A recently released study published in JAMA Internal Medicine online by researchers at the Icahn School of Medicine at Mount Sinai found that "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."
While there have been studies demonstrating the benefits of hospice on caregivers of cancer patients, this is the first study to expand that to all types of serious illnesses.
It's hardly surprising that spouses of patients with life-threatening illnesses should feel depressed in the first place. Watching a spouse or any other loved one deteriorate and not be able to do anything about it is the ultimate in frustration and helplessness.
Back in 1967, psychiatrists Thomas Holmes and Richard Rahe created a rating scale of life's most stressful events. Death of a spouse led the list...and still does. So it's interesting to see, based on the Mount Sinai findings, that having the dying patient in hospice care seems to reduce some of the stress of the caregiver.
The concept of Hospice dates back to the 11th century, but it wasn't until the late 1950's that the principles of today's hospice came into being, pioneered by Dame Cicely Saunders. She emphasized focusing on the patient rather than the disease, and introduced the concept of "total pain" which included spiritual aspects as well.
Today's hospice is considered to be the model for quality, compassionate care for people facing a life-limiting illness or injury. The Mount Sinai study points out that hospice services are focused on palliative rather than curative care and includes medical services, symptom management, spiritual counseling, social services and bereavement counseling, delivered by an interdisciplinary team of professionals. It also includes counseling service for family members.
While the Mount Sinai study demonstrated a link between hospice and the psychological well-being of the surviving spouse, the question remains as to which specific aspects of hospice care are associated with improved depressive symptoms. I asked some of our chaplains with hospice experience to speculate on what the underlying reasons might be.
The Rev. Sue Wintz, our director of professional and community education, points out that when someone is admitted to hospice the support for the spouse starts immediately. Hospice chaplains look for signs of hopelessness, despair, and other symptoms that can lead to depression. The plan for care of grief starts upon admission. Hospice bereavement services continue for about a year, with the chaplain checking up on the spouse periodically, especially on holidays and on the patient's birthday and anniversary. Hospice philosophy treats death as normal and anticipated, not as a "failure" of medical intervention.
The Rev. Jill Bowden, director of chaplaincy services at Memorial Sloan-Kettering Cancer Center, whose mother died in hospice, said that just to have someone present who is professional, compassionate, and in possession of factual information - like what to expect as death nears, and what resources are available to help both patient and family - is a godsend. It's important to not be alone.
Going forward, it's clear that as a growing percentage of our population ages, hospice will play an increasing role in end-of-life care. The Mount Sinai study points to an additional beneficiary of that care... the spouse.
Need help? In the U.S., call 1-800-273-8255 for the National Suicide Prevention Lifeline.
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