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Min J, Song J. Spousal loss and cognitive function: the importance of gender and multiple dimensions of marital quality. Aging Ment Health 2023; 27:755-764. [PMID: 35696361 PMCID: PMC10041968 DOI: 10.1080/13607863.2022.2084715] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 05/28/2022] [Indexed: 11/01/2022]
Abstract
Objectives: Research suggests that the death of a spouse has an adverse effect on a widow(er)'s cognition. However, little research has examined how the marital context before widowhood and gender influence this association. Guided by the social ambivalence and disease (SAD) model, this study examined the associations between spousal loss and cognition , with moderating effects of gender and pre-loss marital quality.Method: We analyzed a national longitudinal data, Midlife in the United States (MIDUS), specifically MIDUS 2 (2004-2005) and MIDUS 3 (2013-2014). The analytic sample consisted of (1) 146 participants who experienced the death of their spouse between MIDUS 2 and MIDUS 3 and (2) 144 age- and gender-matched comparison participants who did not lose their spouse during the period.Results: Adverse influence of widowhood on cognition was more pronounced among bereaved men than bereaved women. Widowed individuals whose relationships with their deceased spouse were ambivalent had poorer cognition than widowed individuals who had aversive relationships with their deceased spouse.Conclusion: Findings suggest that the influence of spousal death on cognitive functioning depends on gender and pre-loss marital quality, emphasizing the importance of considering pre-loss marital relationship and gender dynamics in developing efficient interventions for the widowed.
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Affiliation(s)
- Joohong Min
- Faculty of Human Ecology and Welfare, Faculty of Data
Science for Sustainable Growth, Jeju National University, Jeju, South Korea
| | - Jieun Song
- institute on Aging, University of Wisconsin-Madison, WI,
USA
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2
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Jain U, Liu H, Langa KM, Farron M, Kabeto M, Lee J. Widowhood and cognition among older women in India: New insights on widowhood duration and mediators. SSM Popul Health 2022; 19:101242. [PMID: 36193099 PMCID: PMC9525895 DOI: 10.1016/j.ssmph.2022.101242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 09/22/2022] [Accepted: 09/25/2022] [Indexed: 01/10/2023] Open
Abstract
Background Widowhood, a marital status that disproportionately affects older women, has been associated with poorer health compared to married individuals. However, relatively little is known about the association between widowhood in later-life and cognitive health in low- and middle-income countries. Methods To address this research gap, we used data from the Longitudinal Aging Study in India (2017-19) to investigate the widowhood disparity in cognitive health among mid-aged and older women in India, including how this relationship varies by the duration of widowhood. We further examined the extent to which economic, social, and health conditions mediate this association. Results Cognition scores for widowed women were on average lower by almost 0.1 standard deviations compared to married women. Overall, this disparity increased with widowhood duration, with non-linearities in this association. The disparity in cognition scores increased with widowhood duration up to twenty years but did not increase further among those with longer widowhood duration. Worse physical and mental health were found to mediate almost thirty percent of the total association between widowhood and cognition. These mediators were most useful in explaining the association between lower cognition and widowhood among women who experienced widowhood for ten years or longer. Conclusion The study highlights the significant disadvantage in cognitive functioning among older widowed women in India. The study also provides evidence on potential mediators, suggesting differential effects of mediators at different stages of widowhood.
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Affiliation(s)
- Urvashi Jain
- Department of Economics, Finance and Real Estate, Mitchell College of Business, University of South Alabama, USA
| | - Hui Liu
- Department of Sociology, Michigan State University, USA
| | - Kenneth M. Langa
- Department of Internal Medicine, Institute for Social Research, and VA Center for Clinical Management Research, University of Michigan, USA
| | - Madeline Farron
- Department of Internal Medicine, University of Michigan, USA
| | - Mohammed Kabeto
- Department of Internal Medicine, University of Michigan, USA
| | - Jinkook Lee
- Center for Economic and Social Research, and Department of Economics, University of Southern California, USA
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Barragán-García M, Ramírez-Aldana R, López-Ortega M, Sánchez-García S, García-Peña C. Widowhood Status and Cognitive Function in Community-Dwelling Older Adults from the Mexican Health and Aging Study (MHAS). JOURNAL OF POPULATION AGEING 2022; 15:605-622. [PMID: 37800095 PMCID: PMC10554834 DOI: 10.1007/s12062-020-09322-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 12/17/2020] [Indexed: 10/22/2022]
Abstract
We aimed to determine the association between the duration of widowhood and cognition decline. We compared the decline observed in widowed people compared with married, single, or separated persons using the scores obtained in the cognitive assessment of memory, learning, and visual exploration by adults and older adults in Mexico. The Mexican Health and Aging Study (MHAS) provides the base for this paper. This study is an analysis of the fourth data wave (2015), except for the independent variable: marital status. Marital status was built longitudinally with information from the four surveys (2001, 2003, 2012, and 2015). The sample comprised 6898 adults aged 50 and over. Cognition was assessed with an adapted Cross-Cultural Cognitive Examination (CCCE). Confounders include sociodemographic characteristics (sex, age, schooling, self-perception of economic status, and whether the individual worked or not), multimorbidity, functionality, support networks, and psychological characteristics. Of the total sample, 4094 (59.3%) were women. The mean age was 70.86 years (SD = 7.4). The baseline of the study is 2001. In 2001, 8.7% (n = 600) were widows or widowers. People widowed by 2001 scored -0.158 points in cognition while divorced participants scored - 0.095 points.
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Affiliation(s)
- Mariana Barragán-García
- Instituto Nacional de Geriatría, México, Periférico Sur No. 2767, Col. San Jeronimo Lidice, Del. La Magdalena Contreras, 10200 Ciudad de México, Mexico
| | - Ricardo Ramírez-Aldana
- Instituto Nacional de Geriatría, México, Periférico Sur No. 2767, Col. San Jeronimo Lidice, Del. La Magdalena Contreras, 10200 Ciudad de México, Mexico
| | - Mariana López-Ortega
- Instituto Nacional de Geriatría, México, Periférico Sur No. 2767, Col. San Jeronimo Lidice, Del. La Magdalena Contreras, 10200 Ciudad de México, Mexico
| | - Sergio Sánchez-García
- Unidad de Investigación Epidemiológica y en Servicios de Salud. Área Envejecimiento, Mexican Social Security Institute, Avenida Cuauhtémoc No. 330. Edificio CORCE, Tercer piso. Col. Doctores. Alcaldía Cuauhtémoc, 06720 Ciudad de México, Mexico
| | - Carmen García-Peña
- Instituto Nacional de Geriatría, México, Periférico Sur No. 2767, Col. San Jeronimo Lidice, Del. La Magdalena Contreras, 10200 Ciudad de México, Mexico
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Kung CSJ, Pudney SE, Shields MA. Economic gradients in loneliness, social isolation and social support: Evidence from the UK Biobank. Soc Sci Med 2022; 306:115122. [PMID: 35751988 DOI: 10.1016/j.socscimed.2022.115122] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 05/28/2022] [Accepted: 06/07/2022] [Indexed: 10/18/2022]
Abstract
Despite the substantial literature on how loneliness is associated with poor health and premature mortality, there is little detailed research on the extent of its economic gradients. We provide this evidence using a sample of around 400,000 respondents aged 40-70 years from the UK Biobank, who were assessed between 2006 and 2010. We focus on differences in loneliness, as well as social isolation and a lack of social support, across educational attainment, household income, local area deprivation, and recent experience of financial stress. We employ two statistical approaches, the first exploiting the large sample size and detailed geographical information about where respondents live, so we compare individuals who differ in their economic status but reside within the same postcode district. The second approach exploits the fact that for around 36,000 respondents we observe their social health and economic circumstances at two points in time (second wave of assessment conducted between 2014 and 2020), so we conduct a panel analysis that accounts for intercorrelations between the social health measures, and controls for incomplete follow-up of panel members. Across both approaches, we find a substantially higher probability of reporting loneliness, social isolation and a lack of social support, for men and women with lower economic status. Together with the existing health-loneliness literature, these findings establish a 'loneliness pathway' contributing to health inequalities, and consequently a need for effective interventions that might address loneliness and social isolation as part of a broad policy initiative on health inequalities.
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Affiliation(s)
- Claryn S J Kung
- Research Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK.
| | - Stephen E Pudney
- School of Health and Related Research, University of Sheffield, 30 Regent Street, Sheffield, S1 4DA, UK
| | - Michael A Shields
- Centre for Health Economics, Monash University, 900 Dandenong Road, Caulfield East, VIC, 3145, Australia
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Wang H, Smith-Greenaway E, Bauldry S, Margolis R, Verdery AM. Mourning in a Pandemic: The Differential Impact of COVID-19 Widowhood on Mental Health. J Gerontol B Psychol Sci Soc Sci 2022; 77:2306-2316. [PMID: 35753008 PMCID: PMC9278192 DOI: 10.1093/geronb/gbac085] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES The death of a spouse is an established predictor of mental health decline that foreshadows worsening physical health and elevated mortality. The millions widowed by COVID-19 worldwide may experience even worse health outcomes than comparable pre-pandemic widows given the particularities of dying, mourning, and grieving during a pandemic defined by protracted social isolation, economic precarity, and general uncertainty. If COVID-19 pandemic bereavement is more strongly associated with mental health challenges than pre-pandemic bereavement, the large new cohort of COVID-19 widow(er)s may be at substantial risk of downstream health problems long after the pandemic abates. METHODS We pooled population-based Survey of Health, Ageing and Retirement in Europe data from 27 countries for two distinct periods: (1) pre-pandemic (Wave 8, fielded October 2019-March 2020; N = 46,266) and (2) early pandemic (COVID Supplement, fielded June-August 2020; N = 55,796). The analysis used a difference-in-difference design to assess whether a spouse dying from COVID-19 presents unique mental health risks (self-reported depression, loneliness, and trouble sleeping), compared with pre-pandemic recent spousal deaths. RESULTS We find strong associations between recent spousal death and poor mental health before and during the pandemic. However, our difference-in-difference estimates indicate those whose spouses died of COVID-19 have higher risks of self-reported depression and loneliness, but not trouble sleeping, than expected based on pre-pandemic associations. DISCUSSION These results highlight that the millions of COVID-19 widow(er)s face extreme mental health risks, eclipsing those experienced by surviving spouses pre-pandemic, furthering concerns about the pandemic's lasting impacts on health.
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Affiliation(s)
- Haowei Wang
- Population Research Institute, Department of Sociology and Criminology, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Emily Smith-Greenaway
- Department of Sociology, University of Southern California, Los Angeles, California, USA
| | - Shawn Bauldry
- Department of Sociology, Purdue University, West Lafayette, Indiana, USA
| | - Rachel Margolis
- Department of Sociology, University of Western Ontario, London, Ontario, Canada
| | - Ashton M Verdery
- Address correspondence to: Ashton M. Verdery, PhD, Population Research Institute, Department of Sociology and Criminology, The Pennsylvania State University, Oswald Tower, University Park, PA 16802, USA. E-mail:
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Zhang Z, Liu H, Zhang Y. Marital Loss and Cognitive Function: Does Timing Matter? J Gerontol B Psychol Sci Soc Sci 2022; 77:1916-1927. [PMID: 35512289 PMCID: PMC9535775 DOI: 10.1093/geronb/gbac069] [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: 09/14/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES This study examines the association between age at marital loss (i.e., divorce or widowhood) and cognitive function in later life and whether the association differs by gender. METHODS We used mixed-effects models, drawing on longitudinal data from the Health and Retirement Study (1998-2016). The analytical samples included older adults aged 51 and older who had ever been widowed (N=5,639 with 25,537 person-waves) or divorced (N=10,685 with 50,689 person-waves). RESULTS We find that those who were widowed at younger ages had lower cognitive function than their counterparts who were widowed at older ages, for both men and women, after controlling for covariates. Household income and health-related factors partially accounted for the positive association between age at widowhood and cognitive function. Those who divorced at younger ages also had lower cognitive function than their counterparts who divorced at older ages, but this association was only present among men, not women. Health-related factors partially accounted for the associations between age at divorce and cognitive function among men. DISCUSSION Findings highlight the importance of considering the role of timing of marital loss in cognitive health among older adults.
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Affiliation(s)
- Zhenmei Zhang
- Address correspondence to: Zhenmei Zhang, PhD, Department of Sociology, Michigan State University, 509 East Circle Drive, 316 Berkey Hall, East Lansing, MI 48824-1111, USA. E-mail:
| | - Hui Liu
- Department of Sociology, Michigan State University, East Lansing, Michigan, USA
| | - Yan Zhang
- Center for Demography of Health and Aging, University of Wisconsin-Madison, Madison, Wisconsin, USA
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Freak-Poli R, Kung CSJ, Ryan J, Shields MA. Social Isolation, Social Support, and Loneliness Profiles Before and After Spousal Death and the Buffering Role of Financial Resources. J Gerontol B Psychol Sci Soc Sci 2022; 77:956-971. [PMID: 35373252 PMCID: PMC9071412 DOI: 10.1093/geronb/gbac039] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Indexed: 11/25/2022] Open
Abstract
Objectives We provide new evidence on the profiles of social isolation, social support, and loneliness before and after spousal death for older widows. We also examine the moderating effects of gender and financial resources on changes in social health before and after widowhood. Methods We use 19 waves of data from the Household, Income and Labour Dynamics in Australia Survey, including 749 widowed individuals and a comparison group of around 8,000 married individuals. We apply coarsened exact matching weights and control for age and time trends. Local polynomial smoothed plots show the profiles of social health from 3 years pre- to 3 years postspousal death. All analyses were stratified by gender. Results Spousal death was strongly associated with increased loneliness for women and men, but also an increase in interactions with friends and family not living with the bereaved. For men, financial resources (both income and asset wealth) provided some protection against loneliness. Spousal death was not associated with changes in social support or participation in community activities. Discussion We demonstrate that loneliness is a greater challenge of widowhood than social isolation or a lack of social support. Our findings suggest that interventions focusing only on increasing social interactions are unlikely to alleviate loneliness following spousal death. Moreover, policies that reduce the cost of formal social participation may have limited effectiveness in tackling loneliness, particularly for women. Alternative strategies, such as helping the bereaved form a new sense of identity and screening for loneliness around widowhood by health care workers, could be beneficial.
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Affiliation(s)
- Rosanne Freak-Poli
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Claryn S J Kung
- Centre for Health Economics, Monash Business School, Monash University, Melbourne, Victoria, Australia
| | - Joanne Ryan
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Michael A Shields
- Centre for Health Economics, Monash Business School, Monash University, Melbourne, Victoria, Australia
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Wu-Chung EL, Leal SL, Denny BT, Cheng SL, Fagundes CP. Spousal caregiving, widowhood, and cognition: A systematic review and a biopsychosocial framework for understanding the relationship between interpersonal losses and dementia risk in older adulthood. Neurosci Biobehav Rev 2022; 134:104487. [PMID: 34971701 PMCID: PMC8925984 DOI: 10.1016/j.neubiorev.2021.12.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 11/23/2021] [Accepted: 12/06/2021] [Indexed: 01/18/2023]
Abstract
Accumulating research suggests that stressful life events, especially those that threaten close intimate bonds, are associated with an increased risk of dementia. Grieving the loss of a spouse, whether in the form of caregiving or after the death, ranks among 'life's most significant stressors', evoking intense psychological and physiological distress. Despite numerous studies reporting elevated dementia risk or poorer cognition among spousal caregivers and widow(er)s compared to controls, no review has summarized findings across cognitive outcomes (i.e., dementia incidence, cognitive impairment rates, cognitive performance) or proposed a theoretical model for understanding the links between partner loss and abnormal cognitive decline. The current systematic review summarizes findings across 64 empirical studies. Overall, both cross-sectional and longitudinal studies revealed an adverse association between partner loss and cognitive outcomes. In turn, we propose a biopsychosocial model of cognitive decline that explains how caregiving and bereavement may position some to develop cognitive impairment or Alzheimer's disease and related dementias. More longitudinal studies that focus on the biopsychosocial context of caregivers and widow(er)s are needed.
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Affiliation(s)
| | | | - Bryan T. Denny
- Department of Psychological Sciences, Rice University, Houston, TX
| | | | - Christopher P. Fagundes
- Department of Psychological Sciences, Rice University, Houston, TX,Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX,Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, TX
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Shin SH, Behrens EA, Parmelee PA, Kim G. The Role of Purpose in Life in the Relationship Between Widowhood and Cognitive Decline Among Older Adults in the U.S. Am J Geriatr Psychiatry 2022; 30:383-391. [PMID: 34417084 DOI: 10.1016/j.jagp.2021.07.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 07/18/2021] [Accepted: 07/18/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The objective of this study was to examine the role of purpose in life in the relationship between widowhood and cognitive decline. METHODS This study used a sample of 12,856 respondents (20,408 observations) collected from a national panel survey, the 2006-2014 waves of the Health and Retirement Study (HRS), that sampled older adults aged 50 or older. The study estimated growth-curve models with years since spousal death, purpose in life, and interaction between the two to predict cognition using three measures-total cognition, fluid, and crystallized intelligence scores. We also estimated growth-curve models by sex, race/ethnicity, and education. RESULTS While years since spousal death negatively correlated with cognition, purpose in life positively correlated with cognition. Furthermore, purpose in life had a moderating effect on the relationship between years since spousal death and cognition. This effect was found by using total cognition (coef. = 0.0515; z = 2.64; p < 0.01) and fluid intelligence scores (coef. = 0.0576; z = 3.23; p < 0.05). The same effects were salient among females (coef. = 0.0556; z = 2.19; p < 0.05), Whites (coef. = 0.0526; z = 2.52; p < 0.05), and older adults with more education (coef. = 0.0635; z = 2.10; p < 0.05). CONCLUSION Higher purpose in life relates to the negative correlations between widowhood and cognition of older adults. Educational programs improving purpose in life are a possible avenue for reducing the adverse effect of widowhood on cognition and warrant future exploration.
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Affiliation(s)
- Su Hyun Shin
- Department of Family and Consumer Studies, University of Utah, UT
| | - Emily A Behrens
- Alabama Research Institute on Aging and Department of Psychology, The University of Alabama, AL
| | - Patricia A Parmelee
- Alabama Research Institute on Aging and Department of Psychology, The University of Alabama, AL
| | - Giyeon Kim
- Department of Psychology, Chung-Ang University, Seoul, South Korea.
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Yoon H, Park GR, Kim J. Psychosocial trajectories before and after spousal loss: Does gender matter? Soc Sci Med 2022; 294:114701. [PMID: 35007946 DOI: 10.1016/j.socscimed.2022.114701] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 11/28/2021] [Accepted: 01/04/2022] [Indexed: 10/19/2022]
Abstract
RATIONALE Prior studies have suggested that spousal loss can have negative impacts on widowed persons' lives. However, few studies have examined whether time since spousal loss is related to changes in psychosocial outcomes and there are gender differences in psychosocial trajectories in response to spousal loss. OBJECTIVE This study examines the psychosocial trajectories (depressive symptoms and social engagement) of widowed individuals before and after spousal death. This study also investigates whether psychosocial adjustment trajectories, among individuals who experienced spousal loss, are gendered. METHODS This study uses data from 685 middle- and older-aged adults over seven waves (4284 person-observations) of the Korean Longitudinal Study of Ageing spanning 12 years between 2006 and 2018. This study estimates fixed effects models to account for observed and unobserved individual-level heterogeneity. Gender-stratified fixed effects regression models are used to investigate whether psychosocial changes associated with spousal loss differ by gender. RESULTS Psychosocial adjustment to spousal loss is strikingly gendered. Among men, depressive symptoms began to increase within the first year following spousal loss and continued through the fourth and subsequent years. In contrast, depressive symptoms among widows did not change significantly during and after bereavement. Similar patterns were found for social engagement. Among men, a decrease in frequency of social interactions and participation in social activities was found from the first year of spousal loss to the fourth and subsequent years. No such patterns were found for women. CONCLUSION Spousal loss is a life event that spurs tremendous psychosocial changes for widowed people. This study suggests that spousal loss-associated psychosocial changes occur over a long period of time and are greater in men than in women.
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Affiliation(s)
- Heesoo Yoon
- Department of Health Policy and Management, Korea University, Seoul, Republic of Korea
| | - Gum-Ryeong Park
- Department of Health, Aging & Society, McMaster University, Hamilton, Ontario, Canada; Korea Institute for Health and Social Affairs, Sejong, Republic of Korea
| | - Jinho Kim
- Department of Health Policy and Management, Korea University, Seoul, Republic of Korea; Interdisciplinary Program in Precision Public Health, Korea University, Seoul, Republic of Korea; Center for Demography of Health and Aging, University of Wisconsin-Madison, Madison, WI, USA.
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Singham T, Bell G, Saunders R, Stott J. Widowhood and cognitive decline in adults aged 50 and over: A systematic review and meta-analysis. Ageing Res Rev 2021; 71:101461. [PMID: 34534681 DOI: 10.1016/j.arr.2021.101461] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 09/02/2021] [Accepted: 09/11/2021] [Indexed: 01/21/2023]
Abstract
While widowhood is known to be associated with poorer physical and mental health outcomes, studies examining the association of widowhood with cognition have yielded mixed results. This review aimed to elucidate the link between widowhood and cognitive decline. A systematic search of Medline, Embase, PsycInfo, CINAHL and Scopus (until December 2020) was conducted to identify studies on the association between widowhood (vs. being married) and cognition in cognitively healthy adults aged 50 +. A cross-sectional meta-analysis (of 10 studies; n = 24,668) found a significant association of widowhood with cognition (g = - 0.36, 95% CI [- 0.47, - 0.25], p = < 0.001). Meta-regressions suggested that study design, cognitive domain measured, sample age, difference in mean age between widowed and married groups, and study continent did not account for observed heterogeneity. A longitudinal meta-analysis (of 3 studies; n = 10,378) found that the "continually widowed" group (from baseline to follow-up) showed significantly steeper declines in cognition compared to the "continually married" group (g = - 0.15, 95%CI [- 0.19, - 0.10], p = < 0.001). Findings indicate that widowhood may be a risk factor for cognitive decline. As there are no effective treatments for cognitive impairment, studying mechanisms by which widowhood might be associated with poorer cognition could inform prevention programs for those who have experienced spousal bereavement.
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12
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The association of marital status with cognitive function and the role of gender in Chinese community-dwelling older adults: a cross-sectional study. Aging Clin Exp Res 2021; 33:2273-2281. [PMID: 33156506 DOI: 10.1007/s40520-020-01743-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 10/19/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Evidence of the association between marital status and cognitive function in Chinese older adults is limited. AIMS To examine the relationship between marital status and cognitive function and to explore the role of gender amongst older adults from three Chinese communities. METHODS A total of 1376 participants aged 60 years or over were included in this cross-sectional study. Cognitive function was assessed using the Chinese version of the mini-mental state examination (MMSE). Marital status and other variables were collected using a standardized questionnaire. Multiple linear regression models were used to examine associations between marital statuses and cognitive function amongst the target population. The moderating role of gender in these potential associations has also been explored. RESULTS In univariate linear regression models, compared to being married, both being widowed (β [95% CI]: -1.46[-2.78 to - 0.13]) and being single (β [95% CI]: - 4.88[-6.43 to - 3.38]) were associated with lower MMSE scores. After adjustment for confounding factors, the significant association of being widowed with MMSE scores disappeared (β [95% CI: - 0.08[- 1.04 to 0.86]), but the association of being single with MMSE scores still existed (β [95% CI]: - 1.87[- 3.17 to - 0.58]). Furthermore, the association of being single with MMSE scores was statistically significant in men (β [95% CI]: - 5.25[- 7.17 to - 3.33]) but not in women (β [95% CI: 0.88[- 0.87 to 2.64]). DISCUSSION AND CONCLUSIONS Being single was associated with poorer cognitive function compared with their married counterparts in older Chinese men but not in women. More preventive measurements should be implemented for single men to reduce or delay cognitive decline. This is particularly important in the context of an aging population in China.
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13
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Bertogg A, Leist AK. Partnership and Cognitive Aging in Europe: Mediating Factors and Social Stratification. J Gerontol B Psychol Sci Soc Sci 2021; 76:1173-1185. [PMID: 33528561 PMCID: PMC8200356 DOI: 10.1093/geronb/gbab020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Indexed: 11/26/2022] Open
Abstract
Objectives Living in a partnership has been shown to benefit later life health in general and decrease the risk of cognitive impairment. Few studies have, however, examined whether different types of partnership transitions also differ with respect to their impact on cognitive trajectories, and whether financial resources, healthy behaviors, cognitive stimulation, and social integration can explain these differences. Methods Data came from six waves of the Survey of Health, Ageing and Retirement in Europe, which is a representative panel for the population aged 50 years or older, and were collected between 2004 and 2017 in 20 European countries. Our sample includes 215,989 valid person-year observations from 78,984 persons. The mean age at baseline is 64 years, and individuals were observed on average 2.7 times. Cognitive functioning was assessed with measures of immediate and delayed recall on a memory test and verbal fluency. Fixed effects regression models were employed to exploit individual-level variation in partnership and simultaneous cognitive changes. Results Partnership status was stable in most respondents (around 90%). Compared to remaining partnered and after controlling for sociodemographic factors, transition to divorce was associated with a steeper decline in immediate and delayed recall. Exploring possible mechanisms, both financial resources and social integration, explained these differences. Additional analyses suggested that effects were mostly driven by individuals with lower education. Discussion Partnership transitions remain infrequent events in later life, but our findings indicate that they can induce less favorable cognitive trajectories compared to partnered individuals, particularly for those with lower cognitive reserve.
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Affiliation(s)
- Ariane Bertogg
- Department of History and Sociology/Zukunftskolleg, University of Konstanz, Germany
| | - Anja K Leist
- Department of Social Sciences, University of Luxembourg, Esch-sur-Alzette, Luxembourg
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Farrell MT, Kobayashi LC, Montana L, Wagner RG, Demeyere N, Berkman L. Disparity in Educational Attainment Partially Explains Cognitive Gender Differences in Older Rural South Africans. J Gerontol B Psychol Sci Soc Sci 2021; 75:e161-e173. [PMID: 32211786 DOI: 10.1093/geronb/gbaa035] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES Direction and magnitude of gender differences in late-life cognitive function are inextricably tied to sociocultural context. Our study evaluates education and literacy as primary drivers of gender equality in cognitive performance among middle-aged and older adults in rural South Africa. METHOD Data were collected on 1,938 participants aged 40-79 from Agincourt, South Africa. Cognitive function was measured via the Oxford Cognitive Screen-Plus, a tablet-based assessment with low literacy demands. Four cognitive domains were derived through confirmatory factor analysis: episodic memory, executive function, visual spatial, and language. Structural equation models tested domain-specific gender effects, incrementally controlling for demographic, education, health, and socioeconomic variables. RESULTS In the model adjusting only for demographic factors, men outperformed women on executive function and visual-spatial domains. Adding education and literacy to the model revealed a robust female advantage in episodic memory, and reduced the magnitude of male advantage in executive function and visual and spatial by 47% and 42%, respectively. Health and socioeconomic factors did not alter patterns of gender associations in subsequent models. DISCUSSION In this older South African cohort, gender inequality in cognitive performance was partially attributable to educational differences. Understanding biopsychosocial mechanisms that promote cognitive resilience in older women is critically important given the predominantly female composition of aging populations worldwide.
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Affiliation(s)
- Meagan T Farrell
- Harvard Center for Population and Development Studies, Harvard University, Cambridge, Massachusetts
| | - Lindsay C Kobayashi
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor
| | - Livia Montana
- Harvard Center for Population and Development Studies, Harvard University, Cambridge, Massachusetts
| | - Ryan G Wagner
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nele Demeyere
- Cognitive Neuropsychology Centre, Department of Experimental Psychology, University of Oxford, UK
| | - Lisa Berkman
- Harvard Center for Population and Development Studies, Harvard University, Cambridge, Massachusetts.,Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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Atalay K, Staneva A. The effect of bereavement on cognitive functioning among elderly people: Evidence from Australia. ECONOMICS AND HUMAN BIOLOGY 2020; 39:100932. [PMID: 33152583 PMCID: PMC7572370 DOI: 10.1016/j.ehb.2020.100932] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 09/27/2020] [Accepted: 10/05/2020] [Indexed: 06/11/2023]
Abstract
This paper explores the effects of experiencing the death of a spouse, relative or close friend on cognitive functioning of Australian elderly. Using rich longitudinal data, we show that experiencing a loss is associated with a modest decline in cognitive function. Our results show that on average the effects are more pronounced for males and the strongest effects are associated with the loss of the spouse or a close friend. These events have significant effects on working memory and speed of information processing. We show that the decrease in cognitive functioning is accompanied by decreases in engagement in cognitive activities and declines in socialization. Our results are suggestive that programmes to support grieving individuals, including support for socialization activities, and extending active aging programmes could be important for promoting successful cognitive aging for the growing population of older adults.
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Affiliation(s)
- Kadir Atalay
- School of Economics, University of Sydney, Sydney, NSW 2006, Australia.
| | - Anita Staneva
- Department of Accounting, Finance and Economics, Griffith University, Australia
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Brown SL, Lin IF, Vielee A, Mellencamp KA. Midlife Marital Dissolution and the Onset of Cognitive Impairment. THE GERONTOLOGIST 2020; 61:1085-1094. [PMID: 33245327 PMCID: PMC8437503 DOI: 10.1093/geront/gnaa193] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Marital dissolution has become more common in midlife with the doubling of the divorce rate among middle-aged adults. Guided by the stress model that stipulates losing economic, social, and psychological resources lowers well-being, we posited that midlife adults who experienced divorce or widowhood were at greater risk of cognitive impairment than the continuously married. Subsequent repartnering was expected to negate the increased risk. RESEARCH DESIGN AND METHODS We used data from the 1998-2016 Health and Retirement Study to estimate discrete-time event history models using logistic regression to predict cognitive impairment onset for men and women. RESULTS Roughly 27% of men who experienced spousal death in midlife went on to experience mild cognitive impairment by age 65. For women, experiencing divorce or widowhood was associated with higher odds of cognitive impairment onset although these differentials were accounted for by economic, social, and psychological resources. Men and women who repartnered after marital dissolution did not appreciably differ from their continuously married counterparts in terms of their likelihoods of cognitive impairment onset. DISCUSSION AND IMPLICATIONS A stressful life event, midlife marital dissolution can be detrimental to cognitive well-being, placing individuals at increased risk of developing dementia in later life. The growing diversity of partnership experiences during the second half of life points to the continued importance of examining how union dissolution and formation shape health and well-being.
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Affiliation(s)
- Susan L Brown
- Department of Sociology and Center for Family and Demographic Research, Bowling Green State University, Bowling Green, Ohio, USA
| | - I-Fen Lin
- Department of Sociology and Center for Family and Demographic Research, Bowling Green State University, Bowling Green, Ohio, USA
| | - Alyssa Vielee
- Department of Sociology and Center for Family and Demographic Research, Bowling Green State University, Bowling Green, Ohio, USA
| | - Kagan A Mellencamp
- Department of Sociology and Center for Family and Demographic Research, Bowling Green State University, Bowling Green, Ohio, USA
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Nowakowski AC, Sumerau JE. Women's sexual health in later life: Gaps and opportunities in research and practice. ACTA ACUST UNITED AC 2019; 15:1745506519878092. [PMID: 31564223 PMCID: PMC6769205 DOI: 10.1177/1745506519878092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This article complements emerging reviews and summaries of the recent expansion of sexuality studies within and beyond geriatrics and associated fields. To this end, we synthesize important insights and discussions taking place throughout geriatrics and other fields at present, and situate these conversations in broader discussions concerning sexualities, health, and aging. In so doing, we outline some gaps in existing work as well as opportunities for not only filling these gaps in our understandings of women’s sexual health in later life but also in order to demonstrate the usefulness of expanding prior approaches to analyses concerning womanhood, aging, sexualities, and health over the life course. In conclusion, we outline some specific pathways for future research concerning women’s sexual health in later life.
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Affiliation(s)
- Alexandra Ch Nowakowski
- Department of Geriatrics/Department of Behavioral Sciences and Social Medicine, College of Medicine, Florida State University, Orlando, FL, USA
| | - J E Sumerau
- Department of Sociology, College of Social Sciences and Public Health, The University of Tampa, Tampa, FL, USA
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