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 third major conclusion is that the detrimental effects of bereavement on the surviving spouses' health vary substantially according to the illness trajectory of the deceased. Earlier work has shown that the negative health effects of bereavement varied according to the cause of death of the deceased spouse, but most of these studies used the cause of spousal loss as a way to test for selection bias 56 or to separate expected from unexpected deaths. 57,58 To our knowledge, this is the first large cohort study that has examined the impact of bereavement across different and clinically meaningful illness trajectories. We found that the excess risk of mortality was highest among bereaved older adults whose spouse died suddenly and lowest among those whose spouse died after a trajectory of prolonged dwindling (often marked by the progression of dementia or other neurodegenerative diseases). However, the latter still experience substantially higher rates of death, acute cardiovascular events, hip fractures and self-harm than their married counterparts. In that respect, our findings contrast with the conclusion by Elwert and colleagues that the spouses of people who died from Alzheimer's disease or Parkinson's disease remained unaffected by the widowhood effect. 59 We also observed that bereaved older adults whose spouse died from organ failure experienced a particularly high excess risk of acute cardiovascular events and self-harm, and those whose spouse died from cancer had the highest excess risk of pneumonia after bereavement. Thus, although sudden spousal deaths expose surviving partners to especially high excess mortality, our findings suggest that longer and more predictable illness trajectories do not shield survivors from the adverse health consequences of bereavement. 60