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Health Consequences of Alzheimer’s Caregiving Transitions: Effects of Placement and Bereavement

From the Departments of Psychiatry (I.G., K.A.A., T.L.P., J.E.D., M.R.I.) and Medicine (M.G.Z.), University of California, San Diego, La Jolla, California; San Diego State University (K.A.A.), San Diego, California; Veterans Affairs San Diego Healthcare System (I.G., T.L.P., M.G.Z., M.R.I.), San Diego, California; and the UCSD Cancer Center (J.E.D.), San Diego, California.

Address reprint requests to: Igor Grant, MD, Department of Psychiatry (0680), Stein Clinical Research Building, Room 249, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0680. Email: igrant{at}ucsd.edu

OBJECTIVE: To determine the extent to which the chronic stress of Alzheimer’s disease caregiving may be alleviated by placement or death of the Alzheimer’s disease patient, we prospectively compared groups of caregivers (CG) who continued to care for their Alzheimer’s disease spouse at home, CG who placed their spouses, and CG whose spouses died with similarly aged noncaregiving comparison subjects (control subjects).

METHODS: A sample of 119 CG who had been studied for at least 18 months at 6-month intervals was included in the present analyses (ie, had at least three assessments). Data were gathered on CG mood, blood pressure, and medical symptoms among 38 CG whose spouses were at home at all three visits (home-home-home [HHH]); 28 CG who placed their spouse at follow-up (home-placed-placed [HPP]); 27 CG whose spouses were placed and subsequently died at follow-up (home-placed-deceased [HPD]); and 26 CG whose spouses died at home (home-deceased-deceased [HDD]). Data were compared with 48 noncaregiving control subjects (NC group).

RESULTS: CG in the HPP, HPD, and HDD groups showed improvement in depressive and physical symptoms compared with HHH and NCs. CG had significantly higher systolic blood pressure at rest than did NCs. Both placement and death of the Alzheimer’s disease spouse were associated with higher systolic blood pressure in response to postural challenge in CG experiencing these transitions.

CONCLUSIONS: Despite improvement seen in mood and medical symptoms among CG who place their spouses or experience the spouse’s death, there may be longer term physiological alterations, possibly in sympathoadrenalmedullary arousal, that cause the cardiovascular system to continue to respond to acute stressors such as postural challenge more actively for a period of 6 to 12 months after such transitions.

Key Words: Alzheimer’s caregiving transitions, • health outcomes, • bereavement, • placement.

Abbreviations: AD = Alzheimer’s disease;; ANCOVA = analysis of covariance;; ANOVA = analysis of variance;; BP = blood pressure;; CDR = Clinical Dementia Rating;; CG = caregiver;; DBP = diastolic blood pressure;; HDD = home-deceased-deceased;; HDRS = Hamilton Depression Rating Scale;; HHH = home-home-home;; HPD = home-placed-deceased;; HPP = home-placed-placed;; NC = noncaregiving control subjects;; NK = natural killer cells;; SAM = sympathoadrenalmedullary;; SBP = systolic bloodpressure.

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