Spousal bereavement, mortality and risk of negative health outcomes among older adults: a population-based study

Abstract

Objective: to examine whether spousal bereavement increases the risk of death and negative health outcomes and among older people.Design: cohort study and self-controlled cohort crossover study Setting: routinely collected administrative and healthcare data with individual-level linkage between several national registries in Sweden.Participants: older persons (≥65 years) living in the community whose spouse died in 2013-2014, individually matched with controls.Main outcome measures: death from any cause (primary outcome), acute cardiovascular events, pneumonia, hip fracture, and intentional self-harm (secondary outcomes). In the cohort study, incidence rate ratios were estimated with conditional fixed-effect Poisson regression models adjusted for potential confounders. In the self-controlled cohort crossover study, relative incidence ratios were estimated over the 12 months before and after spousal loss with unadjusted conditional fixed-effect Poisson regression including a bereavement-by-time interaction.Results: 42 918 bereaved older spouses were included and matched to an equal number of married controls (mean age 78.9 [SD 7.2] years, 68% women). During the first year of follow-up, the risk of death from any cause was 1.66 (95% confidence interval 1.53 to 1.80) times higher for bereaved cases than for married controls, and bereaved cases survived on average 4.2 days shorter than married controls. Bereaved cases also experienced an increased risk of acute cardiovascular events (incidence rate ratio 1.34, 1.24 to 1.44), hip fracture (1.48, 1.30 to 1.68), pneumonia (1.14, 1.04 to 1.25), and selfharm (3.49, 2.11 to 5.76). These associations were strongly time-dependent, increasing sharply immediately after spousal loss and weakening as time elapsed. In the self-controlled cohort crossover study, the relative incidence ratios increased for all four secondary outcomes, starting already during the 6-month period preceding spousal loss. Conclusion:Among older persons, the association between spousal bereavement and the risk of negative health outcomes and mortality is most likely causal. Our finding that the risk of adverse health consequences increases already during the 6 months prior to spousal loss indicates that palliative care services have an important role to play in providing timely bereavement care to spouses and other family caregivers.

Acceptance Death as Part of Life: Spouse in Malaysia

“…This study found that the majority of participants did not have health problems or physical changes after the death of their spouse. This is due to chronic diseases being the main cause of death such as heart disease, and stroke, and increasing the mortality rate [16]. However, in this study, it was found that the majority of respondents did not have health problems and physical changes after the death of their spouse.…”

Heavy alcohol consumption before and after negative life events in late mid-life: longitudinal latent trajectory analyses

“…This may be indicative of an anticipatory effect, in that the likelihood of heavy drinking is elevated prior to the event, perhaps because of elevated stress levels or anticipatory grief. 26 Anticipatory effects prior to negative life events have also been suggested in other studies regarding health deterioration prior to spousal loss, 27 and increased heavy drinking prior to losing a loved one (non-spouse). 2 In the case of divorce, this result is in line with previous findings suggesting that heavy drinking often precedes divorce, 7 8 but also that heavy drinking starts decreasing already prior to the divorce.…”