Death following partner bereavement: A self-controlled case series analysis

King, Michael; Lodwick, Rebecca; Jones, Rebecca; Whitaker, Heather; Petersen, Irene

doi:10.1371/journal.pone.0173870

Cited by 13 publications

(8 citation statements)

References 22 publications

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“…Finally, in contrast with prior work which generally has found an increased risk of mortality following spousal bereavement, we find a significant protective association of being widowed over follow-up (King, Lodwick, Jones, Whitaker, & Petersen, 2017; Prior et al, 2017). This finding may be an artifact of confounding by caregiver status (53% of dementia caregivers were widowed relative to 15% of noncaregivers) or study design.…”

Section: Discussioncontrasting

confidence: 99%

Till Death Do Us Part: Intersecting Health and Spousal Dementia Caregiving on Caregiver Mortality

2019

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Objective: We consider whether it is the healthiest dementia caregivers who experience a mortality benefit and whether a protective association is consistent for leading causes of mortality. Method: Using the Health and Retirement study (2000-2012), Cox survival models predict time to death for dementia caregivers, including an interaction between dementia caregiver status and self-rated health. The nationally representative sample consisted of 10,650 married adults aged 51 or older (917 dementia caregivers). Results: A significant interaction between dementia caregiver status and self-rated health suggested that relative to noncaregivers, dementia caregivers had reduced mortality, with this effect particularly strong at lower levels of self-rated health. The protective effect of dementia caregiver status was consistent across death by heart disease, cancer, and cerebrovascular disease. Discussion: These findings add to a growing body of literature suggesting that caregiving may provide a mortality benefit and a reason to maintain health.

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Section: Discussioncontrasting

confidence: 99%

Till Death Do Us Part: Intersecting Health and Spousal Dementia Caregiving on Caregiver Mortality

2019

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“…[28][29][30][31] King and colleagues recently conducted a selfcontrolled case series analysis to examine the mortality risk after the loss of a partner compared with before. 32 However, since it can be argued that the experience of bereavement is not a transient exposure clearly defined in time, these methods can yield biased estimates. 33 Instead, we used a cohort crossover design combining the self-controlled and the cohort approaches to measure the within-individual change in the risk of experiencing adverse health outcomes before and after spousal loss.…”

Section: Self-controlled Cohort Crossover Studymentioning

confidence: 99%

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

Morin

Wastesson

Fors

et al. 2020

Preprint

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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 selfharm (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.

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“…Complicated grief (CG) or Prolonged Grief Disorder (PGD) is a mental health condition involving a pervasive grief response that persists for more than six months following a loss (3). Patients experiencing severe grief responses may benefit from health care support and onward referral for targeted treatment (4)(5)(6)(7).…”

Section: Introductionmentioning

confidence: 99%

“…3 Patients experiencing severe grief responses may benefit from healthcare support and onward referral for targeted treatment. 4 – 7 …”

Section: Introductionmentioning

confidence: 99%

Supporting bereavement and complicated grief in primary care: a realist review

et al. 2021

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BackgroundBereavement can have significant impacts on physical and mental health, and a minority of people experience complicated and prolonged grief responses. Primary care is ideally situated to offer bereavement care, yet UK provision remains variable and practitioners feel uncertain how best to support bereaved patients.AimTo identify what works, how, and for whom, in the management of complicated grief in primary care.Design & settingA review of evidence on the management of complicated grief and bereavement in UK primary care settings.MethodA realist approach was taken which aims to provide causal explanations through the generation and articulation of contexts, mechanisms, and outcomes.ResultsForty-two articles were included. Evidence on the primary care management of complicated or prolonged grief was limited. GPs and nurses view bereavement support as part of their role, yet experience uncertainty over the appropriate extent of their involvement. Patients and clinicians often have differing views on the role of primary care in bereavement. Training in bereavement, local systems for reporting deaths, practitioner time and resources can assist or hinder bereavement care provision. Practitioners find bereavement care can be emotionally challenging. Understanding patients’ needs can encourage a proactive response and help identify appropriate support.ConclusionBereavement care in primary care remains variable and practitioners feel unprepared to provide appropriate bereavement care. Patients at higher risk of complicated or prolonged grief may fail to receive the support they need from primary care. Further research is required to address the potential unmet needs of bereaved patients.

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Death following partner bereavement: A self-controlled case series analysis

Cited by 13 publications

References 22 publications

Till Death Do Us Part: Intersecting Health and Spousal Dementia Caregiving on Caregiver Mortality

Till Death Do Us Part: Intersecting Health and Spousal Dementia Caregiving on Caregiver Mortality

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

Supporting bereavement and complicated grief in primary care: a realist review

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