Is there a desolation effect after dementia? A comparative study of mortality rates in spouses of dementia patients following admission and bereavement

Abstract

SUMMARYMortality rates following patient admission and patient death were measured in the surviving spouses of a sample of dementia patients admitted to a psychogeriatric unit between 1971 and 1986. The vital status of 85% of spouses was confirmed, and the ratio of observed to expected deaths (SMR) was calculated using regional and national mortality statistics.Spouse mortality following first admission to hospital was significantly lower than expected (p < 0.006), and spouse deaths following bereavement were significantly fewer than expected (p < 0.026). When male and female spouse mortality rates were compared, no significant differences were found, but there was a trend towards lower mortality in female spouses.The results give no support to the theory that hospital admission often follows a breakdown in the health of a caring spouse. Previous studies have shown an increase in mortality following conjugal bereavement, but the spouses of dementia patients were relative survivors and outlived their married and widowed counterparts in the general population. The possible relationships between dementia, anticipatory grief, and the impact of bereavement on the health of the surviving spouse are discussed.KEY woms-Dementia, spouse, bereavement, mortality.The historical observation of high mortality rates in the widowed (Durkheim, 1951; OPCS, 1971) has stimulated research into mortality and morbidity following bereavement. MORTALITY AFTER BEREAVEMENTMortality rates in the bereaved are higher than those in the married. Evidence of a 'mortality effect' during the initial 12 months following bereavement is stronger for widowers than for widows. Young et al.( 1 963) found a 40% increase in mortality during the initial six months of bereavement in a group of 4486 widowers aged 55 years and over. Parkes (Parkes et al., 1969) was able to explain the rise in mortality by an increase in cardiovascular deaths which was confined to the six months following bereavement. Rees and Lutkins (1967) confirmed Young's observations in a Welsh rural population and presented evidence of higher mortality rates following bereavement proportional to the nearness of the blood relationship. Helsing and Szklo (1981) were not able to show an increase in the female mortality rate following bereavement, although they did find evidence of significantly greater mortality after bereavement in widowed males. Clayton (1974) did not find evidence of higher mortality rates in a controlled 12-month follow-up study of widows and widowers, but the numbers in this study were insufficient for adequate postbereavement analysis of mortality rates. MORBIDITY AFTER BEREAVEMENTMorbidity studies have tended to rely either on the uncertain relationship between consultation rates and true morbidity or on self-report questionnaires on health after bereavement. Parkes (1964) found

The Effect of Widowhood on Mortality by the Causes of Death of Both Spouses

“…the ability of caregivers to prepare adequately for the predictable death of their spouse. (36) The theory of anticipatory grief is also consistent with our finding of similarly small (albeit statistically significant) widowhood effects in the wake of spouse’s death from cancers that typically lead to death quickly. This suggests that it may be the predictability of the death per se , rather than the duration of spouse’s terminal illness, that may shield the survivor from some of the adverse consequences of bereavement.…”

“…Existing research often considers only a small number of causes of death, such as the broad categories of cancer or violent deaths,(15, 35-38) uses samples with relatively small numbers of cases for each individual cause of death, uses samples that are not nationally representative,(4, 35, 36, 39) uses a cross sectional methodology,(12, 14) or lacks statistical controls for confounding beyond age, sex, and race. (12, 14, 17, 37, 38) By contrast, this study considers 17 causes of death separately for both spouses in a longitudinal and nationally representative sample of 373,189 married couples experiencing a total of 317,300 deaths while adjusting for a wide range of covariates, including baseline health, that are measured for both members of the couple.…”

Life expectation in organic brain disease

“…Similar findings have been reported by many subsequent workers (e.g. Magnusson, 1989;Black & Jolley, 1990;Burns et al, 1990;Ryan, 1993). Puxty et al (1983) had found bronchopneumonia to be the most common immediate cause of death among older people dying after admission to acute medical wards.…”

“…Barclay et al, 1985W. Family history Knesevich et al (1985) found that cases with a family history of dementia lived longer than those without such a history. Ryan (1992) found that patients suffering from dementia died before their (non-demented) spouses, but marital status did not influence survival among patients referred to Salford psychiatric services (Jolley, 1996). Magnusson (1989) found longer survival in social class I.…”

Mortality in elderly patients with organic brain disorder enrolled on the Salford psychiatric case register

“…Low vitamin C intake appears to increase both the risk of developing cognitive impairment and subsequent mortality (Gale et al, 1996). Ryan (1992) found that survival among patients suering from dementia was less than their spouses; but that the impact of either partner's death had no eect on the other's duration of survival. Aphasia (Faber-Langendoen et al, 1988), parietal lobe dysfunction (McDonald, 1969;Burns et al, 1991), psychotic features (Stern et al, 1987) and behavioural abnormalities at the time of presentation or assessment (Barclay et al, 1985;Diesfeldt et al, 1986;Moran et al, 1990) are all associated with shorter survival times (Stern et al, 1987).…”