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Cornwell B, Qu T. "I Love You to Death": Social Networks and the Widowhood Effect on Mortality. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2024; 65:273-291. [PMID: 37378678 DOI: 10.1177/00221465231175685] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
Research on "the widowhood effect" shows that mortality rates are greater among people who have recently lost a spouse. There are several medical and psychological explanations for this (e.g., "broken heart syndrome") and sociological explanations that focus on spouses' shared social-environmental exposures. We expand on sociological perspectives by arguing that couples' social connections to others play a role in this phenomenon. Using panel data on 1,169 older adults from the National Social Life, Health, and Aging Project, we find that mortality is associated with how well embedded one's spouse is in one's own social network. The widowhood effect is greater among those whose spouses were not well connected to one's other network members. We speculate that the loss of a less highly embedded spouse signals the loss of unique, valuable, nonredundant social resources from one's network. We discuss theoretical interpretations, alternative explanations, limitations, and directions for future research.
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Hossain B, James KS. Widowhood status, morbidity, and mortality in India: evidence from a follow-up survey. J Biosoc Sci 2024; 56:574-589. [PMID: 37881942 DOI: 10.1017/s0021932023000226] [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] [Indexed: 10/27/2023]
Abstract
A known health effect of widowhood is an increased mortality risk among surviving spouses, with gender- and age-specific observations. While morbidity conditions with socio-economic factors may exacerbate the effect of widowhood on mortality, no research has attempted to predict mortality among the widowed over the married population with the presence of morbidity in India. Thus, the present study concurrently examines marital status and health in the Indian setting, bringing substantial empirical evidence to explore the link between marital status, morbidity, and mortality. The study used prospective data from India Human Development Survey (IHDS) wave 1 (2004-2005) and wave 2 (2011-2012). In total, 82,607 individuals aged 25 years and above were considered for the analysis. To present the preliminary findings, descriptive statistics and bivariate analysis were used. Using multivariable logistic regression, the interaction effect of marital status and morbidity status was estimated to predict the likelihood of mortality. Across all socio-economic groups, widowed individuals reporting any morbidity had a higher mortality proportion than married people. Young widowers with any morbidity are more susceptible to increased mortality. Asthma among young widowers and cardiovascular diseases among elderly widowers significantly elevate the probability of mortality. However, older widowed women with diabetes had a lower probability of mortality than older married women with diabetes. The widowers' disadvantage in mortality and morbidity may be attributable to less care-receiving and the greater incidence of unhealthy lifestyle practices during the post-widowhood period, indicating the need for more research.
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Affiliation(s)
- Babul Hossain
- International Institute for Population Sciences (IIPS), Mumbai, India
| | - K S James
- International Institute for Population Sciences (IIPS), Mumbai, India
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3
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Cho H, Kim N, Kim K. The Role of Late-Life Work Among Widowed Adults in Korea: A Buffer or Burden for Widow(er)s' Health? J Appl Gerontol 2024:7334648241249619. [PMID: 38671378 DOI: 10.1177/07334648241249619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024] Open
Abstract
To examine the role of work in the bereavement process, we focused on health changes among widowed adults. We analyzed a sample of 518 adults (aged 52-95) from the Korean Retirement and Income Study (2011-2019) who experienced spousal loss during the study period. The widowed participants provided data on their employment status and perceived health at both pre-loss and post-loss. Widowed participants reported worse physical and mental health after the bereavement, but the significant health deterioration was not observed among employed participants. Adjusting for pre-loss health status and other covariates, employed widow(er)s showed a smaller decrease in physical and mental health, compared to their counterparts. The effect of employment on physical health changes was more pronounced for economically vulnerable widow(er)s. Work might serve as a restoring coping strategy for widowed individuals; economic benefits from the job may also contribute to their health and well-being.
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Affiliation(s)
- Hyeonji Cho
- Department of Child Development and Family Studies, College of Human Ecology, Seoul National University, Seoul, Republic of Korea
| | - Nahyun Kim
- Department of Child Development and Family Studies, College of Human Ecology, Seoul National University, Seoul, Republic of Korea
| | - Kyungmin Kim
- Department of Child Development and Family Studies, College of Human Ecology, Seoul National University, Seoul, Republic of Korea
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Wang SH, Wu H, Hsu LY, Lin MC, Fan CC, Chen PC, Hsu CC, Wu CS. Widowhood and mortality risk in Taiwan: a population-based matched cohort study. Int J Epidemiol 2024; 53:dyae034. [PMID: 38553032 DOI: 10.1093/ije/dyae034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 02/17/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND Studying the causes of death among deceased spouses and surviving partners may provide insights into the underlying mechanisms of the association between widowhood and mortality. This study investigated the mortality risk of widowhood in Taiwan, examined the association of the cause of death between widowed individuals and their deceased spouses and explored potential modifying effects by age, gender and duration after widowhood. METHODS This matched cohort study utilized Taiwan's National Health Insurance claims database and National Death Registry. In total, 204 010 widowed men and 596 136 widowed women were identified with a mean follow-up period of 6.9 and 7.9 years, respectively, and 816 040 comparison men and 2 384 544 comparison women were selected. RESULTS Widowhood was associated with an increased mortality risk, with widowed men having a 1.32 increased risk and widowed women having a 1.27 increased risk. Age at spousal death and duration modified the associations after widowhood. The widowed individuals are more likely to die by the same cause as the deceased spouse if they died by suicide, accident, endocrine, gastrointestinal disorders or infection. CONCLUSIONS The study suggests that healthcare policies and interventions should be developed to improve widowed individuals' health and overall welfare.
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Affiliation(s)
- Shi-Heng Wang
- National Center for Geriatrics and Welfare Research, National Health Research Institutes, Miaoli, Taiwan
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Huijing Wu
- National Center for Geriatrics and Welfare Research, National Health Research Institutes, Miaoli, Taiwan
| | - Le-Yin Hsu
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
- Graduate Program of Data Science, National Taiwan University and Academia Sinica, Taipei, Taiwan
| | - Mei-Chen Lin
- National Center for Geriatrics and Welfare Research, National Health Research Institutes, Miaoli, Taiwan
| | - Chun-Chieh Fan
- Center for Population Neuroscience and Genetics, Laureate Institute for Brain Research, Tulsa, OK, USA
- Department of Radiology, School of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Pei-Chun Chen
- National Center for Geriatrics and Welfare Research, National Health Research Institutes, Miaoli, Taiwan
| | - Chih-Cheng Hsu
- National Center for Geriatrics and Welfare Research, National Health Research Institutes, Miaoli, Taiwan
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan
| | - Chi-Shin Wu
- National Center for Geriatrics and Welfare Research, National Health Research Institutes, Miaoli, Taiwan
- Department of Psychiatry, National Taiwan University Hospital, Yunlin Branch, Yunlin, Taiwan
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Naderi A, Liles K, Burns T, Chavez B, Huynh-Dam KT, Kiaris H. Pair bonding and disruption impact lung transcriptome in monogamous Peromyscus californicus. BMC Genomics 2023; 24:789. [PMID: 38114920 PMCID: PMC10729396 DOI: 10.1186/s12864-023-09873-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 12/05/2023] [Indexed: 12/21/2023] Open
Abstract
Social interactions affect physiological and pathological processes, yet their direct impact in peripheral tissues remains elusive. Recently we showed that disruption of pair bonds in monogamous Peromyscus californicus promotes lung tumorigenesis, pointing to a direct effect of bonding status in the periphery (Naderi et al., 2021). Here we show that lung transcriptomes of tumor-free Peromyscus are altered in a manner that depends on pair bonding and superseding the impact of genetic relevance between siblings. Pathways affected involve response to hypoxia and heart development. These effects are consistent with the profile of the serum proteome of bonded and bond-disrupted Peromyscus and were extended to lung cancer cells cultured in vitro, with sera from animals that differ in bonding experiences. In this setting, the species' origin of serum (deer mouse vs FBS) is the most potent discriminator of RNA expression profiles, followed by bonding status. By analyzing the transcriptomes of lung cancer cells exposed to deer mouse sera, an expression signature was developed that discriminates cells according to the history of social interactions and possesses prognostic significance when applied to primary human lung cancers. The results suggest that present and past social experiences modulate the expression profile of peripheral tissues such as the lungs, in a manner that impacts physiological processes and may affect disease outcomes. Furthermore, they show that besides the direct effects of the hormones that regulate bonding behavior, physiological changes influencing oxygen metabolism may contribute to the adverse effects of bond disruption.
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Affiliation(s)
- A Naderi
- Department of Drug Discovery and Biomedical Sciences, College of Pharmacy, University of South Carolina, Columbia, SC, USA
| | - K Liles
- Department of Mathematics and Computer Sciences, Claflin University, Orangeburg, SC, USA
| | - T Burns
- Department of Biology, Claflin University, Orangeburg, SC, USA
| | - B Chavez
- Department of Drug Discovery and Biomedical Sciences, College of Pharmacy, University of South Carolina, Columbia, SC, USA
| | - K-T Huynh-Dam
- Department of Drug Discovery and Biomedical Sciences, College of Pharmacy, University of South Carolina, Columbia, SC, USA
| | - H Kiaris
- Department of Drug Discovery and Biomedical Sciences, College of Pharmacy, University of South Carolina, Columbia, SC, USA.
- Peromyscus Genetic Stock Center, University of South Carolina, Columbia, SC, USA.
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Lee Y, Jiang Y. Examining sociocultural factors in widowhood and cognitive function among older Chinese immigrants: findings from the PINE study. Aging Ment Health 2023; 27:2144-2152. [PMID: 37116185 PMCID: PMC10592049 DOI: 10.1080/13607863.2023.2205350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 04/11/2023] [Indexed: 04/30/2023]
Abstract
Objectives: Although there is growing evidence on widowhood and cognitive function, existing studies have shown mixed results. Little is known about protective factors that may contribute to resilience, thereby ameliorate the adverse effect of widowhood on cognition among older Asian immigrants. This study explored potential moderators (i.e. social support, acculturation, leisure activities) in the association between widowhood and cognitive function among older Chinese immigrants.Method: The study sample included 2,515 adults aged 60 or older who completed two waves (2011-2013 and 2013-2015) of the Population Study of Chinese Elderly in Chicago. Cognitive function was indexed by global cognitive function and episodic memory. Linear regression analyses were conducted with interaction terms.Results: Our results show that social support moderated the relationship between widowhood and global cognitive function, and acculturation moderated the relationship between widowhood and episodic memory. The adverse effect of widowhood on cognitive function was more pronounced at lower levels of social support and acculturation.Conclusion: Our findings indicate buffering roles of social support and acculturation in cognitive health among older Chinese immigrants who experience widowhood. Providing supportive programs and interventions to increase social support and acculturation is suggested to promote cognitive function in this population.
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Affiliation(s)
- Yura Lee
- Department of Social Work, Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee, Wi, United States
| | - Yanping Jiang
- institute for Health, Health Care Policy and Aging Research, Department of Family Medicine and Community Health, Rutgers, the State University of new Jersey, new Brunswick, nJ, United States
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Berendzen KM, Bales KL, Manoli DS. Attachment across the lifespan: Examining the intersection of pair bonding neurobiology and healthy aging. Neurosci Biobehav Rev 2023; 153:105339. [PMID: 37536581 PMCID: PMC11073483 DOI: 10.1016/j.neubiorev.2023.105339] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 07/17/2023] [Accepted: 07/30/2023] [Indexed: 08/05/2023]
Abstract
Increasing evidence suggests that intact social bonds are protective against age-related morbidity, while bond disruption and social isolation increase the risk for multiple age-related diseases. Social attachments, the enduring, selective bonds formed between individuals, are thus essential to human health. Socially monogamous species like the prairie vole (M. ochrogaster) form long-term pair bonds, allowing us to investigate the mechanisms underlying attachment and the poorly understood connection between social bonds and health. In this review, we explore several potential areas of focus emerging from data in humans and other species associating attachment and healthy aging, and evidence from prairie voles that may clarify this link. We examine gaps in our understanding of social cognition and pair bond behavior. Finally, we discuss physiologic pathways related to pair bonding that promote resilience to the processes of aging and age-related disease. Advances in the development of molecular genetic tools in monogamous species will allow us to bridge the mechanistic gaps presented and identify conserved research and therapeutic targets relevant to human health and aging.
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Affiliation(s)
- Kristen M. Berendzen
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco; San Francisco, CA 95158, USA
- Center for Integrative Neuroscience, University of California, San Francisco; San Francisco, CA 95158, USA
- Weill Institute for Neurosciences, University of California, San Francisco; San Francisco, CA 95158, USA
- Kavli Institute for Fundamental Neuroscience, University of California, San Francisco; San Francisco, CA 95158, USA
| | - Karen L. Bales
- Department of Psychology, University of California, Davis; Davis, CA 95616, USA
- Department of Neurobiology, Physiology, and Behavior, University of California, Davis; Davis, CA 95616, USA
| | - Devanand S. Manoli
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco; San Francisco, CA 95158, USA
- Center for Integrative Neuroscience, University of California, San Francisco; San Francisco, CA 95158, USA
- Weill Institute for Neurosciences, University of California, San Francisco; San Francisco, CA 95158, USA
- Kavli Institute for Fundamental Neuroscience, University of California, San Francisco; San Francisco, CA 95158, USA
- Neurosciences Graduate Program, University of California, San Francisco; San Francisco, CA 95158, USA
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Harrop E, Medeiros Mirra R, Goss S, Longo M, Byrne A, Farnell DJJ, Seddon K, Penny A, Machin L, Sivell S, Selman LE. Prolonged grief during and beyond the pandemic: factors associated with levels of grief in a four time-point longitudinal survey of people bereaved in the first year of the COVID-19 pandemic. Front Public Health 2023; 11:1215881. [PMID: 37794891 PMCID: PMC10546414 DOI: 10.3389/fpubh.2023.1215881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 08/16/2023] [Indexed: 10/06/2023] Open
Abstract
Background The COVID-19 pandemic has been a devastating and enduring mass-bereavement event, with uniquely difficult sets of circumstances experienced by people bereaved at this time. However, little is known about the long-term consequences of these experiences, including the prevalence of Prolonged Grief Disorder (PGD) and other conditions in pandemic-bereaved populations. Methods A longitudinal survey of people bereaved in the UK between 16 March 2020 and 2 January 2021, with data collected at baseline (n = 711), c. 8 (n = 383), 13 (n = 295), and 25 (n = 185) months post-bereavement. Using measures of Prolonged Grief Disorder (PGD) (Traumatic Grief Inventory), grief vulnerability (Adult Attitude to Grief Scale), and social support (Inventory of Social Support), this analysis examines how participant characteristics, characteristics of the deceased and pandemic-related circumstances (e.g., restricted visiting, social isolation, social support) are associated with grief outcomes, with a focus on symptoms of PGD. Results At baseline, 628 (88.6%) of participants were female, with a mean age of 49.5 (SD 12.9). 311 (43.8%) deaths were from confirmed/suspected COVID-19. Sample demographics were relatively stable across time points. 34.6% of participants met the cut-off for indicated PGD at c. 13 months bereaved and 28.6% at final follow-up. Social isolation and loneliness in early bereavement and lack of social support over time strongly contributed to higher levels of prolonged grief symptoms, while feeling well supported by healthcare professionals following the death was associated with reduced levels of prolonged grief symptoms. Characteristics of the deceased most strongly associated with lower levels of prolonged grief symptoms, were a more distant relationship (e.g., death of a grandparent), an expected death and death occurring in a care-home. Participant characteristics associated with higher levels of prolonged grief symptoms included low level of formal education and existence of medical conditions. Conclusion Results suggest higher than expected levels of PGD compared with pre-pandemic times, with important implications for bereavement policy, provision and practice now (e.g., strengthening of social and specialist support) and in preparedness for future pandemics and mass-bereavement events (e.g., guidance on infection control measures and rapid support responses).
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Affiliation(s)
- Emily Harrop
- Division of Population Medicine, Marie Curie Research Centre, Cardiff University, Cardiff, United Kingdom
| | | | - Silvia Goss
- Division of Population Medicine, Marie Curie Research Centre, Cardiff University, Cardiff, United Kingdom
| | - Mirella Longo
- Division of Population Medicine, Marie Curie Research Centre, Cardiff University, Cardiff, United Kingdom
| | - Anthony Byrne
- Division of Population Medicine, Marie Curie Research Centre, Cardiff University, Cardiff, United Kingdom
| | | | - Kathy Seddon
- Division of Population Medicine, Marie Curie Research Centre, Cardiff University, Cardiff, United Kingdom
| | - Alison Penny
- National Bereavement Alliance, London, United Kingdom
| | - Linda Machin
- School of Medicine, Keele University, Keele, United Kingdom
| | - Stephanie Sivell
- Division of Population Medicine, Marie Curie Research Centre, Cardiff University, Cardiff, United Kingdom
| | - Lucy E. Selman
- Palliative and End of Life Care Research Group, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
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Katsiferis A, Bhatt S, Mortensen LH, Mishra S, Westendorp RGJ. Sex differences in health care expenditures and mortality after spousal bereavement: A register-based Danish cohort study. PLoS One 2023; 18:e0282892. [PMID: 36947502 PMCID: PMC10032540 DOI: 10.1371/journal.pone.0282892] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 02/26/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Spousal bereavement is a life event that affects older people differently. We investigated the impact of spousal bereavement on medical expenditures and mortality in the general population, emphasizing on age and sex. METHODS Data are from a population-based, retrospective cohort study following 924,958 Danish citizens over the age of 65 years, within 2011-2016. Changes in health care expenditures in those who suffer bereavement were compared with time matched changes among those who did not. Mortality hazards were analysed with time to event analysis. RESULTS A total of 77,722 (~8.4%) individuals experienced bereavement, 65.8% being females. Among males, bereavement was associated with increase of expenditures the year after, that was 42 Euros per week (95% CI, 36 to 48) larger than the non-bereaved group. The corresponding increase for females was 35 Euros per week (95% CI, 30 to 40). The increase of mortality hazards was highest in the first year after bereavement, higher in males than females, in young old and almost absent in the oldest old. Compared with the reference, mortality the year after spousal loss was 70% higher (HR 1.70 [95% CI 1.40 to 2.08]) for males aged 65-69 years and remained elevated for a period of six years. Mortality for females aged 65-69 years was 27% higher in the first year (HR 1.27, [1.07 to 1.52]), normalizing thereafter. CONCLUSION Bereavement affects older people differently with younger males being most frail with limited recovery potential.
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Affiliation(s)
- Alexandros Katsiferis
- Section for Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Statistics Denmark, Copenhagen, Denmark
| | - Samir Bhatt
- Section for Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
| | - Laust Hvas Mortensen
- Section for Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Statistics Denmark, Copenhagen, Denmark
| | - Swapnil Mishra
- Section for Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Rudi G J Westendorp
- Section for Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Statistics Denmark, Copenhagen, Denmark
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Östergren O, Fors S, Rehnberg J. Excess Mortality by Individual and Spousal Education for Recent and Long-Term Widowed. J Gerontol B Psychol Sci Soc Sci 2022; 77:946-955. [PMID: 34878543 PMCID: PMC9071383 DOI: 10.1093/geronb/gbab227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVES The loss of a spouse is followed by a dramatic but short-lived increase in the mortality risk of the survivor. Contrary to expectations, several studies have found this increase to be larger among those with high education. Having a spouse with high education is associated with lower mortality, which suggests that losing a spouse with high education means the loss of a stronger protective factor than losing a spouse with low education. This may disproportionately affect the high educated because of educational homogamy. METHODS We use Swedish total population registers to construct an open cohort of 1,842,487 married individuals aged 60-89 during 2007-2016, observing 239,276 transitions into widowhood and 277,946 deaths. We use Poisson regression to estimate relative and absolute mortality risks by own and spousal education among the married and recent and long-term widows. RESULTS We find an absolute increase in mortality risk, concentrated to the first 6 months of widowhood across all educational strata. The relative increase in mortality risk is larger in higher educational strata. Losing a spouse with high education is associated with higher excess mortality, which attenuates this difference. DISCUSSION When considering the timing and the absolute level of excess mortality, we find that the overall patterns of excess mortality are similar across educational strata. We argue that widowhood has a dramatic impact on health, regardless of education.
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Affiliation(s)
- Olof Östergren
- Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
| | - Stefan Fors
- Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Center for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden
| | - Johan Rehnberg
- Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
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Srivastava S, Debnath P, Shri N, Muhammad T. The association of widowhood and living alone with depression among older adults in India. Sci Rep 2021; 11:21641. [PMID: 34737402 PMCID: PMC8568934 DOI: 10.1038/s41598-021-01238-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 10/26/2021] [Indexed: 11/25/2022] Open
Abstract
Widowhood is a catastrophic event at any stage of life for the surviving partner particularly in old age, with serious repercussions on their physical, economic, and emotional well-being. This study investigates the association of marital status and living arrangement with depression among older adults. Additionally, the study aims to evaluate the effects of factors such as socio-economic conditions and other health problems contributing to the risk of depression among older adults in India. This study utilizes data from the nationally representative Longitudinal Ageing Study in India (LASI-2017-18). The effective sample size was 30,639 older adults aged 60 years and above. Descriptive statistics and bivariate analysis have been performed to determine the prevalence of depression. Further, binary logistic regression analysis was conducted to study the association between marital status and living arrangement on depression among older adults in India. Overall, around nine percent of the older adults suffered from depression. 10.3% of the widowed (currently married: 7.8%) and 13.6% of the older adults who were living alone suffered from depression. Further, 8.4% of the respondents who were co-residing with someone were suffering from depression. Widowed older adults were 34% more likely to be depressed than currently married counterparts [AOR: 1.34, CI 1.2-1.49]. Similarly, respondents who lived alone were 16% more likely to be depressed compared to their counterparts [AOR: 1.16; CI 1.02, 1.40]. Older adults who were widowed and living alone were 56% more likely to suffer from depression [AOR: 1.56; CI 1.28, 1.91] in reference to older adults who were currently married and co-residing. The study shows vulnerability of widowed older adults who are living alone and among those who had lack of socio-economic resources and face poor health status. The study can be used to target outreach programs and service delivery for the older adults who are living alone or widowed and suffering from depression.
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Affiliation(s)
- Shobhit Srivastava
- grid.419349.20000 0001 0613 2600International Institute for Population Sciences, Mumbai, Maharashtra 400088 India
| | - Paramita Debnath
- grid.419349.20000 0001 0613 2600International Institute for Population Sciences, Mumbai, Maharashtra 400088 India
| | - Neha Shri
- grid.419349.20000 0001 0613 2600International Institute for Population Sciences, Mumbai, Maharashtra 400088 India
| | - T. Muhammad
- grid.419349.20000 0001 0613 2600International Institute for Population Sciences, Mumbai, Maharashtra 400088 India
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Gao T, Agho KE, Piya MK, Simmons D, Osuagwu UL. Analysis of in-hospital mortality among people with and without diabetes in South Western Sydney public hospitals (2014-2017). BMC Public Health 2021; 21:1991. [PMID: 34732173 PMCID: PMC8567571 DOI: 10.1186/s12889-021-12120-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 10/25/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Diabetes is a major public health problem affecting about 1.4 million Australians, especially in South Western Sydney, a hotspot of diabetes with higher than average rates for hospitalisations. The current understanding of the international burden of diabetes and related complications is poor and data on hospital outcomes and/or what common factors influence mortality rate in people with and without diabetes in Australia using a representative sample is lacking. This study determined in-hospital mortality rate and the factors associated among people with and without diabetes. METHODS Retrospective data for 554,421 adult inpatients was extracted from the population-based New South Wales (NSW) Admitted Patient Data over 3 financial years (from 1 July 2014-30 June 2015 to 1 July 2016-30 June 2017). The in-hospital mortality per 1000 admitted persons, standardised mortality ratios (SMR) were calculated. Binary logistic regression was performed, adjusting for potential covariates and co-morbidities for people with and without diabetes over three years. RESULTS Over three years, 8.7% (48,038 people) of admissions involved people with diabetes. This increased from 8.4% in 2014-15 to 8.9% in 2016-17 (p = 0.007). Across all age groups, in-hospital mortality rate was significantly greater in people with diabetes (20.6, 95% Confidence intervals CI 19.3-21.9 per 1000 persons) than those without diabetes (11.8, 95%CI 11.5-12.1) and more in men than women (23.1, 95%CI 21.2-25.0 vs 17.9, 95%CI 16.2-19.8) with diabetes. The SMR for those with and without diabetes were 3.13 (95%CI 1.78-4.48) and 1.79 (95%CI 0.77-2.82), respectively. There were similarities in the factors associated with in hospital mortality in both groups including: older age (> 54 years), male sex, marital status (divorced/widowed), length of stay in hospital (staying longer than 4 days), receiving intensive care in admission and being admitted due to primary respiratory and cardiovascular diagnoses. The odds of death in admission was increased in polymorbid patients without diabetes (28.68, 95%CI 23.49-35.02) but not in those with diabetes. CONCLUSIONS In-patients with diabetes continue to have higher mortality rates than those without diabetes and the Australian population. Overall, similar factors influenced mortality rate in people with and without diabetes, but significantly more people with diabetes had two or more co-morbidities, suggesting that hospital mortality may be driven by those with pre-existing health/comorbidities. Urgent measures in primary care to prevent admissions among people with multiple co-morbidities are needed.
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Affiliation(s)
- Tina Gao
- Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Campbelltown, NSW, 2560, Australia
| | - Kingsley E Agho
- School of Health Sciences, Western Sydney University, Campbelltown, NSW, 2560, Australia
- African Vision Research Institute (AVRI), University of KwaZulu-Natal, Durban, 4041, South Africa
| | - Milan K Piya
- Macarthur Diabetes Endocrinology and Metabolism Service, Camden and Campbelltown Hospital, Campbelltown, NSW, 2560, Australia
| | - David Simmons
- Macarthur Diabetes Endocrinology and Metabolism Service, Camden and Campbelltown Hospital, Campbelltown, NSW, 2560, Australia
| | - Uchechukwu L Osuagwu
- Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Campbelltown, NSW, 2560, Australia.
- African Vision Research Institute (AVRI), University of KwaZulu-Natal, Durban, 4041, South Africa.
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13
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Kristensen MS, Thygesen LC, Tay DL, Kumar R, Grønvold M, Aldridge M, Ornstein KA. Size and composition of family networks of decedents: A nationwide register-based study. Palliat Med 2021; 35:1652-1662. [PMID: 33823696 DOI: 10.1177/0269216321998602] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Seriously ill individuals rely heavily on family caregivers at the end of life. Yet many do not have family support. AIM To characterize the size and composition of decedents' family networks by cause of death, demographic, clinical, socioeconomic, and geographic characteristics. DESIGN A cross-sectional population-level study with data collected from nation-wide registers. SETTING/PARTICIPANTS All adults in Denmark born between 1935 and 1998 who died of natural causes between 2009 and 2016 were linked at the time of death to living adult spouses/partners, children, siblings, parents, and grandchildren. RESULTS Among 175,755 decedents (median age: 68 years, range: 18-81 years), 61% had a partner at the time of death and 78% had at least one adult child. Ten percent of decedents had no identified living adult family members. Decedents with family had a median of five relatives. Males were more likely to have a spouse/partner (65%) than females (56%). While 93% of decedents dying of cancer had adult family, only 70% of individuals dying of dementia had adult family at the time of death. The majority of cancer decedents co-resided or lived within 30 km of family (88%), compared to only 65% of those dying from psychiatric illness. CONCLUSIONS While the majority of adults had an extensive family network at the time of death, a substantial proportion of decedents had no family, suggesting the need for non-family based long-term service and support systems. Assessment of family networks can expand our understanding of the end-of-life caregiving process and inform palliative care delivery.
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Affiliation(s)
- Marie S Kristensen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Lau C Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Djin L Tay
- College of Nursing, University of Utah, Salt Lake City, UT, USA
| | - Raj Kumar
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mogens Grønvold
- Department of Public Health, University of Copenhagen, Denmark
| | - Melissa Aldridge
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Katherine A Ornstein
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Salmon C, Song L, Muir K, Pashayan N, Dunning AM, Batra J, Chambers S, Stanford JL, Ostrander EA, Park JY, Lin HY, Cussenot O, Cancel-Tassin G, Menegaux F, Cordina-Duverger E, Kogevinas M, Llorca J, Kaneva R, Slavov C, Razack A, Lim J, Gago-Dominguez M, Castelao JE, Kote-Jarai Z, Eeles RA, Parent MÉ. Marital status and prostate cancer incidence: a pooled analysis of 12 case-control studies from the PRACTICAL consortium. Eur J Epidemiol 2021; 36:913-925. [PMID: 34275018 DOI: 10.1007/s10654-021-00781-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 06/23/2021] [Indexed: 10/20/2022]
Abstract
While being in a committed relationship is associated with a better prostate cancer prognosis, little is known about how marital status relates to its incidence. Social support provided by marriage/relationship could promote a healthy lifestyle and an increased healthcare seeking behavior. We investigated the association between marital status and prostate cancer risk using data from the PRACTICAL Consortium. Pooled analyses were conducted combining 12 case-control studies based on histologically-confirmed incident prostate cancers and controls with information on marital status prior to diagnosis/interview. Marital status was categorized as married/partner, separated/divorced, single, or widowed. Tumours with Gleason scores ≥ 8 defined high-grade cancers, and low-grade otherwise. NCI-SEER's summary stages (local, regional, distant) indicated the extent of the cancer. Logistic regression was used to derive odds ratios (ORs) and 95% confidence intervals (CI) for the association between marital status and prostate cancer risk, adjusting for potential confounders. Overall, 14,760 cases and 12,019 controls contributed to analyses. Compared to men who were married/with a partner, widowed men had an OR of 1.19 (95% CI 1.03-1.35) of prostate cancer, with little difference between low- and high-grade tumours. Risk estimates among widowers were 1.14 (95% CI 0.97-1.34) for local, 1.53 (95% CI 1.22-1.92) for regional, and 1.56 (95% CI 1.05-2.32) for distant stage tumours. Single men had elevated risks of high-grade cancers. Our findings highlight elevated risks of incident prostate cancer among widowers, more often characterized by tumours that had spread beyond the prostate at the time of diagnosis. Social support interventions and closer medical follow-up in this sub-population are warranted.
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Affiliation(s)
- Charlotte Salmon
- Epidemiology and Biostatistics Unit, Centre Armand-Frappier Santé Biotechnologie, Institut national de la recherche scientifique, University of Quebec, 531 boul. des Prairies, Laval, QC, H7V 1B7, Canada
| | - Lixin Song
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
- School of Nursing, University of North Carolina, Chapel Hill, NC, USA
| | - Kenneth Muir
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - Nora Pashayan
- Department of Applied Health Research, University College London, London, WC1E 7HB, UK
- Strangeways Laboratory, Department of Oncology, Centre for Cancer Genetic Epidemiology, University of Cambridge, Worts Causeway, Cambridge, CB1 8RN, UK
| | - Alison M Dunning
- Strangeways Laboratory, Department of Oncology, Centre for Cancer Genetic Epidemiology, University of Cambridge, Worts Causeway, Cambridge, CB1 8RN, UK
| | - Jyotsna Batra
- Australian Prostate Cancer Research Centre-Qld, Institute of Health and Biomedical Innovation and School of Biomedical Sciences, Queensland University of Technology, Brisbane, QLD, 4059, Australia
- Translational Research Institute, Brisbane, QLD, 4102, Australia
| | - Suzanne Chambers
- Faculty of Health Sciences, Australian Catholic University, Sydney, Australia
| | - Janet L Stanford
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, 98109-1024, USA
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, 98195, USA
| | - Elaine A Ostrander
- National Human Genome Research Institute, National Institutes of Health, 50 South Drive, Rm. 5351, Bethesda, MD, 20892, USA
| | - Jong Y Park
- Department of Cancer Epidemiology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA
| | - Hui-Yi Lin
- School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA, 70112, USA
| | - Olivier Cussenot
- Sorbonne Université, GRC n°5, AP-HP, Tenon Hospital, 4 rue de la Chine, 75020, Paris, France
- CeRePP, Tenon Hospital, 75020, Paris, France
| | - Géraldine Cancel-Tassin
- Sorbonne Université, GRC n°5, AP-HP, Tenon Hospital, 4 rue de la Chine, 75020, Paris, France
- CeRePP, Tenon Hospital, 75020, Paris, France
| | - Florence Menegaux
- Exposome and Heredity Team, CESP, UVSQ, INSERM, Gustave Roussy, Paris-Saclay University, 94805, Villejuif, France
| | - Emilie Cordina-Duverger
- Exposome and Heredity Team, CESP, UVSQ, INSERM, Gustave Roussy, Paris-Saclay University, 94805, Villejuif, France
| | - Manolis Kogevinas
- ISGlobal, Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología Y Salud Pública (CIBERESP), 28029, Madrid, Spain
| | - Javier Llorca
- CIBER Epidemiología Y Salud Pública (CIBERESP), 28029, Madrid, Spain
- University of Cantabria, 39005, Santander, Spain
| | - Radka Kaneva
- Molecular Medicine Center, Department of Medical Chemistry and Biochemistry, Medical University of Sofia, Sofia, 2 Zdrave Str., 1431, Sofia, Bulgaria
| | - Chavdar Slavov
- Department of Urology and Alexandrovska University Hospital, Medical University of Sofia, 1431, Sofia, Bulgaria
| | - Azad Razack
- Department of Surgery, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Jasmine Lim
- Department of Surgery, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Manuela Gago-Dominguez
- Genomic Medicine Group, Galician Foundation of Genomic Medicine, Instituto de Investigacion Sanitaria de Santiago de Compostela (IDIS), Complejo Hospitalario Universitario de Santiago, Servicio Galego de Saúde, SERGAS, 15706, Santiago de Compostela, Spain
- Department of Family Medicine and Public Health, Moores Cancer Center, University of California San Diego, La Jolla, CA, 92093-0012, USA
| | - Jose Esteban Castelao
- Genetic Oncology Unit, CHUVI Hospital, Complexo Hospitalario Universitario de Vigo, Instituto de Investigación Biomédica Galicia Sur (IISGS), 36204, Vigo (Pontevedra), Spain
| | | | - Rosalind A Eeles
- The Institute of Cancer Research, London, SM2 5NG, UK
- Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK
| | - Marie-Élise Parent
- Epidemiology and Biostatistics Unit, Centre Armand-Frappier Santé Biotechnologie, Institut national de la recherche scientifique, University of Quebec, 531 boul. des Prairies, Laval, QC, H7V 1B7, Canada.
- School of Public Health, University of Montreal, Montreal, QC, Canada.
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15
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Fagundes CP, Wu EL. Biological mechanisms underlying widowhood's health consequences: Does diet play a role? COMPREHENSIVE PSYCHONEUROENDOCRINOLOGY 2021; 7:100058. [PMID: 35757059 PMCID: PMC9216459 DOI: 10.1016/j.cpnec.2021.100058] [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: 12/31/2020] [Revised: 05/01/2021] [Accepted: 05/02/2021] [Indexed: 11/29/2022] Open
Abstract
The loss of a spouse is a highly stressful event that puts older adults at increased risk for morbidity and mortality. The risk is highest in the first year to 18 months post-loss; nevertheless, widow(er)s, in general, are at heightened risk of cardiovascular disease (CVD) related morbidity and mortality, and to a lesser extent, non-CVD related morbidity and mortality. The primary goal of this article is to argue for a perspective that considers diet and emotion-induced autonomic, neuroendocrine, and immune dysregulation, in unison, to understand the mechanisms underlying morbidity and mortality in early widowhood. Toward this end, we first summarize our previously published work, as well as work from other investigatory teams, showing that compared with those who were not bereaved, widow(er)s have higher levels of pro-inflammatory cytokine production and more dysregulated autonomic and neuroendocrine activity than non-widow(er)s, independent of health behaviors such as diet. We highlight that a major gap in our current understanding of the biobehavioral mechanisms that underlie the widowhood effect is the role of diet and hypothesize that the adverse health impact of grief and associated negative emotions and diet may be more than additive. Therefore, we propose that diet may be a pathway by which widow(er)s are at higher CVD risk requiring further investigation. Losing a spouse is highly stressful event; it increases one’s risk for morbidity and mortality, especially within the first 18 months post-loss. Widow(er)s are at risk of cardiovascular disease (CVD)- and non-CVD related morbidity and mortality. The role of diet is a major gap in our understanding of the biobehavioral mechanisms that underlie the widowhood effect. Diet clearly impacts CVD, and widow(er)s' eating habits are altered for at least the first two years post-loss. The adverse health impact of stress and diet may be more than additive; it may be synergistic.
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16
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Naderi A, Soltanmaohammadi E, Kaza V, Barlow S, Chatzistamou I, Kiaris H. Persistent effects of pair bonding in lung cancer cell growth in monogamous Peromyscus californicus. eLife 2021; 10:e64711. [PMID: 33960931 PMCID: PMC8104960 DOI: 10.7554/elife.64711] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 04/14/2021] [Indexed: 11/13/2022] Open
Abstract
Epidemiological evidence suggests that social interactions and especially bonding between couples influence tumorigenesis, yet whether this is due to lifestyle changes, homogamy (likelihood of individuals to marry people of similar health), or directly associated with host-induced effects in tumors remains debatable. In the present study, we explored if tumorigenesis is associated with the bonding experience in monogamous rodents at which disruption of pair bonds is linked to anxiety and stress. Comparison of lung cancer cell spheroids that formed in the presence of sera from bonded and bond-disrupted deer mice showed that in monogamous Peromyscus polionotus and Peromyscus californicus, but not in polygamous Peromyscus maniculatus, the disruption of pair bonds altered the size and morphology of spheroids in a manner that is consistent with the acquisition of increased oncogenic potential. In vivo, consecutive transplantation of human lung cancer cells between P. californicus, differing in bonding experiences (n = 9 for bonded and n = 7 for bond-disrupted), and nude mice showed that bonding suppressed tumorigenicity in nude mice (p<0.05), suggesting that the protective effects of pair bonds persisted even after bonding ceased. Unsupervised hierarchical clustering indicated that the transcriptomes of lung cancer cells clustered according to the serum donors' bonding history while differential gene expression analysis pointed to changes in cell adhesion and migration. The results highlight the pro-oncogenic effects of pair-bond disruption, point to the acquisition of expression signatures in cancer cells that are relevant to the bonding experiences of serum donors, and question the ability of conventional mouse models to capture the whole spectrum of the impact of the host in tumorigenesis.
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Affiliation(s)
- Asieh Naderi
- Department of Drug Discovery and Biomedical Sciences, College of Pharmacy, University of South CarolinaColumbiaUnited States
| | - Elham Soltanmaohammadi
- Department of Drug Discovery and Biomedical Sciences, College of Pharmacy, University of South CarolinaColumbiaUnited States
| | - Vimala Kaza
- Peromyscus Genetic Stock Center, University of South CarolinaColumbiaUnited States
| | - Shayne Barlow
- Department of Physiology, Pharmacology, and Neuroscience, School of Medicine and Department of Laboratory Animal Resources, University of South CarolinaColumbiaUnited States
| | - Ioulia Chatzistamou
- Department of Pathology, Microbiology and Immunology, School of Medicine, University of South CarolinaColumbiaUnited States
| | - Hippokratis Kiaris
- Department of Drug Discovery and Biomedical Sciences, College of Pharmacy, University of South CarolinaColumbiaUnited States
- Peromyscus Genetic Stock Center, University of South CarolinaColumbiaUnited States
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Abstract
With few exceptions, greater disparities in mortality risk by socio-economic status (SES) have been found among men than among women. Most research has also shown that the higher mortality risk after widowhood (the widowhood effect) is greater for men. However, a different picture appears when examining these associations jointly. Based on Swedish register data, this study shows that widowhood weakens, or even reverses, the sex differences in socio-economic disparities in mortality. The overall findings also indicate that higher SES elevates the widowhood effect for men but diminishes it for women, and that the widowhood effect is greater for women than men in the lowest SES categories. These results imply that men with higher SES are more vulnerable after widowhood, perhaps because of their previous relatively privileged situation. The disadvantage of widows in lower SES categories may reflect exposure to financial strains after spousal loss and inequalities in the healthcare system.
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18
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Noguchi T, Kondo F, Nishiyama T, Otani T, Nakagawa-Senda H, Watanabe M, Imaeda N, Goto C, Hosono A, Shibata K, Kamishima H, Nogimura A, Nagaya K, Yamada T, Suzuki S. The impact of marital transitions on vegetable intake in middle-aged and older Japanese adults: a five-year longitudinal study. J Epidemiol 2020; 32:89-95. [PMID: 33071250 PMCID: PMC8761567 DOI: 10.2188/jea.je20200343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Marital transitions are associated with adverse health events, such as mortality and cardiovascular disease. Since marital transitions (eg, becoming widowed) are unavoidable life events, it is necessary to identify modifiable intermediate outcomes. Thus, we examined the association between marital transitions and vegetable intake among middle-aged and older Japanese adults. Methods This longitudinal study included Japanese adults aged 40–79 years who received an annual health checkup between 2007 and 2011 (baseline) and 5 years later (follow-up). Marital transitions were classified as whether and what type of transition occurred during the 5-year period and comprised five groups: consistently married, married to widowed, married to divorced, not married to married, and remained not married. Changes in total vegetable, green and yellow vegetable, and light-colored vegetable intake from baseline to follow-up were calculated using the Food Frequency Questionnaire. Results Data from 4,813 participants were analyzed (mean age, 59.4 years; 44.1% women). Regarding marital transitions, 3,960 participants were classified as “consistently married,” 135 as “married to widowed,” 40 as “married to divorced,” 60 as “not married to married,” and 529 as “remained not married.” Multivariable linear regression analysis revealed that compared to consistently married, married to widowed was inversely associated with the change in total vegetable intake (β = −16.64, SE = 7.68, P = 0.030) and light-colored vegetable intake (β = −11.46, SE = 4.33, P = 0.008). Conclusion Our findings suggest that being widowed could result in a reduced intake of vegetables. Hence, dietary counseling according to marital situation is necessary.
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Affiliation(s)
- Taiji Noguchi
- Department of Social Science, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology.,Department of Public Health, Nagoya City University Graduate School of Medical Sciences
| | - Fumi Kondo
- Department of Public Health, Nagoya City University Graduate School of Medical Sciences
| | - Takeshi Nishiyama
- Department of Public Health, Nagoya City University Graduate School of Medical Sciences
| | - Takahiro Otani
- Department of Public Health, Nagoya City University Graduate School of Medical Sciences
| | - Hiroko Nakagawa-Senda
- Department of Public Health, Nagoya City University Graduate School of Medical Sciences
| | - Miki Watanabe
- Department of Public Health, Nagoya City University Graduate School of Medical Sciences
| | - Nahomi Imaeda
- Department of Public Health, Nagoya City University Graduate School of Medical Sciences.,Department of Nutrition Science, Faculty of Health Science, Shigakkan University
| | - Chiho Goto
- Department of Public Health, Nagoya City University Graduate School of Medical Sciences.,Department of Health and Nutrition, Faculty of Health and Living, Nagoya Bunri University
| | - Akihiro Hosono
- Department of Public Health, Nagoya City University Graduate School of Medical Sciences.,Atsuta Public Health Center, City of Nagoya
| | - Kiyoshi Shibata
- Department of Public Health, Nagoya City University Graduate School of Medical Sciences.,Department of Health and Nutritional Sciences, Nagoya Keizai University
| | - Hiroyuki Kamishima
- Department of Public Health, Nagoya City University Graduate School of Medical Sciences.,Department of Home Economics, Aichi Gakusen University
| | - Akane Nogimura
- Department of Public Health, Nagoya City University Graduate School of Medical Sciences.,Department of Anesthesiology and Intensive Care Medicine, Nagoya City University Graduate School of Medical Sciences
| | - Kenji Nagaya
- Department of Public Health, Nagoya City University Graduate School of Medical Sciences
| | - Tamaki Yamada
- Okazaki Public Health Center, Okazaki Medical Association
| | - Sadao Suzuki
- Department of Public Health, Nagoya City University Graduate School of Medical Sciences
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Abstract
AIMS Widowed people have increased mortality compared to married people of the same age. Although most widowed people are of older age, few studies include the oldest old. As life expectancy is increasing, knowledge of widowhood into older age is needed. This study aimed to examine mortality and widowhood in older age by comparing mortality in widowed and married people by sex, age, time since spousal loss and cause of death. METHODS A Danish register-based matched cohort study of 10% of widowed persons ⩾65 years in the years 2000-2009. For each randomly drawn widowed person, five married persons were matched on sex and age. Mortality rate ratios (MRR) were calculated using Poisson regression, and stratified according to sex and 5-year age intervals. MRRs were furthermore calculated by time since spousal loss and by specific cause of death. RESULTS The study included 82 130 persons contributing with 642 914.8 person-years. The overall MRR between widowed and married persons with up to 16 years of follow-up was 1.25 (95% CI 1.23-1.28). At age ⩾95 years for men, and ⩾90 years for women, no differences in mortality rates were seen between widowed and married persons. Mortality in widowed persons was increased for most specific causes of death, with the highest MRR from external causes (MRR 1.53 [1.35-1.74]) and endocrine diseases (MRR 1.51 [1.34-1.70]). CONCLUSIONS Widowhood was associated with increased mortality in older age for both men and women until age ⩾95 and ⩾90 years, respectively. Increased mortality was observed for almost all causes of death.
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Jackson I, Osaghae I, Ananaba N, Etuk A, Jackson N, Chido-Amajuoyi OG. Sources of health information among U.S. cancer survivors: results from the health information national trends survey (HINTS). AIMS Public Health 2020; 7:363-379. [PMID: 32617363 PMCID: PMC7327406 DOI: 10.3934/publichealth.2020031] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 06/10/2020] [Indexed: 01/22/2023] Open
Abstract
Background Health information is crucial for preservation of health and maintenance of healthy practices among cancer survivors. This study examines the sources and factors associated with choice of health information source among cancer survivors and those without a cancer history. Methods We examined health information sources utilized by cancer history between 2011–2014 and 2017–2018 using the Health Information National Trends Survey (HINTS). Factors associated with seeking health information were examined using multinomial logistic regression. Data from HINTS 4, cycles 1–4 (2011–2014) and HINTS 5, cycles 1–2 (2017–2018) were combined and used for all analyses. HINTS-FDA, cycles 1–2 (2015–2017) were excluded from this study because the question about a cancer history was not asked. Results Over half of cancer survivors (52.7%) and those without a cancer history (60.9%) obtained their health information through the media. Among cancer survivors, factors associated with health information seeking either through the media or interpersonal communication relative to not seeking information were age, gender, level of education, income, marital status and having a regular healthcare provider. Male survivors were 39% less likely to seek health information from the media (aOR: 0.61; 95% CI: 0.38–0.99) while those with a regular health provider had significantly higher odds of seeking health information via interpersonal communication (aOR: 1.92; 95% CI: 1.09–3.38). In addition, widowed cancer survivors had lower odds of seeking health information from either interpersonal communication (aOR: 0.28; 95% CI: 0.13–0.60) or the media (aOR: 0.30; 95% CI: 0.13–0.69). In the study population without a cancer history, compared to non-Hispanic whites, non-Hispanic blacks, Hispanics and non-Hispanic other categories were significantly less likely to seek health information from the media rather than not seek health information. Conclusion Socioeconomic status, marital status, gender and age are important correlates of choice of health information source among cancer survivors in the US. These factors may be useful in guiding interventions aimed at various groups of cancer surviving populations to ensure that they improve their health seeking behaviors.
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Affiliation(s)
- Inimfon Jackson
- Department of Epidemiology, Human Genetics and Environmental Sciences, University of Texas School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Ikponmwosa Osaghae
- Department of Epidemiology, Human Genetics and Environmental Sciences, University of Texas School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Nnenna Ananaba
- Department of Health Promotion and Behavioral Sciences, University of Texas School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Aniekeme Etuk
- Department of Management, Policy and Community Health, University of Texas School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Nsikak Jackson
- Department of Management, Policy and Community Health, University of Texas School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
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22
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Beaunoyer E, Hiracheta Torres L, Maessen L, Guitton MJ. Grieving in the digital era: Mapping online support for grief and bereavement. PATIENT EDUCATION AND COUNSELING 2020; 103:S0738-3991(20)30331-1. [PMID: 32591255 DOI: 10.1016/j.pec.2020.06.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 06/04/2020] [Accepted: 06/08/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To describe the landscape of digital resources available for grief and bereavement, and to explore cultural variations through the analysis of patterns in three languages with a multinational repartition (English, French and Spanish). METHODS For each language, websites were collected through a systematized approach and classified according to their category (governmental, health, educational, social media, conventional media, spiritual), their country of origin, and the type of support they offered (practical support, services, peer support, informational support, resources). RESULTS A total of 2587 websites (English: 1003; French 678; Spanish: 906) were analyzed. Cultural variations were observed both for the websites' categories and the types of support. Half of the websites presented at least one type of support, informational support being the most prevalent, followed by practical support. English websites presented significantly more support than Spanish websites, with French websites in between. PRACTICE IMPLICATIONS By using an extensive survey, our results allow for a general mapping of online websites that is comparable across languages, but also unveil digital dynamics unknown to date. These results further the multicultural understanding of digital support for grief and bereavement, propose an innovative and operational typology for online support and raise awareness of the current support landscape.
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Affiliation(s)
- Elisabeth Beaunoyer
- Faculty of Medicine, Université Laval, Quebec City, QC, Canada; Faculty of Nursing, Université Laval, Quebec City, QC, Canada; CERVO Brain Research Center, Quebec City, QC, Canada
| | | | - Lenn Maessen
- Faculty of Medicine, Hasselt University, Hasselt, Belgium
| | - Matthieu J Guitton
- Faculty of Medicine, Université Laval, Quebec City, QC, Canada; CERVO Brain Research Center, Quebec City, QC, Canada.
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Liu H, Umberson D, Xu M. Widowhood and mortality: gender, race/ethnicity, and the role of economic resources. Ann Epidemiol 2020; 45:69-75.e1. [PMID: 32336656 PMCID: PMC7304506 DOI: 10.1016/j.annepidem.2020.02.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 02/19/2020] [Accepted: 02/29/2020] [Indexed: 01/13/2023]
Abstract
PURPOSE We examine widowhood effects on mortality across gender and race-ethnicity, with attention to variation in the mediating role of economic resources. METHODS Data were drawn from the Health and Retirement Study (1992-2016). The analytic sample included 34,777 respondents aged 51 years and older who contributed 208,470 person-period records. Discrete-time hazard models were estimated to predict the odds of death among white men, black men, Hispanic men, white women, black women, and Hispanic women separately. The Karlson-Holm-Breen analysis was conducted to examine the mediating role of economic resources across groups. RESULTS Across all gender and racial-ethnic subgroups, widowhood effects on mortality were largest for Hispanic men. Black women and Hispanic women also suffered stronger effects of widowhood on mortality than white women. For both men and women, economic resources were an important pathway through which widowhood increased mortality risk for whites and blacks but not for Hispanics. CONCLUSIONS Findings highlight that gender and race-ethnicity intersect with widowhood status to disadvantage some groups more than others. It is important to explore the complex pathways that contribute to the higher mortality risk of racial-ethnic minorities, especially Hispanic men, after widowhood so that effective interventions can be implemented to reduce those risks.
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Affiliation(s)
- Hui Liu
- Department of Sociology, Michigan State University, East Lansing.
| | - Debra Umberson
- Department of Sociology and Population Research Center, The University of Texas at Austin, Austin
| | - Minle Xu
- Population Research Center, The University of Texas at Austin, Austin
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Jones-Eversley SD, Rice J. A call for epidemiology and thanatology to address the dying, death, and grief pipeline among Blacks in the United States. DEATH STUDIES 2020; 46:140-147. [PMID: 32027243 DOI: 10.1080/07481187.2020.1721618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Dying, death, and grief are significant events that impact individuals, families, and communities. In the United States, Blacks historically have higher morbidity and mortality rates than other racial-ethnic groups. While death is a normal and natural phase of the life-course process, high incidents of infant mortality, premature death, and preventable death are not. The disproportionate burden of dying, death and grief among Blacks have detrimental consequences which demand interdisciplinary interventions from public health and death study researchers. This manuscript explores dying, death and grief from three distinct fields of study: (1) epidemiology of death, (2) social epidemiology of death, and (3) thanatology.
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Affiliation(s)
- Sharon D Jones-Eversley
- Department of Family Studies and Community Development, Towson University, Towson, Maryland, USA
| | - Johnny Rice
- Department of Criminal Justice and Law Enforcement, Coppin State University, Baltimore, Maryland, USA
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Sekgobela G, Peu M, van der Wath A. "They brought my smile back": A phenomenological description of widows' experiences of psychosocial support. DEATH STUDIES 2019; 45:603-612. [PMID: 31584347 DOI: 10.1080/07481187.2019.1671542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The consequences of widowhood can be overwhelming. Widows sometimes experience difficulties to obtain psychosocial support to overcome the challenges they face. In this phenomenological study, purposively selected widows were asked about their experiences of widowhood in terms of different sources of support. The analysis illuminated the meaning widows attach to different sources of psychosocial support. Participants experienced both positive and negative encounters with their sources of support. During negative encounters, widows experienced feelings of disappointment; and when their psychosocial support needs were met, they experienced a sense of happiness and a positive level of satisfaction.
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Affiliation(s)
- Gopolang Sekgobela
- Department of Nursing Science, University of Pretoria, Pretoria, South Africa
| | - Mmapheko Peu
- Department of Nursing Science, University of Pretoria, Pretoria, South Africa
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Ennis J, Majid U. "Death from a broken heart": A systematic review of the relationship between spousal bereavement and physical and physiological health outcomes. DEATH STUDIES 2019; 45:538-551. [PMID: 31535594 DOI: 10.1080/07481187.2019.1661884] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The loss of a loved one is often associated with "death from a broken heart" for the survivor, and there is evidence that shows that widowers and widows are at risk for higher morbidity and mortality than the general population. This systematic review will summarize the physical and physiological health outcomes of spousal bereavement. A systematic database search was conducted, and 38 studies were analyzed. The majority of studies found a statistically significant and positive association between spousal bereavement and adverse physical and physiological health outcomes such as inflammation, cardiovascular risk, chronic pain, and mortality.
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Affiliation(s)
- Jeffrey Ennis
- Ennis Centre for Pain Management, Hamilton, Canada
- Department of Medicine, McMaster University, Hamilton, Canada
| | - Umair Majid
- Ennis Centre for Pain Management, Hamilton, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
- Division of Clinical Decision-Making and Healthcare, University Health Network, Toronto, Canada
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Li YP, Lin HS. Widowhood and health in late life: does health change before or after widowhood in older Taiwanese men and women? J Women Aging 2019; 32:684-699. [DOI: 10.1080/08952841.2019.1618128] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Yueh-Ping Li
- Department of Nursing, National Tainan Junior College of Nursing, Tainan City, Taiwan, ROC
| | - Huey-Shyan Lin
- Department of Health-Business Administration, Dean, Office of Student Affairs, Fooyin University, Kaohsiung city, Taiwan, ROC
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Lin IF, Brown SL, Wright MR, Hammersmith AM. Depressive Symptoms Following Later-life Marital Dissolution and Subsequent Repartnering. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2019; 60:153-168. [PMID: 30957562 PMCID: PMC6565490 DOI: 10.1177/0022146519839683] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
The doubling of the divorce rate among individuals over age 50 during the past 20 years underscores the urgency of studying the consequences of gray divorce and subsequent repartnering for adult well-being. We filled this gap by using the 1998-to-2014 Health and Retirement Study to evaluate how the levels of depressive symptoms changed following gray divorce versus widowhood. Individuals who divorced or became widowed already had experienced higher levels of depressive symptoms before dissolution relative to those who remained married. Compared with those who became widowed, those who transitioned to divorce experienced a lower elevation and a shorter time to recovery in depressive symptoms. When repartnering, both groups experienced similar magnitudes of initial reduction and subsequent rates of increase. Both the negative consequences of marital dissolution and the beneficial effects of repartnership for mental health persisted for several years, although ultimately they reverted to their predissolution levels of depressive symptoms.
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Affiliation(s)
- I-Fen Lin
- 1 Bowling Green State University, Bowling Green, OH, USA
| | - Susan L Brown
- 1 Bowling Green State University, Bowling Green, OH, USA
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Lee Y, Chi I, A Palinkas L. Widowhood, leisure activity engagement, and cognitive function among older adults. Aging Ment Health 2019; 23:771-780. [PMID: 29634291 DOI: 10.1080/13607863.2018.1450837] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVES Maintaining cognitive function is an essential aspect of successful aging. Widowhood is a salient life transition that can affect older adults' cognitive function. Leisure engagement has received increasing attention because it is still modifiable in later life to help prevent cognitive decline. Nonetheless, limited longitudinal studies have examined how widowhood influences cognitive function, and even fewer studies have tested the role of leisure activities in this relationship. METHOD This study delineated the mechanism of widowhood, leisure activity engagement, and cognitive function among older adults using a national longitudinal dataset, the Health and Retirement Study, and its supplementary dataset, the Consumption and Activities Mail Survey, which repeatedly measured individuals' leisure activity engagement. RESULTS Findings showed no significant association between widowhood and cognitive function during a 4-year period. However, engagement in mental activities moderated the impact of widowhood on cognitive function. Specifically, the benefit of mental activity engagement on cognition was more pronounced among individuals who were recently widowed compared to those who were married. This implies a protective role of mental activities in the relationship between widowhood and cognitive function. CONCLUSION Interventions with mentally stimulating activities at the community level to retain cognition among individuals in early phase widowhoodare suggested. Future studies are necessary to explore whether other factors such as changes in physical and mental health and intergenerational support from adult children during widowhood may further influence this mechanism among widowhood, leisure activities, and cognitive function.
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Affiliation(s)
- Yura Lee
- a Department of Social Work , Helen Bader School of Social Welfare , University of Wisconsin-Milwaukee , Milwaukee , Wisconsin, United States
| | - Iris Chi
- b Suzanne Dworak-Peck School of Social Work , University of Southern California , Los Angeles , California , United States
| | - Lawrence A Palinkas
- b Suzanne Dworak-Peck School of Social Work , University of Southern California , Los Angeles , California , United States
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Ornstein KA, Wolff JL, Bollens-Lund E, Rahman OK, Kelley AS. Spousal Caregivers Are Caregiving Alone In The Last Years Of Life. Health Aff (Millwood) 2019; 38:964-972. [PMID: 31158025 PMCID: PMC6760240 DOI: 10.1377/hlthaff.2019.00087] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Caregiving in the last years of life is associated with increased depression and negative health outcomes for surviving spouses, many of whom are themselves in poor health. Yet it is unclear how often spouses are caregiving alone, how they differ from supported spouses, and whether lack of support affects postbereavement outcomes. We hypothesized that spouses who were solo caregivers-that is, the only caregivers (paid or unpaid) who provided assistance with a spouse's self-care or household activities-would experience more depression after bereavement than supported spouses would. Using information from the Health and Retirement Study, we found that 55 percent of the spouses of community-dwelling married people with disability were solo caregivers. Solo caregiving was even common among people who cared for spouses with dementia and those with adult children living close by. Bereavement outcomes did not differ between solo and supported caregiving spouses. Caregiving spouses are often isolated and may benefit from greater support, particularly during the final years before bereavement. While some state and federal policy proposals aim to systematically recognize and assess caregivers, further innovations in care delivery and reimbursement are needed to adequately support seriously ill older adults and their caregivers. Ultimately, the focus of serious illness care must be expanded from the patient to the family unit.
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Affiliation(s)
- Katherine A Ornstein
- Katherine A. Ornstein ( ) is an assistant professor in the Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, in New York City
| | - Jennifer L Wolff
- Jennifer L. Wolff is a professor of public health at Johns Hopkins University, in Baltimore, Maryland
| | - Evan Bollens-Lund
- Evan Bollens-Lund is an analyst in the Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai
| | - Omari-Khalid Rahman
- Omari-Khalid Rahman is an analyst in the Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai
| | - Amy S Kelley
- Amy S. Kelley is an associate professor in the Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai
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Ornstein K, Garrido MM, Siu AL, Bollens-Lund E, Rahman OK, Kelley AS. An Examination of Downstream Effects of Bereavement on Healthcare Utilization for Surviving Spouses in a National Sample of Older Adults. PHARMACOECONOMICS 2019; 37:585-596. [PMID: 30864065 PMCID: PMC6465109 DOI: 10.1007/s40273-019-00787-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
BACKGROUND While bereavement is associated with increased mortality, it is unclear how bereaved families utilize the healthcare system after the death of their loved ones. OBJECTIVE The aim of this study was to examine the association between bereavement and healthcare expenditures for surviving spouses. METHODS We used data from the Health and Retirement Study, a nationally representative cohort study of older adults linked to Medicare claims. We determined a spouse's total Medicare expenditures 2 years before and after their partner's death across six biennial interview waves. Using coarsened exact matching, we created a comparison group of non-bereaved dyads. Costs were wage index- and inflation-adjusted to 2017 dollars. We used generalized linear models and difference-in-differences (DID) analysis to calculate the average marginal effects of bereavement on Medicare spending by gender. We also examined subgroup differences based on caregiver status, cause of death, and length of terminal illness. RESULTS Our sample consisted of 941 bereaved dyads and a comparison group of 8899 matched dyads. Surviving female spouses (68% of the sample) had a $3500 increase in spending 2 years after death (p < 0.05). Using DID analyses, bereavement was associated with a $625 quarterly increase in Medicare expenditures over 2 years for women. There was no significant increase in post-death spending for male bereaved surviving spouses. Results were consistent for spouses who survived at least 2 years after the death of their spouse (70% of the sample) CONCLUSIONS: Bereavement is associated with increased healthcare spending for women regardless of their caregiving status, the cause of death, or length of terminal illness. Further study is required to examine why men and women have different patterns of healthcare spending relative to the death of their spouses.
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Affiliation(s)
- Katherine Ornstein
- Department of Geriatrics and Palliative Medicine, Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, Box 1070, One Gustave Levy Place, New York, NY 10029, , Ph: 212-659-5555/ F: 212-849-2566
| | - Melissa M. Garrido
- Department of Health Law, Policy and Management, Boston VA Healthcare System, Boston University School of Public Health, 150 S. Huntington Ave, Boston, MA 02130, , 617-819-5198
| | - Albert L. Siu
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, Box 1070, One Gustave Levy Place, New York, NY 10029, , Ph: 212-241-4290
| | - Evan Bollens-Lund
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, Box 1070, One Gustave Levy Place, New York, NY 10029, , Ph: 212-241-3160
| | - Omari-Khalid Rahman
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, Box 1070, One Gustave Levy Place, New York, NY 10029, , Ph: 212-241-3160
| | - Amy S. Kelley
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, Box 1070, One Gustave Levy Place, New York, NY 10029, , Ph: 212-241-1446
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Escolar-Pujolar A, Córdoba Doña JA, Goicolea Julían I, Rodríguez GJ, Santos Sánchez V, Mayoral Sánchez E, Aguilar Diosdado M. The effect of marital status on social and gender inequalities in diabetes mortality in Andalusia. ACTA ACUST UNITED AC 2017; 65:21-29. [PMID: 29233513 DOI: 10.1016/j.endinu.2017.10.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Revised: 09/21/2017] [Accepted: 10/01/2017] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To assess the modifying effect of marital status on social and gender inequalities in mortality from diabetes mellitus (DM) in Andalusia. MATERIAL AND METHODS A cross-sectional study was conducted using the Andalusian Longitudinal Population Database. DM deaths between 2002 and 2013 were analyzed by educational level and marital status. Age-adjusted rates (AARs) and mortality rate ratios (MRRs) were calculated using Poisson regression models, controlling for several social and demographic variables. The modifying effect of marital status on the association between educational level and DM mortality was evaluated by introducing an interaction term into the models. All analyses were performed separately for men and women. RESULTS There were 18,158 DM deaths (10,635 women and 7,523 men) among the 4,229,791 people included in the study. The risk of death increased as the educational level decreased. Marital status modified social inequality in DM mortality in a different way in each sex. Widowed and separated/divorced women with the lowest educational level had the highest MRRs, 5,1 (95%CI: 3,6-7,3) and 5,6 (95% CI:3,6-8,5) respectively, while single men had the highest MRR, 3,1 (95%CI: 2,7-3,6). CONCLUSIONS Educational level is a key determinant of DM mortality in both sexes, and is more relevant in women, while marital status also plays an outstanding role in men. Our results suggest that in order to address inequalities in DM mortality, the current focus on individual factors and self-care should be extended to interventions on the family, the community, and the social contexts closest to patients.
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Affiliation(s)
- Antonio Escolar-Pujolar
- Consejería de Salud de la Junta de Andalucía, Delegación Territorial en Cádiz, Cádiz, España.
| | | | | | | | - Vanesa Santos Sánchez
- Dipartamenti di Scienze Economiche e Aziendali, Università degli Studi di Sassari, Sassari, Cerdeña, Italia
| | | | - Manuel Aguilar Diosdado
- Servicio de Endocrinología y Nutrición, Hospital Universitario Puerta del Mar, Servicio Andaluz de Salud, Cádiz, España
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Dunlay SM, Roger VL, Weston SA, Bangerter LR, Killian JM, Griffin JM. Patient and Spousal Health and Outcomes in Heart Failure. Circ Heart Fail 2017; 10:CIRCHEARTFAILURE.117.004088. [PMID: 29030371 DOI: 10.1161/circheartfailure.117.004088] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 09/12/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND A diagnosis of heart failure (HF) often requires a comprehensive lifestyle change to maintain disease stability. When patients with HF are married, the spouse frequently assumes the caregiving role. Our objectives were to describe the health of spouses of married patients with HF, and examine whether the health of a spouse impacts patient outcomes. METHODS AND RESULTS We identified 905 patients that were married at the time of incident HF diagnosis in Olmsted County, MN, from 2000 to 2012. Using Rochester Epidemiology Project resources, the patient and their spouse's comprehensive longitudinal health histories were linked. Spousal health at patient HF diagnosis was assessed by comorbidity burden, self-reported difficulty with activities of daily living and prior hospitalizations. The associations of spousal health with patient outcomes and patient death with spousal outcomes were examined using Cox and Andersen-Gill models. Spouses of patients with HF were elderly (mean age, 71 years), often had comorbid conditions, and 16% had difficulty with ≥1 activities of daily living. After adjustment for patient age, sex, and comorbidity, there were no independent associations of spousal health and patient risk of death or hospitalization after HF diagnosis. However, the risk of hospitalization (adjusted hazard ratio, 1.34; 95% confidence interval, 1.11-1.60; P=0.002) and death (hazard ratio, 2.10; 95% confidence interval, 1.60-2.75; P<0.001) increased in the surviving spouse after patient death. CONCLUSIONS We found no evidence that the health of a spouse impacts patient outcomes after HF diagnosis. However, after a patient with HF dies, their surviving spouse's risk of hospitalization and death increases.
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Affiliation(s)
- Shannon M Dunlay
- From the Department of Cardiovascular Diseases (S.M.D., V.L.R.) and Department of Health Sciences Research (S.M.D., V.L.R., S.A.W., L.R.B., J.M.G., J.M.K.), Mayo Clinic, Rochester, MN.
| | - Véronique L Roger
- From the Department of Cardiovascular Diseases (S.M.D., V.L.R.) and Department of Health Sciences Research (S.M.D., V.L.R., S.A.W., L.R.B., J.M.G., J.M.K.), Mayo Clinic, Rochester, MN
| | - Susan A Weston
- From the Department of Cardiovascular Diseases (S.M.D., V.L.R.) and Department of Health Sciences Research (S.M.D., V.L.R., S.A.W., L.R.B., J.M.G., J.M.K.), Mayo Clinic, Rochester, MN
| | - Lauren R Bangerter
- From the Department of Cardiovascular Diseases (S.M.D., V.L.R.) and Department of Health Sciences Research (S.M.D., V.L.R., S.A.W., L.R.B., J.M.G., J.M.K.), Mayo Clinic, Rochester, MN
| | - Jill M Killian
- From the Department of Cardiovascular Diseases (S.M.D., V.L.R.) and Department of Health Sciences Research (S.M.D., V.L.R., S.A.W., L.R.B., J.M.G., J.M.K.), Mayo Clinic, Rochester, MN
| | - Joan M Griffin
- From the Department of Cardiovascular Diseases (S.M.D., V.L.R.) and Department of Health Sciences Research (S.M.D., V.L.R., S.A.W., L.R.B., J.M.G., J.M.K.), Mayo Clinic, Rochester, MN
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A pilot study of virtual support for grief: Feasibility, acceptability, and preliminary outcomes. COMPUTERS IN HUMAN BEHAVIOR 2017. [DOI: 10.1016/j.chb.2017.04.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Myroniuk TW. Marital Dissolutions and the Health of Older Individuals in a Rural African Context. J Gerontol B Psychol Sci Soc Sci 2017; 72:656-664. [PMID: 27382043 PMCID: PMC5927165 DOI: 10.1093/geronb/gbw077] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 06/13/2016] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES Research from high-income countries has often found a negative relationship between marital dissolutions and health. This paper assesses that relationship among older sub-Saharan Africans, on a now-aging continent. Such individuals are likely to be at risk of a dissolution, or have already experienced one, due to high rates of marriage. METHODS Data from over 1,200 rural Malawians, age 45+, are employed from the 2008 and 2010 waves of the Malawi Longitudinal Study of Families and Health. Cross-sectional and lagged dependent variable regressions examine the relationship between marital dissolutions and 4 measures of self-reported health: retrospective health, relative health (compared with others in one's village), and age-standardized SF-12 mental and physical health scales. RESULTS Worse relative, mental, and physical health are associated with being currently divorced/widowed compared with being married. However, worse retrospective health is linked to becoming divorced/widowed between 2008 and 2010. Those divorced/widowed prior to 2008, and who remained so through 2010, are in worse relative and physical health. DISCUSSION The findings question the relative hardship of marital dissolutions for those who have managed to survive into old age, and call for the collection of more detailed longitudinal data on older Africans on this topic.
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Affiliation(s)
- Tyler W Myroniuk
- Department of Sociology and Anthropology, George Mason University, Fairfax, Virginia
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Chen F, Bao L, Shattuck RM, Borja JB, Gultiano S. Implications of Changes in Family Structure and Composition for the Psychological Well-Being of Filipino Women in Middle and Later Years. Res Aging 2016; 39:275-299. [PMID: 26475652 DOI: 10.1177/0164027515611181] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The health implications of multigenerational coresidence for older adults is a well-researched topic in the aging literature. Much less is known of its impact for women in midlife. We used data from the Cebu Longitudinal Health and Nutrition Study (2002, 2005, 2007, and 2012) to study the influence of transitions in multigenerational household composition on depressive symptoms for women in midlife transitioning into old age. Our initial analysis showed little effect when we use the conventional classification of nuclear versus extended family and transition in and out of extended family. When we described shifts in the family environment by compositional changes, that is, change in the presence and absence of particular family members, we found significant association between depressive symptoms and two types of role transitions: the loss of a spouse in the household and the entry and exit of grandchildren in the household.
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Affiliation(s)
- Feinian Chen
- 1 Department of Sociology, Maryland Population Research Center, University of Maryland, College Park, MD, USA
| | - Luoman Bao
- 1 Department of Sociology, Maryland Population Research Center, University of Maryland, College Park, MD, USA
| | - Rachel M Shattuck
- 1 Department of Sociology, Maryland Population Research Center, University of Maryland, College Park, MD, USA
| | - Judith B Borja
- 2 USC-Office of Population Studies Foundation, University of San Carlos, Cebu City, Philippines
| | - Socorro Gultiano
- 2 USC-Office of Population Studies Foundation, University of San Carlos, Cebu City, Philippines
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Brenn T, Ytterstad E. Increased risk of death immediately after losing a spouse: Cause-specific mortality following widowhood in Norway. Prev Med 2016; 89:251-256. [PMID: 27311340 DOI: 10.1016/j.ypmed.2016.06.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 04/25/2016] [Accepted: 06/12/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE This paper examines the short-term risk of cause-specific death following widowhood. METHOD We followed all individuals registered as married in Norway in 1975 for marital status and mortality until 2006. Widowed individuals were followed for mortality for 7years following widowhood. Causes of death were categorized into five cause-groups. Life tables were used in survival analyses. RESULTS Deaths among the widowed were most frequent in the week following widowhood. In this week and compared to married individuals, there were more deaths including those from malignant cancer in men (hazard ratio (HR) of 1.51; 95% CI: 1.12, 1.89), from external causes in men (HR=3.64; 95% CI: 2.01, 5.28), and from respiratory diseases (HR=2.18; 95% CI: 1.52, 2.84 in men and HR=3.18; 95% CI: 2.26, 4.09 in women). A majority of respiratory deaths were from pneumonia. Thereafter excess mortality among the widowed dropped gradually. Although these numbers stabilized, they were still elevated in year 7. Excess mortality was particularly high in the youngest age group considered (55-64years) and decreased with age, though more so in men than in women. Only a few more widowed individuals than expected died of a condition in the same cause-group as their spouses. CONCLUSION A novel finding was that excess deaths in the week following widowhood also were from cancer and respiratory diseases. Men in the youngest age group seemed most vulnerable. Prevention should be considered directly after the death of a spouse, and measures should be aimed at virtually all causes of death.
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Affiliation(s)
- Tormod Brenn
- Department of Community Medicine, UiT The Arctic University of Norway, N-9037 Tromsø, Norway.
| | - Elinor Ytterstad
- Department of Mathematics and Statistics, UiT The Arctic University of Norway, N-9037 Tromsø, Norway.
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Fenelon A, Danielsen S. Leaving my religion: Understanding the relationship between religious disaffiliation, health, and well-being. SOCIAL SCIENCE RESEARCH 2016; 57:49-62. [PMID: 26973031 PMCID: PMC4792192 DOI: 10.1016/j.ssresearch.2016.01.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 12/28/2015] [Accepted: 01/22/2016] [Indexed: 05/28/2023]
Abstract
Religious disaffiliation-leaving the religious tradition in which one was raised for no religious affiliation in adulthood-has become more common in recent years, though few studies have examined its consequences for the health and well-being of individuals. We use an innovative approach, comparing the health and subjective well-being of religious disaffiliates to those who remain affiliated using pooled General Social Survey samples from 1973 through 2012. We find that religious disaffiliates experience poorer health and lower well-being than those consistently affiliated and those who are consistently unaffiliated. We also demonstrate that the disadvantage for those who leave religious traditions is completely mediated by the frequency of church attendance, as disaffiliates attend church less often. Our results point to the importance of the social processes surrounding religious disaffiliation and emphasize the role of dynamics in the relationship between religious affiliation and health.
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Affiliation(s)
- Andrew Fenelon
- National Center for Health Statistics, Office of Analysis and Epidemiology, Hyattsville, MD, USA.
| | - Sabrina Danielsen
- Department of Cultural and Social Studies, Creighton University, USA.
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Lohman M, Dumenci L, Mezuk B. Depression and Frailty in Late Life: Evidence for a Common Vulnerability. J Gerontol B Psychol Sci Soc Sci 2015; 71:630-40. [PMID: 25617399 DOI: 10.1093/geronb/gbu180] [Citation(s) in RCA: 97] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Accepted: 12/02/2014] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The study purpose is to estimate the correlation between depression and competing models of frailty, and to determine to what degree the comorbidity of these syndromes is determined by shared symptomology. METHODS Data come from the 2010 Health and Retirement Study. Analysis was limited to community-dwelling participants 65 and older (N = 3,453). Depressive symptoms were indexed by the 8-item Centers for Epidemiologic Studies Depression (CESD) scale. Frailty was indexed by 3 alternative conceptual models: (a) biological syndrome, (b) frailty index, and (c) functional domains. Confirmatory factor analysis (CFA) was used to estimate the correlation between depression and each model of frailty. RESULTS Each of the 3 frailty latent factors was significantly correlated with depression: biological syndrome (ρ = .68, p < .01), functional domains (ρ = .70, p < .01), and frailty index (ρ = .61, p < .01). Substantial correlation remained when accounting for shared symptoms between depression and the biological syndrome (ρ = .45) and frailty index (ρ = .56) models. DISCUSSION Results indicate that the correlation of frailty and depression in late life is substantial. The association between the two constructs cannot be fully explained by symptom overlap, suggesting that psychological vulnerability may be an important component of frailty.
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Affiliation(s)
- Matthew Lohman
- Department of Psychiatry, Institute of Geriatric Psychiatry, Weill Cornell Medical College, White Plains, New York.
| | | | - Briana Mezuk
- Department of Family Medicine and Population Health, Division of Epidemiology, Virginia Commonwealth University School of Medicine, Richmond
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Cheng Y, Grühn D. Age Differences in Reactions to Social Rejection: The Role of Cognitive Resources and Appraisals. J Gerontol B Psychol Sci Soc Sci 2014; 70:830-9. [PMID: 24870029 DOI: 10.1093/geronb/gbu054] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Accepted: 04/15/2014] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Social rejection is a negative social experience individuals of all ages may encounter in everyday life. It is unclear whether social rejection affects older adults more or less than younger adults. This study investigated age differences in reactions following a direct rejection and the moderating effects of cognitive resources and appraisals. METHOD Eighty-three younger (18-26 years) and 53 older (60-86 years) adults engaged in an online interview during which they were either accepted or rejected seemingly by another participant. We examined participants' self-reported mood before and after the interview as well as verbal self-complexity. RESULTS Older adults reported greater increases in hurt feelings following rejection than younger adults. The age difference was further moderated by cognitive resources and appraisals. Among older rejected adults, those who were poorer in processing speed and those who appraised the rejection more negatively felt more hurt feelings. Older rejected adults were also rated lower in self-complexity than older accepted adults, whereas younger rejected adults and accepted adults did not differ. DISCUSSION The findings are largely consistent with life-span developmental theories and highlight the importance of cognitive processes when examining age differences in experiencing social rejection.
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Affiliation(s)
- Yanhua Cheng
- Department of Psychology, North Carolina State University, Raleigh.
| | - Daniel Grühn
- Department of Psychology, North Carolina State University, Raleigh
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