End-of-life care and the effects of bereavement on family caregivers of persons with dementia

N Engl J Med. 2003 Nov 13;349(20):1936-42. doi: 10.1056/NEJMsa035373.


Background: Although family caregiving has been intensively studied in the past decade, little attention has been paid to the impact of end-of-life care on caregivers who are family members of persons with dementia or to the caregivers' responses to the death of the patient.

Methods: Using standardized assessment instruments and structured questions, we assessed the type and intensity of care provided by 217 family caregivers to persons with dementia during the year before the patient's death and assessed the caregivers' responses to the death.

Results: Half the caregivers reported spending at least 46 hours per week assisting patients with activities of daily living and instrumental activities of daily living. More than half the caregivers reported that they felt they were "on duty" 24 hours a day, that the patient had frequent pain, and that they had had to end or reduce employment owing to the demands of caregiving. Caregivers exhibited high levels of depressive symptoms while providing care to the relative with dementia, but they showed remarkable resilience after the death. Within three months of the death, caregivers had clinically significant declines in the level of depressive symptoms, and within one year the levels of symptoms were substantially lower than levels reported while they were acting as caregivers. Seventy-two percent of caregivers reported that the death was a relief to them, and more than 90 percent reported belief that it was a relief to the patient.

Conclusions: End-of-life care for patients with dementia was extremely demanding of family caregivers. Intervention and support services were needed most before the patient's death. When death was preceded by a protracted and stressful period of caregiving, caregivers reported considerable relief at the death itself.

Publication types

  • Clinical Trial
  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Activities of Daily Living
  • Aged
  • Aged, 80 and over
  • Attitude to Death
  • Bereavement*
  • Caregivers / psychology*
  • Dementia / therapy*
  • Depression / diagnosis
  • Depression / etiology
  • Female
  • Home Care Services / statistics & numerical data
  • Humans
  • Male
  • Psychotherapy
  • Self-Help Groups / statistics & numerical data
  • Terminal Care / psychology*