Spousal bereavement and four-year trajectories of medication use: A nationwide register-based study in Swedish older adults

BACKGROUND

Medication use around widowhood has been poorly described for most medication classes. Medication use patterns can reflect health consequences of spousal loss, as previously shown for psychotropic drugs.

METHODS

We used data from nationwide health registers (2008-2020) to describe the patterns of use of dispensed medications in all widowed Swedes aged ≥65 years followed between 2 years before and 2 years after spousal death. All prescription drugs used by at least 5% of the cohort were considered according to their therapeutic subgroups (Anatomical Therapeutic Chemical [ATC] classification system 2nd level). We used group-based trajectory models to cluster widowed individuals into up to 4 distinct longitudinal patterns of monthly medication use. We ranked the therapeutic subgroups with similar patterns according to their plausibility to reflect potential health effects of spousal loss, compared to those of psycholeptics (mainly anxiolytics, hypnotics) and psychoanaleptics (mainly antidepressants) as the references.

RESULTS

From 212,111 widowed adults included (68% female and 70% aged ≥75 years), we observed a significant increasing trend in medication use, especially after spousal death, for 21 out of the 39 different therapeutic subgroups that were used by at least 5% (most represented pharmacological groups: cardiovascular system, nervous system, and alimentary tract and metabolism). This increasing trend often concerned only a small proportion of individuals, with varying magnitude and speed of change in medication use across therapeutic subgroups. The patterns of use of antiepileptics, laxatives, skin emollients/protectives, analgesics, and drugs for anemia, constipation, or peptic ulcers, were the closest to those of references, displaying the largest changes in use, and were therefore ranked as the most likely to reflect health effects of spousal loss.

CONCLUSION

Our results confirmed the increase in psychotropic medications' use in widowed older adults and identified several potential physical health effects of spousal loss that warrant further research.

Trajectories of antidepressant use before and after union dissolution and re-partnering in later life: a prospective total population register-based cohort study

BACKGROUND

Grey divorce and later remarriage have become increasingly common in high-income countries, but previous evidence on their impacts on mental health is scarce. Even less is known about the effects of non-marital separation and re-partnering in later life.

METHODS

Using Finnish registry data from 1996 to 2018 on 228 644 individuals aged 50-70 in 2000-2014, trajectories of antidepressant (AD) use 4 years before and 4 years after divorce, non-marital separation, bereavement and subsequent re-partnering were examined using individual fixed-effects (FE) linear probability models.

RESULTS

In adjusted FE models, for both genders AD use increased during the 4 years before divorce (men: 5.00 percentage points (95% CI 4.50 to 5.50); women: 6.96 (95% CI 6.34 to 7.59)), non-marital separation (men: 3.20 (95% CI 2.72 to 3.69); women: 5.98 (95% CI 5.30 to 6.66)) and bereavement (men: 4.53 (95% CI 3.97 to 5.09); women: 5.64 (95% CI 5.25 to 6.04)), with the increase accelerating immediately before the event. AD use gradually declined after union dissolution, after which it stabilised on a persistently higher level compared with pre-dissolution. Re-partnering was only associated with a small and transitory reduction in AD use (0.1-1.5 percentage points). The increases in AD use associated with union dissolution were larger in women than in men, whereas the small reductions in AD use associated with re-partnering were particularly short-lived among women.

CONCLUSIONS

Our results suggest that union dissolution in later life is associated with large and persistent increases in AD use, whereas the reductions associated with re-partnering are limited both in magnitude and duration.

The effect of widowhood on depression of caregivers

BACKGROUND

It is known that caregivers are more likely to be depressed compared to those without caregiving burden. The disappearance of caregiving burden after widowhood may alleviate depression, but at the same time the diminishment of marital resources caused by widowhood may exacerbate depression. So, what effect does widowhood have on depression among caregivers?, which was valuable for promoting the mental health of caregivers in the context of China's aging.

METHODS

China Health and Retirement Longitudinal Study (CHARLS), a longitudinal data, was selected and the effect of widowhood on depression among middle-aged and elderly caregivers was explored by using Ordinary Least Squares and Propensity Score Matching methods based on 2018 CHARLS data. The channels and subgroup difference were also analyzed.

RESULTS

Widowhood significantly increased CES-D scores of caregivers, and there were higher CES-D scores among women, the middle-aged, rural residents, and those with higher levels of education. Widowhood increased depression of caregivers through reducing personal economic resources, and increasing possibilities to live with children and participate in social activities.

CONCLUSIONS

Caregivers who experienced widowhood tend to be depressed and concerted efforts are needed. On the one hand, more social security measures and economic subsidy policy should focus on the middle-aged adults and elderly who experienced widowhood. On the other one hand, it is helpful to relieve depression by providing more social support from society and families to the middle-aged adults and elderly who experienced widowhood.

Does the suddenness matter? Antidepressant use before and after a spouse dies suddenly or expectedly of stroke

Aims: Changes in mental health at the time of widowhood may depend on the expectedness of spousal death, but scant evidence is available for spousal deaths attributable to stroke. Methods: Using register-linkage data for Finland, we assessed changes in antidepressant use before and after spousal death for those whose spouses died suddenly of stroke between 1998 and 2003 (N=1820) and for those whose spouses died expectedly of stroke, with prior hospitalisation for cerebrovascular disease (N=1636). We used both population-averaged logit models and individual fixed-effects linear probability models. The latter models control for unobserved time-invariant heterogeneity between the individuals. Results: Our study indicates that the suddenness of a spouse's death from stroke plays a role in the well-being of the surviving spouse. Increases in antidepressant use appeared larger following widowhood for those whose spouses died suddenly of stroke relative to those whose spouses had a medical history of cerebrovascular disease. Conclusions: The suddenness of a spouse's death from stroke plays a role for the surviving spouse. The results suggest multifaceted timings of distress surrounding spousal death, depending on the suddenness of a spouse's death from stroke.

The Human Rights of Older People With Mental Health Conditions and Psychosocial Disability to a Good Death and Dying Well

The human right to a good death and dying well is as important as the right to life. At stake at the end of life are human rights to dignity, autonomy, self-determination and respect for will and preferences, equitable access to quality health care that is needs-based, and respect for family and relationships. Older people with dementia, those with serious mental illness, and those with intellectual disability are vulnerable to "bad deaths" due to violations of these rights. In this paper we explore why this is so and examine existing and potential solutions. A human rights-approach to end-of-life care and policy for older persons with mental health conditions and psychosocial disability is one that is needs-based, encompassing physical and mental health, palliative care, social, and spiritual support services provided in the context of inclusive living. Most importantly, end of life care must be self-determined, and not "one size fits all." An important remedy to existing violations is to strengthen human rights frameworks to cater specifically to older persons' needs with a UN convention on the rights of older persons. Finally, as health professionals we have important contributions to make at the coalface by accepting our responsibilities in the area of death and dying. With the concept of the palliative psychiatrist gaining traction and recognition that death is our business, we add that human rights is also our business.