Spousal Risk of Death Linked to Partner's Hospitalization

A new study shows that spouses have a higher risk of death when their partners are hospitalized during a given year. That risk increases when their partners are suffering from severely mentally or physically disabling conditions such as dementia or a psychiatric illness.

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This morning's health report exams what some people call dying of a broken heart. It's the idea that when one spouse dies, a partner is at higher risk of dying soon after. A major study explored that phenomenon, and it adds a new dimension. It's not just a loved one's death, but also a loved one's illness that can put a partner at risk. NPR's Joseph Shapiro has more.

JOSEPH SHAPIRO reporting:

Renee Dunham's(ph) mother died in the spring. Her father died the following spring, just a year later.

Ms. RENEE DUNHAM: My mom died in 2000. My dad died in 2001. Mom was 91, and Dad was 92.

SHAPIRO: Dunham's mother had dementia. Her father cared for her for several years, until she moved to a place set up for people with dementia.

Ms. DUNHAM: It was clearly breaking his heart and exhausting him to attend to all the detail that he had to attend to with mother. But he did it heartfully. I mean, they were very close.

SHAPIRO: Scientists talk about the bereavement effect, or the widower effect. Dr. Nicholas Christakis is a specialist in end of life care at Harvard Medical School.

DR. NICHOLAS CHRISTAKIS: (Specialist in End of Life Care, Harvard Medical School): We know that if my partner, if my spouse dies, I'm more likely to die myself.

SHAPIRO: Christakis says, scientists have measured that for at least 150 years.

Dr. CHRISTAKIS: The first published paper was by, I think he was a recorder of vital statistics in England, the last name was Farr, F-a-r-r.

SHAPIRO: William Farr is considered one of the founders of medical statistics. In 1858, he published a paper that looked at death rates among widows.

Dr. CHRISTAKIS: And Mr. Farr noticed this phenomenon, whereby the mortality rate in widowers was higher than the mortality rate in those who were married.

SHAPIRO: Now, Dr. Christakis has taken those calculations a lot farther. Christakis used computers, of course, instead of ink and a blotter. He looked a the Medicare records for more than a half million elderly couples. He, too, found that the death of a spouse puts a partner at a higher risk of death.

But Christakis was particular interested in something else. He wanted to know if a spouse's illness, not just death, put a partner at risk, too.

Dr. CHRISTAKIS: What we didn't know, at least not clearly, was the extent to which illness in my spouse, quite apart from death in my spouse, increases my risk of death. And the answer is that it does. Illness has a separate effect than death does on me.

SHAPIRO: Christakis looked at when a sick spouse was first hospitalized, then he looked to see if that person's partner died. Among men, seven percent died within a year after a wife was hospitalized for a stroke. Almost nine percent of men died within a year after a wife was hospitalized for dementia. For women, the numbers were smaller, but for men and women, Christakis found that the risk of death was higher, depending on the illness of the spouse.

Dr. CHRISTAKIS: Diseases that we found that are particularly bad for partners are dementia, psychiatric disease, congestive heart failure, hip fracture, and lung disease. Those are all very mentally or physically disabling conditions.

SHAPIRO: And ones that may require the spouse to do a lot of care giving. One surprise came when Christakis looked at people with cancer. It was often quickly fatal. But, in general, cancer had a less impact on a care giving spouse than an illness that lingered for many years, like Alzheimer's disease, or a psychiatric illness.

Dr. CHRISTAKIS: So, for example, in the case of women who are married to men who become sick, if the man has a psychiatric disease, or if the man has dementia, it's actually more harmful to the wife than if the man was dead.

SHAPIRO: In other words, a spouse is at greater risk of dying while watching a partner sick with dementia or a psychiatric illness, and then becomes less likely to die once the spouse with one of those conditions dies. One reason may be one that other scientists have studied.

Richard Schultz is a professor of psychiatry at the University of Pittsburgh. He has examined what he calls the relief effect.

Professor RICHARD SCHULTZ (Psychiatry, University of Pittsburgh): It's a relief that the suffering of your loved one has ended. The burdens that you've experienced to provide effective care for that individual has ended. People do better within three months, six months after the death of a loved one. And we see this particularly in situations where a person has been taking care of a dementia patient for a number of years.

SHAPIRO: Renee Dunham's family suggests that watching a spouse get ill and die can be more complicated than what's captured by statistics, that there's no straight line between care giving for a disabled or dying loved one, and then one's own illness or death. Dunham says after her mother died, her father's heart disease flared up; his diabetes, too. He went from using one cane to two, to using a walker, and then he died. But Dunham says it was more than just a period of decline.

Ms. DUNHAM: Dad had a kind of renaissance after mother died. He had a renewed interest in what was going on around him. He was able, I think, with less guilt, to go back to the things that he loved so much. He listened a great deal to classical music, he read, he enjoyed discussions about philosophy and ethics. And he loved walking out of doors, and I think it was a big weight off him. I think he actually was doing better health wise, for a little while.

SHAPIRO: The study on death after the hospitalization of a spouse appears in the New England Journal of Medicine.

Joseph Shapiro, NPR News.

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