Abstract
Background and objectivesPopulation ageing has rapidly increased the number of people requiring end-of-life care across the globe. Governments have responded by promoting end-of-life in the community. Partly as a consequence, older spouses are frequently providing for their partner’s end-of-life care at home, despite potentially facing their own health issues. While there is an emerging literature on young-old caregivers, less is known about spouse carers over 75 who are likely to face specific challenges associated with their advanced age and relationship status. The aim of this review, therefore, is to identify and synthesise the literature concerning the experiences of caregiver’s aged 75 and over whose partner is approaching end-of-life. We conducted a mixed-method systematic review and narrative synthesis of the empirical literature published between 1985 and May 2019, identified from six databases: Medline, PsychINFO, Cumulative Index to Nursing and Allied Health Literature, Embase, Sociological s and Social Service s. Hand searching and reference checking were also conducted. Gough’s Weight of Evidence and Morgan’s Feminist Quality Appraisal tool used to determine the quality of papers. From the initial 7819 titles, 10 qualitative studies and 9 quantitative studies were included. We identified three themes: 1) “Embodied impact of care” whereby caring was found to negatively impact carers physical and psychological health, with adverse effects continuing into bereavement; 2) “Caregiving spouse’s conceptualisation of their role” in which caregiver’s navigated their self and marriage identities in relation to their partner’s condition and expectations about gender and place; 3) “Learning to care” which involved learning new skills and ways of coping to remain able to provide care. We identified a recent up-surge in published papers about very old spousal caregivers, which now comprise a small, medium-quality evidence base. This review outlines a range of potential lines of inquiry for future research including further clarification of the impact of caregiving on the likelihood of mortality, the incidence of men and women providing end-of-life care amongst this age group, and the role of anticipatory grief in shaping their perceptions of their relationship and their own longevity.
Highlights
Ageing populations across the world present significant challenges to traditional health and social care models [1, 2], in no small part because people have more protracted end-of-life phases [3]
Aim: to undertake a systematic review and narrative synthesis of the qualitative and quantitative literature published since 1985 concerning the experiences of oldest-old carers whose partner is approaching end-of-life
Search results are summarised in the adapted Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) flowchart (Fig 2 and S1 Checklist) [64] and the characteristics are displayed in supplementary S2 Table
Summary
Ageing populations across the world present significant challenges to traditional health and social care models [1, 2], in no small part because people have more protracted end-of-life phases [3]. Despite the fact that the majority of deaths internationally occur amongst the over-65s, there remains relatively little policy concerning their needs and care preferences towards end-of-life [5] This paucity of policy and research is starker still when considering the oldest-old [6,7,8], who are the fastest growing age-group in developed countries [9]. Scholars working with family caregivers have voiced concerns that the ‘care in the community’ approach relies on family members to take on intense, often 24/7 care for indefinite periods of time [13,14,15] with input from professionals only late in the dying trajectory [16] if ever [17] Alongside this care they are expected to manage their own feelings about the impending death of their relation [18, 19]. This review outlines a range of potential lines of inquiry for future research including further clarification of the impact of caregiving on the likelihood of mortality, the incidence of men and women providing end-of-life care amongst this age group, and the role of anticipatory grief in shaping their perceptions of their relationship and their own longevity
Sign-in/Register to view highlights & summary 
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call