Spousal bereavement, mortality and risk of negative health outcomes among
older adults: a population-based study
Authors: Morin Lucas , Wastesson Jonas W. , Fors Stefan , Agahi Neda , Johnell Kristina 
Published: April 2020

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 self-harm
(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.

What is already known

Bereavement is associated with an excess risk of
mortality in the surviving spouses.

There is some evidence that spousal loss is also
associated with acute cardiovascular events.

Previous studies have often focused on young and
relatively healthy groups of people, although bereavement of
a spouse typically occurs as we reach older ages.

What this study adds

Spousal bereavement comes with a rapid and substantial
increase in mortality, acute cardiovascular events, hip
fracture, pneumonia, self-harm, non-elective hospitalisation
and nursing home admission.

The excess risk of negative health events observed
already during the months before spousal loss indicates the
influence of an ‘anticipatory effect’.

Although sudden spousal deaths expose surviving partners
to especially high excess mortality, longer and more
predictable illness trajectories do not shield spouses from
the adverse health consequences of bereavement.

Implications for clinical practice and health
policy

Bereavement support should be offered without delay to
mitigate short-term hazards and then maintained over a
sufficiently long period of time.

Such support should be provided not only to recently
bereaved individuals, but also to the spouses of seriously
ill older people with poor 6-month prognosis.

Palliative care services could have an important role in
providing bereavement support to older adults.