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

Lucas Morin; Jonas W Wastesson; Stefan Fors; Neda Agahi; Kristina Johnell

The copyright holder for this preprint . https://doi.org/10. 1101 /2020 presence of residual confounding. Another limitation is that the categorization of end-of-life illness trajectories of the deceased spouses is both an over-simplification of the actual trajectory of functional decline that these persons followed and an imperfect proxy for the burden of caregiving that the surviving spouses experienced during the final months and weeks before spousal loss. In the selfcontrolled cohort crossover design, we were unable to conduct subgroup analyses by illness trajectories due to a very low number of events during each hazard period for most outcomes. Moreover, outcomes were limited to serious health events related to somatic conditions. Although we recognize that endpoints related to the development of chronic diseases, quality of life, or mental health are very important to bereaved older adults and highly relevant for clinicians and policy makers, the lack of sufficiently detailed data from primary care practitioners and the risk of detection bias (whereby bereaved individuals would, for instance, be more likely to be reported as having depressive symptoms and worse quality of life) prevented us from including these aspects in the present study. Finally, we were unable to investigate the long-term health consequences of spousal bereavement.