Understanding the Abrupt Effect of Spousal Bereavement on Mortality: an Application of Complex Dynamic Systems Theory

BackgroundThe process of aging renders older people susceptible for adverse outcomes upon stress. Various indicators derived from complex systems theory have been proposed for quantifying resilience in living organisms, including humans. We investigated the ability of system-based indicators in capturing the dynamics of resilience in humans who suffer the adversity of spousal bereavement and tested their predictive power in mortality as a finite health transition.MethodsUsing longitudinal register data on weekly healthcare consumption of all Danish citizens over the age of 65 from January 1st, 2011, throughout December 31st, 2016, we performed statistical comparisons of the indicators ‘average’, ‘slope’, ‘mean squared error’, and ‘lag-1 autocorrelation’ one year before and after spousal bereavement, stratified for age and sex. The relation between levels of these indicators before bereavement and mortality hazards thereafter was determined by time to event analysis and the added value for mortality prediction was estimated by the time dependent area under the receiver operating characteristic curve.ResultsThe study included 934,003 citizens of whom 51,890 experienced spousal bereavement and 2862 died in the first year thereafter. Values of all dynamic indicators were significantly higher with increasing age, in men compared to women, and except lag-1 autocorrelation, higher in the year after bereavement (all p-values < 0.001). All dynamic indicators before bereavement were positively related with mortality hazards thereafter (all p-values < 0.001). The area under the curve of the final model to predict mortality, including all relevant indicators, was 77.7% for males and it was 81.8% for females.ConclusionsIt is concluded that healthcare consumption is increased, more volatile and accelerating with aging and in men compared to women. High values of these dynamic indicators before bereavement indicate loss of resilience as manifested by their predictive value to predict mortality when mourning after spousal loss.

Psychological Adjustment to Spousal Bereavement in Older Adults: A Systematic Review

Research articles examining psychological adjustment to spousal bereavement in older adults (65+) were identified through searches on five electronical databases alongside forward citation and reference list searches. A total of 15 articles involving 686 unique participants were identified. Five characteristics were discovered which can facilitate and inhibit psychological adjustment to spousal bereavement in older adults: the pre-loss spousal relationship, social support, finding meaning and spirituality in loss, the surviving spouse’s personality traits, and death characteristics. These findings support that concepts of ‘meaning making’ and social support should be incorporated into therapeutic work with bereaved spouses to help facilitate psychological adjustment.

The Complexity of Military Bereavement in Gender Regime: Experiences of Turkish Martyr Spouses

This feminist qualitative study investigates spousal bereavement experiences of Turkish martyr spouses within the context of gender regime, based on semi-structured interviews with 21 martyr spouses. From on the thematic analysis of these interviews, this study demonstrates that (1) the spousal bereavement process was complicated conjointly by traumatic and military context as well as martyrdom, (2) this complexity created conditions requiring struggle, and (3) coping resources were available to deal with this complexity. Further, it presents “how the Turkish gender regime affected the spousal bereavement process of martyr spouses.” This study finds that martyr spouses’ steps toward back to normal life, namely recovery after loss, were not supported or acknowledged by society. The authors propose the concept of “disenfranchised recovery” to explain this situation, based on concept of disenfranchised grief.

Matters of the Heart: Grief, Morbidity, and Mortality

Spousal bereavement is associated with elevated risk of morbidity and mortality. Several well-regarded multidisciplinary research teams have investigated the biopsychosocial processes underlying why widows and widowers are at elevated physical-health risk. Here, we review research from multiple investigators showing that, on average, widows and widowers exhibit maladaptive patterns of autonomic, neuroendocrine, and immune activity compared with matched comparison subjects. Widows and widowers also exhibit poorer health behaviors than they did before their spouse’s death, and the considerable variation in postloss psychological-adjustment trajectories among widows and widowers likely corresponds to physical-health risk trajectories. Yet there is little biobehavioral research on patterns of change in physical-health risk after the death of a spouse. We summarize recently published work demonstrating how attachment theory can characterize and predict individual differences in physical-health biomarkers, highlighting the need for a biopsychosocial approach to understanding and characterizing postloss trajectory patterns. We conclude by discussing the possibility that this line of inquiry could help researchers, and ultimately providers, identify adjustment trajectories earlier and thus deliver appropriate interventions when they are most needed.

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

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.