C.P.M. Knipscheer

The end of life: informal care for dying older people and its relationship to place of death

Objective: This study examined the features of informal end-of-life care of older people living in the community and the association between informal care characteristics and dying at home. Methods: Retrospective data were obtained from interviews and self-administered questionnaires of 56 persons who had been primary caregivers of older relatives in the last three months of their lives. Results: Results showed that informal caregivers of terminally ill older people living in the community provided a considerable amount of personal, household, and management care. Secondary informal caregivers and formal caregivers assisted resident primary caregivers less often than nonresident primary caregivers. Primary caregivers who felt less burdened, who gave personal care more intensively, and/or who were assisted by secondary caregivers, were more likely to provide informal end-of-life care at home until the time of death. Conclusions: Our study showed that informal care at the end of life of older people living in the community is complex, since the care required is considerable and highly varied, and involves assistance from secondary informal caregivers, formal home caregivers as well as institutional care. Burden of informal care is one of the most important factors associated with home death. More attention is needed to help ease the burden on informal caregivers, specifically with regard to resident caregivers and spouses. Since these resident caregivers were disadvantaged in several respects (i.e., health, income, assistance from other carers) compared to nonresident caregivers, interventions by formal caregivers should also be directed towards these persons, enabling them to bear the burden of end-of-life care.

Religious Denomination and Depression in Older Dutch Citizens: Patterns and Models

This study describes the distribution of depressive symptoms in older Dutch citizens (N = 3,020) across religious denominations. Reformed Calvinists had the lowest depressive scores (CES-D); Protestants from liberal denominations the highest; Roman Catholics, Dutch Reformed, and nonchurch members were in between. Two types of explanatory mechanisms are examined: (a) social integration and (b) positive self-perceptions, which both help to prevent depression. Alternatively, strict Calvinist doctrines are hypothesized to enforce negative self-perceptions, facilitating depression. For 2,509 respondents, complete data were available on social integration and self-perceptions, as well as on the parental religious denomination. Explanatory effects were tested using hierarchic regression models. The negative association between Calvinist background and depressive symptoms was partly explained by size of social network, and between Roman Catholic background and depressive symptoms by self-esteem. Leaving church had a positive association with depressive symptoms. This depressogenic effect remained after controlling for explanatory variables.

Onset of physical impairment of independently living older adults and the support received from sons and daughters in The Netherlands.

This study examined the relation between the onset of physical impairment of older parents and the instrumental and emotional support received from adult children in the Netherlands. The data were derived from 1,313 older parents who participated twice in a large survey with an interval of about one year between the times of measurement. For the 356 parent-child relationships of the 186 parents who experienced an onset of physical impairment, the support intensities were compared with the support in the child relationships of parents who remained in good health. The results indicated that, given the onset of physical impairment, both sons and daughters are likely to increase the intensity of instrumental and emotional support to their parent, but the increase is the strongest in mother-daughter relationships. Multivariate regression analyses showed that the intensity of support was significantly determined by the onset of parental physical impairment, but even more so by the type of parent-child relationship.