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Strand BH, Håberg AK, Eyjólfsdóttir HS, Kok A, Skirbekk V, Huxhold O, Løset GK, Lennartsson C, Schirmer H, Herlofson K, Veenstra M. Spousal bereavement and its effects on later life physical and cognitive capability: the Tromsø study. GeroScience 2024:10.1007/s11357-024-01150-y. [PMID: 38594472 DOI: 10.1007/s11357-024-01150-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 03/31/2024] [Indexed: 04/11/2024] Open
Abstract
Spousal bereavement is associated with health declines and increased mortality risk, but its specific impact on physical and cognitive capabilities is less studied. A historical cohort study design was applied including married Tromsø study participants (N=5739) aged 50-70 years with baseline self-reported overall health and health-related factors and measured capability (grip strength, finger tapping, digit symbol coding, and short-term recall) at follow-up. Participants had data from Tromsø4 (1994-1995) and Tromsø5 (2001), or Tromsø6 (2007-2008) and Tromsø7 (2015-2016). Propensity score matching, adjusted for baseline confounders (and baseline capability in a subset), was used to investigate whether spousal bereavement was associated with poorer subsequent capability. Spousal bereavement occurred for 6.2% on average 3.7 years (SD 2.0) before the capability assessment. There were no significant bereavement effects on subsequent grip strength, immediate recall, or finger-tapping speed. Without adjustment for baseline digit symbol coding test performance, there was a negative significant effect on the digit symbol coding test (ATT -1.33; 95% confidence interval -2.57, -0.10), but when baseline digit symbol coding test performance was taken into account in a smaller subsample, using the same set of matching confounders, there was no longer any association (in the subsample ATT changed from -1.29 (95% CI -3.38, 0.80) to -0.04 (95% CI -1.83, 1.75). The results in our study suggest that spousal bereavement does not have long-term effects on the intrinsic capacity components physical or cognition capability to a notable degree.
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Affiliation(s)
- Bjørn Heine Strand
- Department for Physical Health and Aging, Norwegian Institute of Public Health, Oslo, Norway.
- Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway.
| | - Asta K Håberg
- Department for Physical Health and Aging, Norwegian Institute of Public Health, Oslo, Norway
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU, Trondheim, Norway
| | - Harpa Sif Eyjólfsdóttir
- Aging Research Center (ARC), Karolinska Institutet, Stockholm, Sweden
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
- Stockholm University, Stockholm, Sweden
| | - Almar Kok
- Department of Epidemiology & Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Aging & Later Life Programme, Amsterdam, The Netherlands
| | - Vegard Skirbekk
- Department for Physical Health and Aging, Norwegian Institute of Public Health, Oslo, Norway
- Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | | | - Gøril Kvamme Løset
- NOVA - Norwegian Social Research, Oslo Metropolitan University, Oslo, Norway
| | - Carin Lennartsson
- Aging Research Center (ARC), Karolinska Institutet, Stockholm, Sweden
- Swedish Institute for Social Research (SOFI), Stockholm University, Stockholm, Sweden
| | - Henrik Schirmer
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
- Department of Cardiology, Akershus, University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Katharina Herlofson
- NOVA - Norwegian Social Research, Oslo Metropolitan University, Oslo, Norway
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Boerner K, Stokes J, Jansen T. Widowhood and bereavement in late life. Curr Opin Psychol 2024; 55:101748. [PMID: 38071788 DOI: 10.1016/j.copsyc.2023.101748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/25/2023] [Accepted: 11/13/2023] [Indexed: 01/28/2024]
Abstract
Bereavement is a common and often challenging experience in late life. Evidence shows that while many older adults manage to adjust well and demonstrate resilience in response to the death of a close person, bereavement puts a substantial minority at risk of adverse mental and physical health impacts including mortality. Current research further indicates that 1) this is the case across different countries and cultures across the globe; 2) that the COVID-19 pandemic posed unprecedented challenges for coping with late-life bereavement; 3) that loneliness and social isolation among bereaved older adults tend to be prevalent and harmful, particularly under pandemic but also in nonpandemic circumstances; and, recently, 4) that bereavement may be a risk factor for cognitive decline in this population.
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Affiliation(s)
- Kathrin Boerner
- Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Ammerländer Heerstraße 140, 26129 Oldenburg, Germany; Department of Gerontology, University of Massachusetts Boston, 100 Morrissey Blvd., Boston, MA 02125, USA.
| | - Jeffrey Stokes
- Department of Gerontology, University of Massachusetts Boston, 100 Morrissey Blvd., Boston, MA 02125, USA
| | - Taylor Jansen
- Department of Gerontology, University of Massachusetts Boston, 100 Morrissey Blvd., Boston, MA 02125, USA
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Lyew T, Kazan J, Patel K, Croswell E, Minhaj S, Lopaczynski A, Neagoe I, Stahl ST. Incorporating technology in research with older bereaved adults: Lessons learned from conducting an internet-based randomized controlled trial. Internet Interv 2023; 34:100645. [PMID: 38099093 PMCID: PMC10719521 DOI: 10.1016/j.invent.2023.100645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 06/27/2023] [Accepted: 07/07/2023] [Indexed: 12/17/2023] Open
Abstract
Objective Digital health interventions (DHI) involve multiple interactions between the user, technology platform, and study team, posing challenges for implementation. This paper describes the lessons learned while implementing an internet-based randomized controlled trial (RCT) for reducing depression symptom burden in older acutely-bereaved adults. Methods The RCT was entitled "Widowed Elders' Lifestyle after Loss" (or WELL), which compared the efficacy of a DHI to an enhanced usual care (EUC) for reducing depression symptoms in adults 60+ years who lost their spouse/life partner within the previous 12 months. Participants randomized to the DHI used their own tablet, smartphone, or pc to record the timing and regularity of sleep, meals, and physical activity twice daily, for 12 weeks. The also received weekly health coaching sessions from a clinician certified in motivational interviewing. Participants randomized to the EUC arm received weekly calls from research staff and were assessed on the same schedule as intervention participants. All study procedures were conducted virtually. Methodological and procedural challenges were discussed weekly with study staff and the primary investigator. Results Many challenges can be categorized as follows recruiting virtually, obtaining informed consent, training older adults to use technology, and establishing rapport with older adults. Solutions required researcher and interventionist flexibility in adapting to new strategies. For instance, we redesigned the informed consent process to include a user-friendly brochure that enhanced participants' understanding of the RCT and improved our enrollment rate. We also utilized user-engagement in refining an intervention protocol. Conclusion We resolved implementation challenges without compromising internal validity via interdisciplinary collaborations with mobile programmers to ensure our technology met the unique and varied needs of aging users. The solutions from this study may promote the recruitment and retainment of older adults in research studies that use technology-based interventions.
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Affiliation(s)
- Thandi Lyew
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, PA, USA
| | - Joseph Kazan
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Khusbu Patel
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Emilee Croswell
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Sejuty Minhaj
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Ioana Neagoe
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Sarah T. Stahl
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
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Zhang Q, Liu Z, Qian H, Hu Y, Gao X. Interpersonal Competition in Elderly Couples: A Functional Near-Infrared Spectroscopy Hyperscanning Study. Brain Sci 2023; 13:brainsci13040600. [PMID: 37190565 DOI: 10.3390/brainsci13040600] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/14/2023] [Accepted: 03/29/2023] [Indexed: 04/05/2023] Open
Abstract
Elderly people tend not to compete with others, and if they do, the mechanism behind the competition is not clear. In this study, groups of elderly couples and matched cross-sex controls were recruited to perform a competitive button-pressing task, while their brain signals were simultaneously collected using functional near-infrared spectroscopy (fNIRS) hyperscanning. Several fundamental observations were made. First, controls showed attenuated interpersonal competition across task processes, but couples held the competition with each other. Second, couples demonstrated increased inter-brain synchronization (IBS) between the middle temporal cortex and the temporoparietal junction across task processes. Third, Granger causality analysis in couples revealed significant differences between the directions (i.e., from men to women, and from women to men) in the first half of the competitive task, whereas there was no significant difference in the second half. Finally, the groups of couples and controls could be successfully discriminated against based on IBS by using a machine-learning approach. In sum, these findings indicate that elderly couples can maintain interpersonal competition, and such maintenance might be associated with changes in the IBS of the mentalizing system. It suggests the possible positive impact of long-term spouse relationships on interpersonal interactions, both behaviorally and neurally, in terms of competition.
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Affiliation(s)
- Qian Zhang
- Department of Psychology, Education College, Shanghai Normal University, Shanghai 200234, China
| | - Zhennan Liu
- Department of Psychology, Education College, Shanghai Normal University, Shanghai 200234, China
| | - Haoyue Qian
- Institute of Neuroscience, Key Laboratory of Primate Neurobiology, CAS Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences, Shanghai 200031, China
- Shanghai Institute of Early Childhood Education, Shanghai Normal University, Shanghai 200234, China
| | - Yinying Hu
- Department of Psychology, Education College, Shanghai Normal University, Shanghai 200234, China
| | - Xiangping Gao
- Department of Psychology, Education College, Shanghai Normal University, Shanghai 200234, China
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Jain U, Liu H, Langa KM, Farron M, Kabeto M, Lee J. Widowhood and cognition among older women in India: New insights on widowhood duration and mediators. SSM Popul Health 2022; 19:101242. [PMID: 36193099 PMCID: PMC9525895 DOI: 10.1016/j.ssmph.2022.101242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 09/22/2022] [Accepted: 09/25/2022] [Indexed: 01/10/2023] Open
Abstract
Background Widowhood, a marital status that disproportionately affects older women, has been associated with poorer health compared to married individuals. However, relatively little is known about the association between widowhood in later-life and cognitive health in low- and middle-income countries. Methods To address this research gap, we used data from the Longitudinal Aging Study in India (2017-19) to investigate the widowhood disparity in cognitive health among mid-aged and older women in India, including how this relationship varies by the duration of widowhood. We further examined the extent to which economic, social, and health conditions mediate this association. Results Cognition scores for widowed women were on average lower by almost 0.1 standard deviations compared to married women. Overall, this disparity increased with widowhood duration, with non-linearities in this association. The disparity in cognition scores increased with widowhood duration up to twenty years but did not increase further among those with longer widowhood duration. Worse physical and mental health were found to mediate almost thirty percent of the total association between widowhood and cognition. These mediators were most useful in explaining the association between lower cognition and widowhood among women who experienced widowhood for ten years or longer. Conclusion The study highlights the significant disadvantage in cognitive functioning among older widowed women in India. The study also provides evidence on potential mediators, suggesting differential effects of mediators at different stages of widowhood.
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Affiliation(s)
- Urvashi Jain
- Department of Economics, Finance and Real Estate, Mitchell College of Business, University of South Alabama, USA
| | - Hui Liu
- Department of Sociology, Michigan State University, USA
| | - Kenneth M. Langa
- Department of Internal Medicine, Institute for Social Research, and VA Center for Clinical Management Research, University of Michigan, USA
| | - Madeline Farron
- Department of Internal Medicine, University of Michigan, USA
| | - Mohammed Kabeto
- Department of Internal Medicine, University of Michigan, USA
| | - Jinkook Lee
- Center for Economic and Social Research, and Department of Economics, University of Southern California, USA
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Bi T, Kou H, Kong Y, Shao B. Widowhood Impairs Emotional Cognition Among Elderly. Front Aging Neurosci 2022; 13:808885. [PMID: 35173602 PMCID: PMC8841410 DOI: 10.3389/fnagi.2021.808885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 12/31/2021] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe negative impacts of spousal bereavement on the emotional health of the elderly (e.g., depression and anxiety) have been revealed. However, whether widowhood impairs emotional cognition among the elderly is less known. The purpose of this study is to reveal the emotional cognitive deficits among the widowed elderly.MethodsIn this study, we recruited 44 widowed elderly (WE) and 44 elder couples (non-widowed elderly, NWE) and examined their emotional cognition including attention and visual working memory, which were measured by the visual search task and delayed-match-to-sample task, respectively. Three kinds of emotional faces (i.e., sad, angry, and happy) were adopted as the attentional or mnemonic targets.ResultsIt revealed that WE had a general deficit in search efficiency across emotional types, while they showed mnemonic deficits in negative faces but not positive faces. Furthermore, the modeling analysis revealed that the level of depression or state anxiety of the elderly moderated the effects of widowhood on the deficits of mnemonic processing, i.e., the deficits were only evident among WE with the high level of depression or state anxiety.ConclusionThese findings reveal the attentional deficits in sad, angry, and happy faces and the mnemonic deficits in sad and angry faces among elderly who suffer from widowhood and point out the important role of emotional problems such as depression and state anxiety in modulating these emotional cognitive deficits.
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Zhao Y, Inder B, Kim JS. Spousal bereavement and the cognitive health of older adults in the US: New insights on channels, single items, and subjective evidence. ECONOMICS AND HUMAN BIOLOGY 2021; 43:101055. [PMID: 34530393 DOI: 10.1016/j.ehb.2021.101055] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 07/13/2021] [Accepted: 08/16/2021] [Indexed: 06/13/2023]
Abstract
This study provides novel insights into older adults' cognitive functioning before and after widowhood onset and possible effect channels. It further examines gender heterogeneity in the adaptation to (anticipated or actual) spousal bereavement, comparing objective evidence with subjective evidence of cognitive abilities. We used longitudinal data of up to 26,584 participants of the Health and Retirement Study, aged over 50 at recruitment, assessed biennially between 1998 and 2016. Two-way fixed effects with dynamic treatment effects were estimated for various cognitive measures, including six aggregated indices and six single item scales. After adjusting for effect channels including depression, social vulnerability, and stress, there remained significant widowhood effects on older adults' cognitive health. Using single item scales, we established the adverse contemporaneous and adaptation effects on bereaved older females' short-term memory, semantic memory, and numeracy. For bereaved older males, working memory and focus-of-attention deteriorated after widowhood onset. Meanwhile, subjective memory rating remained intact, contrary to objective evidence. We conclude that cognitive transitions to and from widowhood can exhibit distinctive patterns across objective and subjective cognitive domains. With the effect channels in mind, cognitive intervention for widowed older adults should be tailored to the temporal distance to spousal loss, gender, and task.
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Affiliation(s)
- Yuejun Zhao
- Department of Economics, University of Gothenburg, Sweden.
| | - Brett Inder
- Department of Econometrics and Business Statistics, Monash University, Australia.
| | - Jun Sung Kim
- Department of Economics, College of Politics and Economics, Kyung Hee University, Korea.
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Srivastava P, Trinh TA. The effect of parental smoking on children's cognitive and non-cognitive skills. ECONOMICS AND HUMAN BIOLOGY 2021; 41:100978. [PMID: 33610090 DOI: 10.1016/j.ehb.2021.100978] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 12/03/2020] [Accepted: 01/04/2021] [Indexed: 06/12/2023]
Abstract
Economic research emphasises the importance of cognitive and non-cognitive skills in children for long-term labour market, health and social outcomes. In contrast to previous studies that focus on the effects of maternal smoking during pregnancy, we contribute to the literature by examining whether parental current smoking impacts on children's cognitive and non-cognitive development. We exploit data from the Longitudinal Study of Australian Children and address potential endogeneity and self-selectivity bias using robust estimation methods. Overall, we find evidence that parental smoking results in worse development outcomes in children. Specifically, our fixed-effects estimates indicate that children living with parents who are smokers exhibit lower cognitive outcomes ranging between 0.09 and 0.17 standard deviation, while the impacts on non-cognitive outcomes range between 0.06 and 0.80 standard deviation. We also provide insights on some of the mechanisms of transmission. Our findings suggest that campaigns, programs and policies that reduce tobacco consumption may have positive externalities in terms of improving children's cognitive and non-cognitive development, and long-term labour market outcomes.
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Affiliation(s)
- Preety Srivastava
- School of Economics, Finance and Marketing, RMIT University, Melbourne, VIC, 3000, Australia.
| | - Trong-Anh Trinh
- School of Economics, Finance and Marketing, RMIT University, Melbourne, VIC, 3000, Australia.
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Lim-Soh JW. Social participation in widowhood: Evidence from a 12-year panel. J Gerontol B Psychol Sci Soc Sci 2021; 77:972-982. [PMID: 33914062 DOI: 10.1093/geronb/gbab072] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Social participation is important to the quality of life of older adults, especially widows. This is the first study to test whether older widows' formal and informal social participation rises or declines using multiple panel observations pre- and post-bereavement. The paper also tests the moderating effects of economic and marital satisfaction, depression, and husband's illness before death on these trends. METHODS Seven waves of the Korean Longitudinal Study of Ageing are used to track changes in four measures of social participation - meeting and contacting a child, meeting friends, and attending a formal group. A comparison group of married individuals, weighted with coarsened exact matching, controls for age and time trends. Mixed model regressions estimate the effects of widowhood over time. RESULTS Social participation shows little change before bereavement and rises significantly after bereavement for all measures. However, frequencies of meeting and contacting a child peak and decline early post-bereavement, while meeting friends and attending a group show delayed but long-lasting effects. Moderators economic and marital satisfaction are positively associated with overall social participation levels, but negatively associated with social participation post-bereavement. DISCUSSION Increased social participation after bereavement underscores the resilience of widows and the social support they receive. However, differences in timing suggest that contact with children is gradually substituted with extra-familial relationships in the long run. The negative moderating roles of economic and marital satisfaction point to a paradox where seemingly well-off individuals may be more vulnerable to widowhood.
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Affiliation(s)
- Jeremy W Lim-Soh
- Lee Kuan Yew School of Public Policy, National University of Singapore
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