Elderly caregiving spouses involved in end-of-life care: Attending to their needs

Even though death may be more readily anticipated with the elderly, older caregiving spouses may be emotionally devastated at the prospect of impending widowhood and the loss of a lifelong companion. This vulnerability can be exacerbated by involvement in a protracted and intensive caregiving experience. Spouses, primarily wives, compared to other caregiving groups, generally provide the most extensive and comprehensive care, maintain the role longer, and tolerate greater levels of disability. Age has an overarching impact on the challenges spousal caregivers face. Their own age-related frailty or health-limiting conditions can impede care provision efforts and compound the distress they experience. As part of a longitudinal investigation of elderly spousal cancer caregivers (n=138), funded by NIMH, surveys were conducted with caregiver spouses (mean age 63.6, 90% white, 40% husbands) during the final months of their spouse's terminal illness. Regression analyses found that after controlling for the other variables, anticipatory grief was significantly and directly correlated with the number of caregiving tasks the well spouses performed and the number of activity-limiting conditions they experienced. Conversely, anticipatory grief was found to be significantly lower among spouses reporting sufficient informational support. Similar results were obtained in the models predicting scores on the General Severity Index and probable caseness on the Brief Symptom Inventory. Programmatically, these findings point out the importance of sufficient informational support and caregiver physical well-being to older caregiving spouses' psychological functioning and emphasize the importance of end-of-life services attending to the dying patient and caregiving spouse as a unit of care.