Delayed Hospice Care Can Increase Depression Among Survivors After Death of a Loved One

Delayed enrollment in hospice can result in increased depression among family members after the death of their loved one, according to a study by Yale researchers published in the American Journal of Psychiatry.

The study followed over 200 family caregivers from the patient’s first enrollment with hospice, through their death, and then for six months after the death. The team studied the impact of hospice use on family well-being after the patient’s death.

“We found that shorter hospice enrollment was linked to elevated depression among family caregivers, who are often the spouse or daughter of the deceased,” said lead author Elizabeth Bradley, associate professor of public health at Yale School of Medicine. “The finding is particularly troublesome because nationally the length of hospice enrollment has been declining, with more patients enrolling only in the last week or days of life. This is the first study to examine the impact of that trend on families’ well being, and it looks like the impact is significant.”

“It is often difficult to discuss, plan for, and then enroll with hospice, especially if the family is not fully aware of and accepting the patient’s prognosis,” said Emily Cherlin, co-author and research associate at Yale. “But the study reveals the importance of thinking about hospice earlier in the course of an illness.

The inadequate preparation for the death, including delays in seeking and receiving appropriate hospice care can measurably compromise post-loss adjustment, according to the study.

The study was sponsored by the Nathan Cummings Foundation, The John D. Thompson Hospice Institute for Education, Training and Research and the Donaghue Medical Research Foundation.

Other co-authors include Holly Prigerson, Stanislav Kasl and Melissa Carlson of Yale; and Rosemary Johnson-Huzerler of the Connecticut Hospice.

Citation: The American Journal of Psychiatry, Vol. 161, issue 12, December 2004.