., of Cornell University and Weill Cornell Medical College, New York, write: "Is hospice the right prescription for reducing depressive symptom severity among widowed caregivers? Results from the study by Ornstein et al in this issue of JAMA Internal Medicine suggest that hospice care has a modest antidepressant effect among surviving spouses. ... Hospice care may offset the emotional costs of caregiving by creating an environment that is less depressing. ... Nevertheless, it is not surprising that hospice use was associated with only moderate improvement in bereavement-related depression in the study by Ornstein et al. As with prolonged grief disorder, major depressive disorder following the death of a spouse is likely to be rooted, perhaps deeply, in the surviving spouse's relationship to the decedent and in the intricacies and configuration of their life together," the commentary concludes.
(JAMA Intern Med. Published online May 26, 2015. doi:10.1001/jamainternmed.2015.1726. Available pre-embargo to the media at http://media.jamanetwork.com.)
Editor's Note: The authors made funding/support disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
INFORMATION:
Media Advisory: To contact corresponding author Katherine A. Ornstein, Ph.D., M.P.H., call Renatt Brodsky at 646-605-5946 or email renatt.brodsky@mountsinai.org. To contact corresponding commentary author Holly G. Prigerson, Ph.D., call Ashley Paskalis at 646-317-7378 or email asp2011@med.cornell.edu.
To place an electronic embedded link in your story: Links will be live at the embargo time: http://archinte.jamanetwork.com/article.aspx?doi=10.1001/jamainternmed.2015.1722 and http://archinte.jamanetwork.com/article.aspx?doi=10.1001/jamainternmed.2015.1726
Delayed clamping of the umbilical cord to help prevent iron deficiency in infancy was associated with improved scores in fine-motor and social skills in children at age 4, particularly in boys, although it was not associated with any effect on overall IQ or behavior compared with children whose cords were clamped seconds after delivery, according to an article published online by JAMA Pediatrics.
Iron deficiency is a global health issue among preschool children associated with impaired neurodevelopment that can affect cognitive, motor and behavioral abilities. Delaying ...
In an analysis that included more than 70,000 participants from 13 studies, subclinical hyperthyroidism was associated with an increased risk for hip and other fractures including spine, according to a study in the May 26 issue of JAMA. Subclinical hyperthyroidism is a low serum thyroid-stimulating hormone concentration in a person without clinical symptoms and normal thyroid hormone concentrations on blood tests.
Overt hyperthyroidism is an established risk factor for osteoporosis and fractures. Associations between subclinical thyroid dysfunction and fractures are unclear ...
Although some data have suggested that supplementation with soy isoflavone may be an effective treatment for patients with poor asthma control, a randomized trial that included nearly 400 children and adults found that use of the supplement did not result in improved lung function or clinical outcomes, including asthma symptoms and episodes of poor asthma control, according to a study in the May 26 issue of JAMA. Soy isoflavones are plant (soybean) derived chemicals that have anti-oxidant effects.
Increases in asthma prevalence and severity over the last several decades ...
Individually rare but collectively common intermediate-size copy number variations may be negatively associated with educational attainment, according to a study in the May 26 issue of JAMA. Copy number variations (CNVs) are regions of the genome that differ in the number of segments of DNA.
The Database of Genomic Variants catalogs approximately 2.4 million DNA CNVs. Some of them have been previously implicated as causal of a wide variety of traits and conditions. According to background information in the article large (defined as larger than 500 kb), recurrent CNVs ...
In a small study in Chile that included patients with gallbladder cancer, exposure to aflatoxin (a toxin produced by mold) was associated with an increased risk of gallbladder cancer, according to a study in the May 26 issue of JAMA.
In Chile, gallbladder cancer is a leading cause of cancer death in women. Exposure to aflatoxin, a liver carcinogen, is associated with gallbladder cancer in primates. Aflatoxin contamination has been identified in Chile, including in aji rojo (red chili peppers). Aji rojo is associated with gallbladder cancer; however, the association of ...
(NEW YORK -- May 26, 2015) Spouses of patients receiving hospice for three or more days more frequently reported reduced depression symptoms, compared to surviving spouses of patients who did not receive hospice, according to a study led by researchers at the Icahn School of Medicine at Mount Sinai published online today in JAMA Internal Medicine.
This is the first national study to examine depressive symptoms as an outcome for spouses of people with all types of serious illnesses that used hospice care, which is designed to improve quality of life as opposed to offering ...
A typical characteristic of the brain of an Alzheimer sufferer is the presence of insoluble Tau protein aggregates. Scientists at VIB, KU Leuven and Janssen Pharmaceutica have demonstrated that the distribution of these aggregates through the brain is facilitated by synaptic connections between brain cells. This news is highly significant because the focus is increasingly on repairing synaptic connections as a therapeutic strategy in neurodegenerative diseases such as Alzheimer's. In fact, it is generally accepted that a loss of synaptic connections leads to a loss in cognitive ...
Biologists from the University of Leicester have discovered that one of nature's most important pollinators - the buff-tailed bumblebee - either ascends to the status of queen or remains a lowly worker bee based on which genes are 'turned on' during its lifespan.
The paper, entitled 'Reproductive workers show queen-like gene expression in an intermediately eusocial insect, the buff-tailed bumble bee Bombus terrestris', which is published in the journal Molecular Ecology, suggests that the development of an individual bumblebee into its designated caste of male, worker ...
Sperm in the first fraction of ejaculate are more numerous, move more and present better quality DNA than those lagging behind. This is the conclusion of a study led by the Ginemed fertility clinic, which confirms that while the objective of the first fraction is to fertilise the egg, the second phase is so that no sperm from any other male has a chance to fertilise it.
A study led by the Ginemed Assisted Human Reproduction Clinic analyses the advantages of using fractions of ejaculate separately in in-vitro fertilisation as a way to improve the sample of the semen.
The ...
Strapped into a motion-enabled simulator and wearing 3D glasses, 36 adolescent volunteers recently experienced what it was like to "travel" through a field of virtual stars. The experiments provided new and convention-busting data about how sensory stimuli are processed by the brains of individuals with Autism Spectrum Disorder.
The study, entitled "Self-motion perception in autism is compromised by visual noise but integrated optimally across multiple senses," was published online in the Proceedings of the National Academy of Sciences on May 4th, 2015. The authors of ...
