Preparedness for the death of a loved one and mental health in bereaved caregivers of patients with dementia: findings from the REACH study.

BACKGROUND: Although it has been suggested that family and friends who are prepared for the death of a loved one have less distress, the relationship between preparedness and bereavement mental health is inconclusive.
OBJECTIVES: To determine the relationship between preparedness for the death and mental health in bereaved caregivers of dementia patients and explore predictors of preparedness.
DESIGN: A prospective study of family caregivers of persons with dementia. Standardized assessment instruments and structured questions were used to collect data at study entry and at 6, 12, and 18 months. Multiple caregiving-related variables were collected. Bereaved caregivers reported whether they were "not at all" prepared or prepared for the death of their loved one.
SUBJECTS: Two hundred twenty-two bereaved caregivers
RESULTS: Twenty-three percent of caregivers were not prepared for the death. These caregivers had more depression, anxiety, and complicated grief symptoms. Black caregivers, caregivers with less education, those with less income, and those with more depressive symptoms prior to the death were more likely to perceive themselves as "not at all" prepared. In contrast, the amount of pain the care recipient was in prior to death was positively associated with preparedness.
CONCLUSIONS: Despite providing high-intensity care, often for years, many bereaved caregivers perceived themselves as unprepared for the death. These caregivers had more depression, anxiety, and complicated grief symptoms. Future work should be directed to confirming these findings and determining how best to intervene with high-risk caregivers.