Caregiver adjustment to care recipient nursing home placement and death
Dooley, William Keith
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Research on informal caregiving in late life has only recently addressed complexities involved in the shift from in-home care provision to cessation of the caregiver role. Existing models of caregiver adjustment to caregiving transitions suggest complex relations among life-span development, care-related factors, and post-caregiving outcomes. This study examined depressive symptoms, grief, and relief among informal caregivers following care recipient (CR) nursing home placement and CR death. A sample of 132 caregivers completed face-to-face surveys before and after a transition; 624 caregivers who continued to provide in-home care during the study provided data for baseline comparisons. Participants provided information on demographic and other background characteristics, quality of their past relationship with the CR, care-related stress, pre-transition depressive symptoms, and post-transition depressive symptoms, grief, and relief. Continuing caregivers, caregivers who experienced CR nursing home placement, and caregivers who experienced CR death did not differ with respect to pre-transition depressive symptoms. There were mean-level increases in depressive symptoms after a transition, which differed by transition type and CR cognitive impairment status. Regression analyses indicated that less time providing in-home care, poor caregiver health, higher care-related stress, and more pre-transition depressive symptoms predicted more post-transition depressive symptoms. Male caregivers, those who co-resided with a CR and who reported poorer health, better historical relationship with the CR, less care-related stress, and more pre-transition depressive symptoms experienced stronger post-transition grief. Poorer historical relationship quality with the CR, more care-related stress, and more pre-transition depressive symptoms predicted more post-transition relief. Type of transition moderated relations between duration of in-home care provision and post-transition depressive symptoms; care-related stress and post-transition relief; and pre-transition depressive symptoms and post-transition relief. Results support existing models of stress accumulation and depletion of coping resources following a caregiving transition. However, the co-existence of negative (depressive symptoms, grief), and positive (relief) outcomes indicates that transitions produce ambiguous emotional responses, and individual differences across the lifespan contribute to post-caregiving adjustment. This research should inform mental health professionals designing targeted caregiver interventions following CR institutionalization and death and raises new questions concerning the effects of mixed emotional reactions on long-term adjustment in former caregivers.