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March 26, 2023
EXECUTIVE SUMMARY
A Danish study has found that men are 70% more likely to die in the year following the loss of their wife, while women’s risk rises by only 27%.
- The research tracked the health outcomes of nearly 925,000 Danish seniors over six years, measuring medical expenses and post-loss risk of dying.
- The team found that women only experienced an increased risk of dying post-loss if they were relatively young, …
- … while the risk rose for men regardless of age, with the degree of increased risk being incrementally lower for older men.
- The study author speculated that elderly widows may be better at “absorbing the shock” of their spouse’s loss, …
- … whereas men’s “physical and emotional health relies on the willingness of their spouse to take care of them.”
The study highlights the need for bereavement services, home care assistance, social interaction, and mental health support for surviving spouses.
DEEP DIVE
Losing a spouse may be more lethal for men, finds study
Medical Express
by Alan Mozes
March 24, 2023
While losing a spouse can shorten anyone’s life, new Danish research suggests widowers may be far more vulnerable than widows.
After six years spent tracking health outcomes among nearly 925,000 Danish seniors, investigators determined that when a man between the ages of 65 and 69 loses his wife he is 70% more likely to die in the year that follows, when compared with his non-widowed peers.
Among surviving wives, however, that rise in risk was just 27%.
Why the difference? Study author Alexandros Katsiferis said he could only offer a few theories.
“We do not have the data to accurately answer that question, so we cannot be very confident on the reasons why this phenomenon tends to happen,” noted Katsiferis, a doctoral fellow with the section for epidemiology in the department of public health at the University of Copenhagen.
But he pointed out that elderly widows may be better than widowers at “absorbing the shock, [including] the hurdles of taking care of a sick husband, along with all the needs and quirks” leading up to the husband’s passing.
By contrast, it could be that the “physical and emotional health [of men] relies on the willingness of their spouse to take care of them,” he added. “So, when their wife is out of their life, you get this collapse.”
Katsiferis and his colleagues noted that all of the study participants were 65 and older, with an average age of 73 to 75. About 55% were women.
During the study period, more than 8% lost a spouse, though there was a gender gap here as well: While just over 6% of the male enrollees ended up losing a wife, that figure was 10% among women. On average, survivors were between 77 and 79 when their spouse died.
The research team tracked two main indicators of survivors’ health post-loss: the amount of money they spent on health care in the three years following their loss and their own post-loss risk of dying during the study.
The health care spending analysis focused on any shifts in money laid out for survival home care, hospitalization, prescription drugs, and/or primary care among roughly half of the pool of widows and widowers. (This was money spent above and beyond the expenses that would be covered by Denmark’s national health care system.)
The analysis revealed that while survivor health care expenses rose across the board in the year after spousal loss, it rose significantly more among men, regardless of the age of the man when he lost his wife. Only among survivors who lost their spouse at the age of 85 or older were rising medical expenses roughly equal between men and women.
On the other front, the investigators found that women only experienced an increased risk for dying post-loss if they were relatively young-meaning between 65 and 69-when their husband passed. In that case, risk rose by 27%. But if they had been 70 or older at the time of their loss, their own risk for dying was either no higher than women who had not been widowed or even somewhat lower.
Not so for men. Husbands who had lost their wives when they were between 65 and 84 all saw their own risk of dying rise, though the degree of increased risk was incrementally lower among husbands who were older at the time of loss. Only among men 85 and up was risk seen to decrease slightly.
As to what could be done to improve health and longevity among surviving spouses, Katsiferis cautioned that the issue is “a multifaceted, complex problem with no straight answer.”
Still, he pointed to the need for bereavement services, home care assistance, social interaction and efforts to ensure that survivors are not isolated following their loss.
The findings were published online March 22 in the journal PLOS ONE.
“Mental health support is also another obvious crucial process that should be part of the solution,” Katsiferis added, noting that such support may be less sought out among surviving husbands, out of “the fear of showing vulnerability.”
That thought was seconded by Dr. Mohana Karlekar, section chief of palliative care medicine at Vanderbilt University Medical Center in Nashville, Tenn.
“Grief is real. For men and women,” she said. “It can manifest as anxiety or depression. And it can manifest physically in so many ways-as headaches, as weight loss, insomnia, joint pain, aches.”
“Grief is real. For men and women,” …
“It can manifest as anxiety or depression.
And it can manifest physically in so many ways-as headaches, as weight loss, insomnia, joint pain, aches.”
But, Karlekar added, “Historically, women tend to be more social and more willing to talk about these things.
In addition, if you’ve been the main caregiver leading up to your loss, you’ve probably already been more secluded than usual, even before.
So you may not know how to ask, or who to ask, for help. And typically that’s even more of an issue for men.”
For those who are concerned about the health and welfare of survivors, it can be helpful to embrace “the guiding principle that palliative care is based upon, which is valuing the person,” she advised.
“Siblings, friends, people from your church community: we all have to pay attention to those who are grieving.
I have a patient who died, suddenly, at the age of 78, after falling down the stairs. The family wasn’t expecting it,” Karlekar said.
“But I was able to meet with the family, have conversations. And the widow is doing really well now, because she has a family, a community of people who are there and who are able to check in on her. It’s so important. Community matters.”
More information:
Alexandros Katsiferis et al, Sex differences in health care expenditures and mortality after spousal bereavement: A register-based Danish cohort study, PLOS ONE (2023). DOI: 10.1371/journal.pone.0282892
Originally published at https://medicalxpress.com.
ORIGINAL PUBLICATION
Sex differences in health care expenditures and mortality after spousal bereavement: A register-based Danish cohort study
PLOS ONE
Alexandros Katsiferis ,Samir Bhatt,Laust Hvas Mortensen,Swapnil Mishra,Rudi G. J. Westendorp
March 22, 2023
ABSTRACT
Background
- Spousal bereavement is a life event that affects older people differently.
We investigated the impact of spousal bereavement on medical expenditures and mortality in the general population, emphasizing on age and sex.
Methods
- Data are from a population-based, retrospective cohort study following 924,958 Danish citizens over the age of 65 years, within 2011–2016.
- Changes in health care expenditures in those who suffer bereavement were compared with time matched changes among those who did not.
- Mortality hazards were analysed with time to event analysis.
Results
- A total of 77,722 (~8.4%) individuals experienced bereavement, 65.8% being females.
- Among males, bereavement was associated with increase of expenditures the year after, that was 42 Euros per week (95% CI, 36 to 48) larger than the non-bereaved group.
- The corresponding increase for females was 35 Euros per week (95% CI, 30 to 40).
The increase of mortality hazards was highest in the first year after bereavement, higher in males than females, in young old and almost absent in the oldest old.
- Compared with the reference, mortality the year after spousal loss was 70% higher (HR 1.70 [95% CI 1.40 to 2.08]) for males aged 65–69 years and remained elevated for a period of six years.
- Mortality for females aged 65–69 years was 27% higher in the first year (HR 1.27, [1.07 to 1.52]), normalizing thereafter.
Conclusion
Bereavement affects older people differently with younger males being most frail with limited recovery potential.
Introduction [excerpt from the paper]
Major life events such as bereavement are stressors that effect individual’s behavior, well-being, and health [1].
The ability of individuals to maintain function when perturbed by these types of stressors is defined as resilience [2].
In medicine the term is of particular interest since it allows to predict whether a patient can withstand future health-shocks and or the accompanying interventions.
The need for tools that measure and provide insights regarding resilience in older adults is thus one of the top priorities in the field of aging [3–9].
The process of ageing inevitably comes with incremental damage to molecules, tissues and organs which makes people increasingly vulnerable to stressors, a process named frailty, describing the body’s inability to maintain homeostasis and efficiently regulate all those physiological, systemic variables which account for their respective recovery potential [10].
However, resilience, also referred to adaptive capacity or recovery potential, is a heterogeneous phenomenon, given the fact that every individual is exposed to a unique series of stressors over their life span [11].
It is also a dynamic trait interacting with age and gender as the ageing process affecting the two sexes differently [12].
Spousal bereavement, i.e., death of a spouse, is a major life event linked with various mental, physical, and behavioral complications and also associated with increased hospitalization and mortality hazard [13–17], known as the ‘widowhood effect’ [18].
Importantly, the effect of bereavement on mortality appears to be modified by age and sex, and time since the spouse passed away [19–24].
The socioeconomic status of individuals, the amount of (in)formal care, as well as the pre-existing medical condition are factors that influence the widowhood effect and provide targets for intervention, especially for older adults [22, 23].
The changes in health care use of spousal bereaved individuals have also been studied, indicating a sex and age effect.
However, data on health care use were limited to medications and primary care annual visits, thus not considering the use of home and residential care, the latter being highly pertinent for older adults [25].
In general, spousal loss may be associated with a variety of different health related complications preceding bereavement and these parallel changes have been poorly studied.
We investigated and compared the health status of bereaved individuals both before and after spousal loss with non-bereaved ones using overall health care expenditures derived from unique longitudinal, Danish national registries.
The rationale behind using these expenditures is that they serve as a quantitative indicator or proxy of a person’s health status [26].
The changes in health expenditures were then related with patterns of all-cause mortality in an attempt to detect sex differences and age differentials in the consequences of bereavement.
Originally published at https://journals.plos.org/
