1
|
Liu G, Liang J, Hong C, Gao C, Guan B, Liang R, Luo Y, Zheng X. Sensory impairment, loneliness, and the discordance between subjective and objective cognitive function among older adults: A multi-cohort study. Arch Gerontol Geriatr 2024; 124:105482. [PMID: 38735224 DOI: 10.1016/j.archger.2024.105482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 04/28/2024] [Accepted: 05/06/2024] [Indexed: 05/14/2024]
Abstract
OBJECTIVES This study aimed to examine the association between sensory impairment and the discordance between subjective/objective cognitive function among older adults and test the mediating effect of loneliness. METHODS We used data from four cohort studies conducted in 16 countries (N = 19,119). Sensory impairment and subjective cognitive impairment were self-reported. Objective cognitive impairment was measured in three dimensions. Generalized estimating equations were conducted to examine the association between sensory impairment and discordance in subjective/objective cognitive function. Cross-lagged panel model and a bootstrap method with 2,000 samples were employed to verify the mediating effect. RESULTS Sensory impairment was related to an increased risk of subjective cognitive impairment (OR = 4.70, 95 % CI 4.33-5.10), objective impairment (OR = 1.51, 95 %CI 1.31-1.74), as well as the discordance in subjective/objective cognitive function (OR = 1.35, 95 %CI 1.06-1.71 for older adults with normal subjective cognitive function). In contrast, sensory impairment was associated with a decreased risk of discordant subjective/objective cognitive function among those with subjective cognitive impairment (OR = 0.79, 95 %CI 0.66-0.94). Moreover, loneliness mediated the association between sensory impairment and subjective cognitive impairment (standardized indirect effect = 0.002, 95 %CI 0.001-0.004), objective cognitive impairment (standardized indirect effect = 0.005, 95 %CI 0.003-0.007) as well as the discordance in subjective/objective cognitive function (standardized indirect effect = 0.001, 95 %CI 0.001-0.003 for older adults with normal subjective cognitive function). CONCLUSIONS Significant association between sensory impairment and discordance in subjective/objective cognitive function and the mediating role of loneliness were revealed, varying by subjective cognitive function. Early screening on sensory impairment and targeted interventions on loneliness should be considered in future policies on cognitive impairment.
Collapse
Affiliation(s)
- Guangwen Liu
- Department of Global Health, School of Public Health, Peking University, Beijing 100191, China
| | - Jersey Liang
- Department of Health Management and Policy, School of Public Health, University of Michigan, MI 48109, United States
| | - Chenlu Hong
- Department of Global Health, School of Public Health, Peking University, Beijing 100191, China
| | - Changqing Gao
- The Mental Health Center of Kunming Medical University, Kunming 650225, China
| | - Boyuan Guan
- Department of Global Health, School of Public Health, Peking University, Beijing 100191, China; Department of International and Domestic Cooperation, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Richard Liang
- Department of Epidemiology and Population Health, School of Medicine, Stanford University, CA 94305, USA
| | - Yanan Luo
- Department of Global Health, School of Public Health, Peking University, Beijing 100191, China; School of Population Medicine and Public Health, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing 100730, China.
| | - Xiaoying Zheng
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing 100730, China; HeSAY, Peking University, Beijing 100871, China.
| |
Collapse
|
2
|
Gouin JP, Dymarski M. Couples-based health behavior change interventions: A relationship science perspective on the unique opportunities and challenges to improve dyadic health. COMPREHENSIVE PSYCHONEUROENDOCRINOLOGY 2024; 19:100250. [PMID: 39155951 PMCID: PMC11326928 DOI: 10.1016/j.cpnec.2024.100250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 07/05/2024] [Accepted: 07/12/2024] [Indexed: 08/20/2024] Open
Abstract
Epidemiological studies indicate that better marital quality is associated with less morbidity and premature mortality. A number of interpersonal processes related to marital quality are also associated with health-relevant surrogate biomarkers across different physiological systems. Despite these replicated correlational findings, few interventions have harnessed interpersonal processes as potential interventions to enhance health. Building on Dr. Janice Kiecolt-Glaser's model of relationships and health, we propose that couples-based health behavior change interventions may represent an effective way to decrease dysregulation across autonomic, endocrine and immune systems and, ultimately, improve dyadic health. Given that the cohabiting partner is an essential part of the social context in which the behavior change is being pursued, it is important to consider the relational issues triggered by dyadic interventions. Using a relationship science perspective, this article reviews the literature on couples' concordance in health behaviors and health outcomes, the potential pathways underlying this concordance, theories of the couple as a self-sustaining social system, dyadic adaptation of individual self-regulation strategies, effective and ineffective social support and social control in couple relationships, the integration of relationship-building and health behavior change strategies, and the consideration of key moderators related to the nature of the relationship and the context surrounding the relationship. These findings highlight the importance of adopting a relationship science perspective when designing and testing dyadic interventions to improve health outcomes. The data reviewed provide insights on how to optimize couples-based health behavior change interventions to reduce physiological dysregulation and improve dyadic health.
Collapse
Affiliation(s)
| | - Maegan Dymarski
- Department of Psychology, Concordia University, Montreal, Canada
| |
Collapse
|
3
|
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.
Collapse
|
4
|
Wheatley T, Thornton MA, Stolk A, Chang LJ. The Emerging Science of Interacting Minds. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2024; 19:355-373. [PMID: 38096443 PMCID: PMC10932833 DOI: 10.1177/17456916231200177] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
For over a century, psychology has focused on uncovering mental processes of a single individual. However, humans rarely navigate the world in isolation. The most important determinants of successful development, mental health, and our individual traits and preferences arise from interacting with other individuals. Social interaction underpins who we are, how we think, and how we behave. Here we discuss the key methodological challenges that have limited progress in establishing a robust science of how minds interact and the new tools that are beginning to overcome these challenges. A deep understanding of the human mind requires studying the context within which it originates and exists: social interaction.
Collapse
Affiliation(s)
- Thalia Wheatley
- Consortium for Interacting Minds, Psychological and Brain Sciences, Dartmouth, Hanover, NH USA
- Santa Fe Institute
| | - Mark A. Thornton
- Consortium for Interacting Minds, Psychological and Brain Sciences, Dartmouth, Hanover, NH USA
| | - Arjen Stolk
- Consortium for Interacting Minds, Psychological and Brain Sciences, Dartmouth, Hanover, NH USA
| | - Luke J. Chang
- Consortium for Interacting Minds, Psychological and Brain Sciences, Dartmouth, Hanover, NH USA
| |
Collapse
|
5
|
Meulman I, Loef B, Stadhouders N, Moger TA, Wong A, Polder JJ, Uiters E. Estimating healthcare expenditures after becoming divorced or widowed using propensity score matching. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2023; 24:1047-1060. [PMID: 36251142 PMCID: PMC10406688 DOI: 10.1007/s10198-022-01532-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 09/28/2022] [Indexed: 06/16/2023]
Abstract
Becoming divorced or widowed are stressful life events experienced by a substantial part of the population. While marital status is a significant predictor in many studies on healthcare expenditures, effects of a change in marital status, specifically becoming divorced or widowed, are less investigated. This study combines individual health claims data and registered sociodemographic characteristics from all Dutch inhabitants (about 17 million) to estimate the differences in healthcare expenditure for individuals whose marital status changed (n = 469,901) compared to individuals who remained married, using propensity score matching and generalized linear models. We found that individuals who were (long-term) divorced or widowed had 12-27% higher healthcare expenditures (RR = 1.12, 95% CI 1.11-1.14; RR = 1.27, 95% CI 1.26-1.29) than individuals who remained married. Foremost, this could be attributed to higher spending on mental healthcare and home care. Higher healthcare expenditures are observed for both divorced and widowed individuals, both recently and long-term divorced/widowed individuals, and across all age groups, income levels and educational levels.
Collapse
Affiliation(s)
- Iris Meulman
- Center for Health and Society, National Institute for Public Health and the Environment, P.O. Box 1, 3720 BA, Bilthoven, The Netherlands.
- Department Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands.
| | - Bette Loef
- Center for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Niek Stadhouders
- Scientific Center for Quality of Healthcare, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Tron Anders Moger
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
| | - Albert Wong
- Department of Statistics, Informatics and Modeling, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Johan J Polder
- Center for Health and Society, National Institute for Public Health and the Environment, P.O. Box 1, 3720 BA, Bilthoven, The Netherlands
- Department Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| | - Ellen Uiters
- Center for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| |
Collapse
|
6
|
Chen MA, Suchting R, Thayer JF, Fagundes CP. Resilience to stress across the lifespan: Childhood maltreatment, heart rate variability, and bereavement. Psychol Aging 2023; 38:247-262. [PMID: 36951695 PMCID: PMC10192121 DOI: 10.1037/pag0000738] [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] [Indexed: 03/24/2023]
Abstract
Following a stressful life event, there is considerable variation in how individuals respond and adapt. Multiple models of risk and resilience show that adverse childhood experiences may be associated with an individual's response to stress later in life. While there is considerable support that early adversity can sensitize the stress response system and lead to adverse outcomes later in life, there is mounting evidence that in adolescence and young adulthood, certain biological predispositions to stress may be associated with resilience in the context of subsequent stressors. In this study, we evaluated how individual differences in vagally mediated heart rate variability moderated the relationship between childhood maltreatment and grief among a sample of individuals experiencing a stressful life event (i.e., spousal bereavement) over time. Data were collected at approximately 3, 4.5, and 6.5 months after the death of a spouse (n = 130). Heart rate variability moderated the relationship between childhood maltreatment and grief symptoms over time (b = -0.03, p < .001), such that among individuals with more severe experiences of childhood maltreatment, those with higher heart rate variability had a faster recovery from grief than those with low heart rate variability. This research highlights an overall pattern of resilience among older adult's following spousal bereavement, as well as the relationships between childhood maltreatment, heart rate variability, and differential responses to grief following the loss of a spouse. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
Collapse
Affiliation(s)
- Michelle A. Chen
- Institute of Policy Research, Northwestern University, Evanston, IL
| | - Robert Suchting
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center, Houston, TX
| | - Julian F. Thayer
- Department of Psychological Science, University of California, Irvine, Irvine, CA
- Department of Psychology, The Ohio State University, Columbus, OH
| | - Christopher P. Fagundes
- Department of Psychological Sciences, Rice University, Houston, TX
- Department of Behavioral Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX
- Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, TX
| |
Collapse
|
7
|
Paoletti J, Chen MA, Wu-Chung EL, Brown RL, LeRoy AS, Murdock KW, Heijnen CJ, Fagundes CP. Employment and family income in psychological and immune outcomes during bereavement. Psychoneuroendocrinology 2023; 150:106024. [PMID: 36702040 PMCID: PMC9974808 DOI: 10.1016/j.psyneuen.2023.106024] [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: 08/19/2022] [Revised: 11/25/2022] [Accepted: 01/04/2023] [Indexed: 01/07/2023]
Abstract
Spousal bereavement is one of the most stressful experiences in adulthood. In a sample of 183 widow(er)s, bereaved about three months prior, we examined the intersection of employment, family income, and health outcomes (proinflammatory marker production, perceived stress, and grief symptoms). Bereaved employees had higher levels of monocyte-stimulated interleukin-6, tumor necrosis factor-α, chemokine ligands 4, and perceived stress than bereaved retirees. We also found an interaction such that family income was positively associated with perceived stress and grief symptoms for employed window(er)s, but not for retirees. These findings align with the reserve capacity model, which states that people at higher levels of socioeconomic status have more psychosocial resources to address psychosocial stressors. Employment likely served as an added psychological and inflammatory burden for all bereaved workers, except those with the highest incomes.
Collapse
Affiliation(s)
| | | | | | - Ryan L Brown
- University of California San Francisco, United States
| | | | | | - Cobi J Heijnen
- University of Texas MD Anderson Cancer Center, United States
| | - Christopher P Fagundes
- Rice University, United States; University of Texas MD Anderson Cancer Center, United States; Baylor College of Medicine, United States
| |
Collapse
|
8
|
Zhu Z, Wang Z, Wu Y, Chen X, Liu H, Zhang J, Liu M, Liu Y. The Widowhood Effect on Mortality in Older Patients with Hip Fracture. Int J Gen Med 2022; 15:7693-7700. [PMID: 36238540 PMCID: PMC9552787 DOI: 10.2147/ijgm.s384862] [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] [Received: 08/03/2022] [Accepted: 09/27/2022] [Indexed: 11/05/2022] Open
Abstract
Objective Widowed people have increased mortality than married people of the same age, a phenomenon known as the widowhood effect. This study aimed to investigate whether this effect exists in older patients with hip fracture. Methods Using our own hip fracture database, a total of 1101 hip fracture patients were consecutively included from January 2014 to December 2021. Marital status was stratified as married (n = 793) and widowed (n = 308). Patients survival status was obtained from medical records or telephone follow-ups, and the outcomes were all-cause mortality at 30 days, 1 year and at latest follow-up. Univariate and multivariate Cox proportional hazard models were used to assess the association between marital status and mortality, and subgroup analyses according to sex were also conducted. Results Compared with married patients, widowed patients were more likely to be older, female and intertrochanteric fracture, and were less likely to be urban area, smoking, drinking, and surgical treatment (P < 0.05). After a median follow-up of 37.1 months, the 30-day mortality was 4.3% (n = 47), 1-year mortality was 19.3% (n = 178), and total mortality was 34.2% (n = 376). Multivariate Cox analysis showed that widowed marital status remained an independent risk factor for 1-year mortality (HR = 1.437, 95% CI: 1.054–1.959, P = 0.022), and total mortality (HR = 1.296, 95% CI: 1.038–1.618, P = 0.022), whereas this association was not found in 30-day mortality (HR = 1.200, 95% CI: 0.607–2.376, P = 0.599). Moreover, subgroup analyses also found that the widowhood effect on mortality was present in both male and female. Conclusion Widowed marital status seems to be an independent risk factor for long-term mortality in older patients with hip fracture.
Collapse
Affiliation(s)
- Zhonglun Zhu
- Department of Orthopedics, People’s Hospital of Deyang City, Deyang, People’s Republic of China
| | - Zhicong Wang
- Department of Orthopedics, People’s Hospital of Deyang City, Deyang, People’s Republic of China,Department of Orthopedics, The First Affiliated Hospital of Dalian Medical University, Dalian, People’s Republic of China
| | - Yuxuan Wu
- Department of Orthopedics, People’s Hospital of Deyang City, Deyang, People’s Republic of China
| | - Xi Chen
- Department of Orthopedics, People’s Hospital of Deyang City, Deyang, People’s Republic of China
| | - Hailong Liu
- Department of Orthopedics, People’s Hospital of Deyang City, Deyang, People’s Republic of China
| | - Jianjun Zhang
- Department of Orthopedics, People’s Hospital of Deyang City, Deyang, People’s Republic of China
| | - Mozhen Liu
- Department of Orthopedics, The First Affiliated Hospital of Dalian Medical University, Dalian, People’s Republic of China
| | - Yuehong Liu
- Department of Orthopedics, People’s Hospital of Deyang City, Deyang, People’s Republic of China,Correspondence: Yuehong Liu, Department of Orthopedics, People’s Hospital of Deyang City, Deyang, People’s Republic of China, Email
| |
Collapse
|
9
|
Brown RL, LeRoy AS, Chen MA, Suchting R, Jaremka LM, Liu J, Heijnen C, Fagundes CP. Grief Symptoms Promote Inflammation During Acute Stress Among Bereaved Spouses. Psychol Sci 2022; 33:859-873. [PMID: 35675903 PMCID: PMC9343888 DOI: 10.1177/09567976211059502] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 10/26/2021] [Indexed: 11/15/2022] Open
Abstract
The death of a spouse is associated with maladaptive immune alterations; grief severity may exacerbate this link. We investigated whether high grief symptoms were associated with an amplified inflammatory response to subsequent stress among 111 recently bereaved older adults. Participants completed a standardized psychological stressor and underwent a blood draw before, 45 min after, and 2 hr after the stressor. Those experiencing high grief symptoms (i.e., scoring > 25 on the Inventory of Complicated Grief) experienced a 45% increase in interleukin-6 (IL-6; a proinflammatory cytokine) per hour, whereas those experiencing low grief symptoms demonstrated a 26% increase. In other words, high grief was related to a 19% increase in IL-6 per hour relative to low grief. The grief levels of recently bereaved people were associated with the rate of change in IL-6 following a subsequent stressor, above and beyond depressive symptoms. This is the first study to demonstrate that high grief symptoms promote inflammation following acute stress.
Collapse
Affiliation(s)
- Ryan L. Brown
- Department of Psychological Sciences,
Rice University
| | | | | | - Robert Suchting
- Department of Psychiatry and Behavioral
Sciences, McGovern Medical School, The University of Texas Health Science Center at
Houston
| | - Lisa M. Jaremka
- Department of Psychological and Brain
Sciences, University of Delaware
| | - Jia Liu
- Department of Behavioral Sciences, The
University of Texas MD Anderson Cancer Center
| | - Cobi Heijnen
- Department of Behavioral Sciences, The
University of Texas MD Anderson Cancer Center
| | - Christopher P. Fagundes
- Department of Psychological Sciences,
Rice University
- Department of Behavioral Sciences, The
University of Texas MD Anderson Cancer Center
- Department of Psychiatry and Behavioral
Sciences, Baylor College of Medicine
| |
Collapse
|
10
|
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] [MESH Headings] [Grants] [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.
Collapse
Affiliation(s)
- E Lydia Wu-Chung
- Department of Psychological Sciences, Rice University, Houston, TX, United States.
| | - Stephanie L Leal
- Department of Psychological Sciences, Rice University, Houston, TX, United States
| | - Bryan T Denny
- Department of Psychological Sciences, Rice University, Houston, TX, United States
| | - Samantha L Cheng
- Department of Psychological Sciences, Rice University, Houston, TX, United States
| | - Christopher P Fagundes
- Department of Psychological Sciences, Rice University, Houston, TX, United States; Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, United States; Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
| |
Collapse
|
11
|
Aschwanden D, Sutin AR, Ledermann T, Luchetti M, Stephan Y, Sesker AA, Zhu X, Terracciano A. Subjective Cognitive Decline: Is a Resilient Personality Protective Against Progression to Objective Cognitive Impairment? Findings from Two Community-Based Cohort Studies. J Alzheimers Dis 2022; 89:87-105. [PMID: 35848026 PMCID: PMC9843496 DOI: 10.3233/jad-220319] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Subjective cognitive decline (SCD) is related to personality functioning and risk of subsequent objective cognitive impairment. OBJECTIVE The aim of this study was to examine whether lower neuroticism and higher conscientiousness-resilient personality traits-protect against conversion from SCD to objective cognitive impairment in two longitudinal community-based cohorts. METHODS Data from the Health and Retirement Study (N = 1,741, Mean age = 68.64 years, Follow-up mean = 7.34 years) and the National Health and Aging Trends Survey (N = 258, Mean age = 79.34 years, Follow-up mean = 4.31 years) were analyzed using Cox regression analysis, controlling for sociodemographic covariates, symptoms of anxiety and depression, and apolipoprotein ɛ4. RESULTS The pooled results showed that lower neuroticism and higher conscientiousness were associated with decreased risk of conversion from SCD to objective cognitive impairment. CONCLUSION Among individuals with SCD, those with a resilient personality may have more cognitive and psychological reserve to maintain cognitive functioning and delay conversion to objective cognitive impairment. The findings further contribute to a better understanding of personality along the cognitive continuum: The observed effect sizes were smaller than those reported in cognitively normal individuals but larger than in individuals with mild cognitive impairment. Personality could provide useful information to identify individuals with SCD who may develop objective cognitive impairment-namely those who hold a vulnerable personality (higher neuroticism, lower conscientiousness).
Collapse
Affiliation(s)
- Damaris Aschwanden
- Department of Geriatrics, Florida State University College of Medicine, Florida, USA
| | - Angelina R. Sutin
- Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Florida, USA
| | - Thomas Ledermann
- Department of Human Development and Family Science, Florida State University College of Health and Human Sciences, Florida, USA
| | - Martina Luchetti
- Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Florida, USA
| | | | - Amanda A. Sesker
- Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Florida, USA
| | - Xianghe Zhu
- Department of Geriatrics, Florida State University College of Medicine, Florida, USA
| | - Antonio Terracciano
- Department of Geriatrics, Florida State University College of Medicine, Florida, USA
| |
Collapse
|
12
|
Yang F, Gu D. Widowhood, widowhood duration, and loneliness among older adults in China. Soc Sci Med 2021; 283:114179. [PMID: 34225038 DOI: 10.1016/j.socscimed.2021.114179] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 06/07/2021] [Accepted: 06/24/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Widowhood is a distressful life event that is associated with loneliness in older adults. However, widowhood is not a binary event, and little is known about the role of widowhood duration in loneliness and about the relationship between widowhood duration and loneliness in different age and sex groups. Given the increases in aging population and in widowed older adults in China, we examined whether and how widowhood and widowhood duration were associated with loneliness in different age and sex groups among Chinese older adults. METHODS Five waves of Chinese Longitudinal Healthy Longevity Survey 2002-2014 were used. The analysis included 34,440 sampled individuals aged 65 and above. Random intercept ordered logistic models were used to examine relations between widowhood, its duration and loneliness in the entire sample and by age and sex groups. RESULTS Results show that with a wide set of covariates controlled for, widowhood was a significant correlate of loneliness in older adults (OR = 2.34, p < .001); and those who were remarried after widowhood were less likely to be lonely compared to their not-remarried counterparts (OR = 0.47, p < .001). In addition, widowhood was associated with more than twice greater odds of loneliness in the first couple of years following bereavement of spouse (OR = 3.09, p < .001) compared to the currently married older adults. The increased odds ratio of loneliness slightly decreased with the length of widowhood, but it was still significant, even after 40 years of bereavement (OR = 1.96, p < .001). CONCLUSIONS These findings are mostly consistent across age and sex groups. In conclusion, this study sheds light on the relationship between widowhood duration and loneliness and the role of remarriage in widowed older adults' loneliness based on a nationwide survey in China. Widowhood has an acute and long-lasting effect on loneliness in older adults. Remarriage after widowhood could largely reduce or offset the risk of loneliness.
Collapse
Affiliation(s)
- Fang Yang
- Department of Social Work, School of Sociology and Political Science, Shanghai University, China. Building 2, #231, Nanchen Road 333, Baoshan District, Shanghai, PR China.
| | | |
Collapse
|
13
|
Cardiovascular Events After Partner Bereavement, What is the Role of Low Dose Aspirin and Beta-Blockers? Curr Probl Cardiol 2021; 47:100883. [PMID: 34103192 DOI: 10.1016/j.cpcardiol.2021.100883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 05/02/2021] [Indexed: 11/20/2022]
Abstract
Bereavement due to loss of a partner is one of the most stressful life events, often leading to adverse physiological responses. Spousal loss has been associated with an increased morbidity and mortality, particularly from cardiovascular disease. Use of aspirin and/or beta adrenergic blockers have previously been suggested to play a role in cardiovascular risk associated with early bereavement. However, the available literature regarding this topic is limited. In this review article, we explore the potential beneficial role of aspirin and beta blockers in early bereavement. Our systematic review suggests that most studies have found aspirin and beta blockers to be beneficial in preventing adverse cardiovascular outcomes associated with early bereavement. Further randomized controlled long-term studies are warranted with adequate sample size to clearly establish the role of these medications on cardiovascular disease in late bereavement.
Collapse
|
14
|
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.
Collapse
|
15
|
Fagundes CP, Wu EL. Matters of the heart: Grief, morbidity, and mortality. CURRENT DIRECTIONS IN PSYCHOLOGICAL SCIENCE 2020; 29:235-241. [PMID: 33758475 PMCID: PMC7983846 DOI: 10.1177/0963721420917698] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Spousal bereavement is associated with an elevated risk of morbidity and mortality. Several well-regarded multidisciplinary research teams have sought to understand the biopsychosocial processes underlying why widow(er)s are at elevated physical health risk. In this paper, we review research from multiple investigatory teams, including our own, showing that, on average, widow(er)s exhibit maladaptive patterns of autonomic, neuroendocrine, and immune activity compared to matched comparisons. Widow(er)s also exhibit poorer health behaviors than they did before their spouse's death. There is considerable variation in post-loss psychological adjustment trajectories among widow(er)s, which likely corresponds to physical health risk trajectories. Yet, there is little biobehavioral research on patterns of change in physical health risk after the death of a spouse. We summarize recently published work demonstrating the utility of attachment theory to characterize and predict individual differences in physical health biomarkers; we highlight the need for a biopsychosocial approach to understand and characterize post-loss trajectory patterns. We conclude by discussing the possibility that this line of inquiry could help researchers, and ultimately providers, identify adjustment trajectories earlier and thus deliver appropriate interventions when they are most needed.
Collapse
Affiliation(s)
- Christopher P Fagundes
- Rice University, Houston, TX
- The University of Texas MD Anderson Cancer Center, Houston, TX
- Baylor College of Medicine, Houston, TX
| | | |
Collapse
|
16
|
Abstract
OBJECTIVE Using an integrative view of psychology, neuroscience, immunology, and psychophysiology, the present review of literature curates the findings that have had an impact on the field of bereavement research and shaped its development. METHODS Beginning with pivotal systematic descriptions of medical and psychological responses to the death of a loved one by Lindemann in the mid-1940s, this selective review integrates findings in bereavement research from studies that investigate medical outcomes after loss, their psychological predictors, and biopsychosocial mechanisms. RESULTS Morbidity and mortality after the death of a loved one have long been a topic of research. Early researchers characterized somatic and psychological symptoms and studied immune cell changes in bereaved samples. More recent research has repeatedly demonstrated increased rates of morbidity and mortality in bereaved samples, as compared with married controls, in large epidemiological studies. Recent developments also include the development of criteria for prolonged grief disorder (also termed complicated grief). Newer methods, including neuroimaging, have observed that the greatest impact of the death of a loved one is in those who have the most severe psychological grief reactions. Research addressing the mechanisms tying bereavement to medical outcomes is relatively scarce, but differences in rumination, in inflammation, and in cortisol dysregulation between those who adapt well and those who do not have been offered with some evidence. CONCLUSIONS Recommendations to propel the field forward include longitudinal studies to understand differences between acute reactions and later adaptation, comparing samples with grief disorders from those with more typical responses, and integrating responses in brain, mind, and body.
Collapse
|
17
|
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.
Collapse
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
| |
Collapse
|
18
|
Widowhood and mortality risk of older people in rural China: do gender and living arrangement make a difference? AGEING & SOCIETY 2019. [DOI: 10.1017/s0144686x19000436] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractIncreased mortality after spousal bereavement has been observed in many populations. Few studies have investigated the widowhood effect in a traditional culture where the economy is underdeveloped. The reasons for the widowhood effect and its gender dynamic are not well understood. In this study, we assessed whether the widowhood-associated excess mortality exists and differs by gender and living arrangement in rural China. We used a six-wave panel of data derived from rural people over 60 years old in the Chaohu region of China. Cox regression analyses suggest that there was a positive effect of spousal loss on mortality for older rural Chinese and this effect was gender different. Our findings also suggest that living with adult children after spousal loss played a protective role in reducing the risk of older men's death, though it tended to increase older men's mortality risk in general.
Collapse
|
19
|
Oksuzyan A, Mussino E, Drefahl S. Sex differences in mortality in migrants and the Swedish-born population: Is there a double survival advantage for immigrant women? Int J Public Health 2019; 64:377-386. [PMID: 30799526 PMCID: PMC6451703 DOI: 10.1007/s00038-019-01208-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 09/10/2018] [Accepted: 01/18/2019] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES In the present study, we examine whether the relationships between country of origin or reason for migration and mortality differ between men and women. METHODS We apply hazard regression models on high-quality Swedish register data with nationwide coverage. RESULTS Relative to their Swedish counterparts, migrants from Nordic and East European (EU) countries and former Yugoslavia have higher mortality. This excess mortality among migrants relative to Swedes is more pronounced in men than in women. Migrants from Western and Southern European countries; Iran, Iraq, and Turkey; Central and South America; and Asia, have lower mortality than Swedes, and the size of the mortality reduction is similar in both sexes. The predictive effects of the reason for migration for mortality are also similar in migrant men and women. CONCLUSIONS This study provides little support for the hypothesis of a double survival advantage among immigrant women in Sweden. However, it does show that the excess mortality in migrants from Nordic and EU countries and former Yugoslavia relative to the Swedish-born population is more pronounced in men than in women.
Collapse
Affiliation(s)
- Anna Oksuzyan
- Max Planck Institute for Demographic Research, Konrad-Zuse-Straße 1, 18057, Rostock, Germany.
| | - Eleonora Mussino
- Demography Unit, Department of Sociology, Stockholm University, Stockholm, Sweden
| | - Sven Drefahl
- Demography Unit, Department of Sociology, Stockholm University, Stockholm, Sweden
| |
Collapse
|
20
|
Holm AL, Berland AK, Severinsson E. Factors that influence the health of older widows and widowers-A systematic review of quantitative research. Nurs Open 2019; 6:591-611. [PMID: 30918710 PMCID: PMC6419130 DOI: 10.1002/nop2.243] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Revised: 11/22/2018] [Accepted: 01/07/2019] [Indexed: 11/16/2022] Open
Abstract
AIM To examine factors that influence the health of older widows and widowers. The review question was: What is the evidence of the relationship between widowhood and health in older adults? DESIGN Systematic review. DATA SOURCES Academic Search Elite, CINAHL, Medline (Ovid) and PubMed were searched for articles published between January 2013-December 2017. REVIEW METHODS A systematic review of quantitative research with a qualitative thematic analysis. RESULTS The selection process resulted in 12 studies. One of the themes that emerged was: emotional challenges related to experiences of bereavement, depression and anxiety, which was based on the sub-theme social support as the main strategy for coping with emotional pain and suffering. The second theme was: struggling with poor physical health. The findings indicate that healthcare professionals need knowledge and skills to deal with the health consequences of widowhood in old age. Building community teams can prevent emotional and physical health problems, as well as reduce mortality.
Collapse
Affiliation(s)
- Anne Lise Holm
- Faculty of Health and Social SciencesWestern Norway University of Applied SciencesHaugesundNorway
| | - Astrid Karin Berland
- Faculty of Health and Social SciencesWestern Norway University of Applied SciencesHaugesundNorway
| | - Elisabeth Severinsson
- Centre for Women’s, Family and Child Health, Faculty of Health and Social SciencesUniversity of South‐Eastern NorwayKongsbergNorway
| |
Collapse
|
21
|
Fagundes CP, Brown RL, Chen MA, Murdock KW, Saucedo L, LeRoy A, Wu EL, Garcini LM, Shahane AD, Baameur F, Heijnen C. Grief, depressive symptoms, and inflammation in the spousally bereaved. Psychoneuroendocrinology 2019; 100:190-197. [PMID: 30368120 PMCID: PMC6889080 DOI: 10.1016/j.psyneuen.2018.10.006] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 09/03/2018] [Accepted: 10/10/2018] [Indexed: 12/26/2022]
Abstract
Grief is conceptualized by strong negative emotions, which include longing, sadness, and preoccupations with thoughts, recollections, and images of the spouse. In the initial months after the loss of a spouse, those who are widowed are at risk for cardiovascular problems and premature mortality. In the general population, depression is characterized by chronic low-grade inflammation, a key predictor of cardiovascular problems, morbidity, and mortality. Although depression and grief share similarities, they are distinct constructs. We aimed to identify if grief was related to inflammation among those who had a spouse recently die. We also sought to determine if those who are widowed and already experience elevated levels of depressive symptoms compared with the general population had higher levels of inflammation compared with those who are widowed who report fewer depressive symptoms. Ninety-nine recently bereaved individuals (M = 84.74 days since passing, SD = 18.17) completed a blood draw and psychological assessments. Proinflammatory T cell-derived cytokines were assessed, which included interferon gamma (IFN-γ), interleukin (IL)-6, tumor necrosis factor alpha (TNF-α), IL17-A, and IL-2. Bereaved individuals with a higher grief severity (using an established cut-score) had higher levels of the proinflammatory cytokines IFN-γ, IL-6, and TNF-α than those with less grief severity. Those who experienced higher levels of depression exhibited elevated levels of proinflammatory cytokines compared with those who had lower levels of depression (using a continuous measure of depressive symptoms, as well as an established cut score). This is the first study to demonstrate that inflammatory markers can distinguish those who are widowed based on grief severity such that those who are higher on grief severity have higher levels of inflammation compared with those who are lower on grief severity. These findings also add to the broader literature on depression and inflammation by showing that even in a population with high levels of depressive symptoms, there is a positive relationship between depression and inflammation.
Collapse
Affiliation(s)
- Christopher P Fagundes
- Rice University, Houston, TX, United States; The University of Texas MD Anderson Cancer Center, Houston, TX, United States; Baylor College of Medicine, Houston, TX, United States.
| | | | | | - Kyle W Murdock
- The Pennsylvania State University, University Park, PA, United States
| | | | | | - E Lydia Wu
- Rice University, Houston, TX, United States
| | | | | | - Faiza Baameur
- The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Cobi Heijnen
- The University of Texas MD Anderson Cancer Center, Houston, TX, United States; The Pennsylvania State University, University Park, PA, United States
| |
Collapse
|
22
|
Prior A, Fenger-Grøn M, Davydow DS, Olsen J, Li J, Guldin MB, Vestergaard M. Bereavement, multimorbidity and mortality: a population-based study using bereavement as an indicator of mental stress. Psychol Med 2018; 48:1437-1443. [PMID: 28851470 DOI: 10.1017/s0033291717002380] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Mental stress is associated with higher mortality, but it remains controversial whether the association is causal or a consequence of a higher physical disease burden in those with a high mental stress load. Understanding causality is important when developing targeted interventions. We aimed to estimate the effect of mental stress on mortality by performing a 'natural' experiment using spousal bereavement as a disease-independent mental stressor. METHODS We followed a population-based matched cohort, including all individuals in Denmark bereaved in 1997-2014, for 17 years. Prospectively recorded register data were obtained for civil and vital status, 39 mental and physical diagnoses, and socioeconomic factors. RESULTS In total, 389 316 bereaved individuals were identified and 137 247 died during follow-up. Bereaved individuals had higher all-cause mortality than non-bereaved references in the entire study period. The relative mortality in the bereaved individuals was highest shortly after the loss (adjusted hazard ratio (aHR), first month: 2.50, 95% confidence interval (CI) 2.37-2.63; aHR, 6-12 months: 1.38, 95% CI 1.34-1.42). The excess mortality rate associated with bereavement rose with increasing number of physical diseases (1.33 v. 7.00 excess death per 1000 person-months for individuals with 0 v. ⩾3 physical conditions during the first month) and was exacerbated by the presence of mental illness. The excess mortality among bereaved individuals was primarily due to death from natural causes. CONCLUSIONS Bereavement was associated with increased short-term and long-term mortality, even after adjustment for morbidities, which suggests that mental stress may play a causal role in excess mortality.
Collapse
Affiliation(s)
- A Prior
- Research Unit for General Practice,Department of Public Health,Aarhus University,Bartholins Allé 2, Aarhus,Denmark
| | - M Fenger-Grøn
- Research Unit for General Practice,Department of Public Health,Aarhus University,Bartholins Allé 2, Aarhus,Denmark
| | - D S Davydow
- Department of Psychiatry and Behavioral Sciences,University of Washington,Box 359911,325 Ninth Ave,Seattle, WA,USA
| | - J Olsen
- Department of Clinical Epidemiology,Aarhus University Hospital,Olof Palmes Allé 43-45,Aarhus N,Denmark
| | - J Li
- Department of Clinical Epidemiology,Aarhus University Hospital,Olof Palmes Allé 43-45,Aarhus N,Denmark
| | - M-B Guldin
- Research Unit for General Practice,Department of Public Health,Aarhus University,Bartholins Allé 2, Aarhus,Denmark
| | - M Vestergaard
- Research Unit for General Practice,Department of Public Health,Aarhus University,Bartholins Allé 2, Aarhus,Denmark
| |
Collapse
|
23
|
Fagundes CP, Murdock KW, LeRoy A, Baameur F, Thayer JF, Heijnen C. Spousal bereavement is associated with more pronounced ex vivo cytokine production and lower heart rate variability: Mechanisms underlying cardiovascular risk? Psychoneuroendocrinology 2018; 93:65-71. [PMID: 29702444 DOI: 10.1016/j.psyneuen.2018.04.010] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 04/05/2018] [Accepted: 04/11/2018] [Indexed: 12/27/2022]
Abstract
The loss of a spouse is a highly stressful event that puts people at excess risk of mortality. Excess mortality among those who are widowed is highest in the first six months after the death of a spouse and decreases over time. Heart disease accounts for the largest proportion of these deaths. The psychological stress associated with stressful life events can enhance inflammation and lower heart rate variability (HRV). Both lower HRV and higher inflammation are risk factors for cardiovascular morbidity and mortality. Thirty-two recently bereaved individuals (Mean = 89.68 days since death, SD = 17.09) and 33 age-matched comparisons completed a blood draw, EKG, and self-report questionnaires. In both adjusted and unadjusted models, spousal bereavement was associated with enhanced pro-inflammatory cytokine production by in vitro lipolysaccharide-stimulated peripheral blood leukocytes. Moreover, spousal bereavement was associated with lower HRV in comparison to the comparison group. This study is the first to demonstrate that bereavement is associated with a more pronounced ex vivo cytokine production and lower HRV in a population that exclusively consisted of widows and widowers. These findings add to the growing literature revealing the mechanisms that underlie bereavement-related cardiovascular problems. Future longitudinal studies are needed to determine the temporal relation between these risks. Understanding the biological mechanisms that underlie this stressful life event could allow researchers to create therapeutic targets for interventions to reduce or prevent the toll of a "broken heart."
Collapse
Affiliation(s)
- Christopher P Fagundes
- Rice University, Houston, TX, United States; The University of Texas MD Anderson Cancer Center, Houston, TX, United States; Baylor College of Medicine, Houston, TX, United States.
| | - Kyle W Murdock
- The Pennsylvania State University, University Park, PA, United States
| | - Angie LeRoy
- Rice University, Houston, TX, United States; University of Houston, Houston, TX, United States
| | - Faiza Baameur
- The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | | | - Cobi Heijnen
- The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| |
Collapse
|
24
|
Abstract
OBJECTIVES The aim of this study was to assess the association of widowhood with the severity and extent of coronary artery disease (CAD), and whether it is modified by sex or socioeconomic status. PATIENTS AND METHODS A total of 1068 patients undergoing coronary angiography at five centers in Saudi Arabia and the United Arab Emirates were included in the study. CAD was defined as more than 70% lumen stenosis in a major epicardial vessel or more than 50% in the left main coronary artery. Multivessel disease was defined as more than one diseased vessel. RESULTS Of 1068 patients, 65 (6%) were widowed. Widowed patients were older (65±15 vs. 59±12), more likely to be female (75 vs. 25%), less likely to be smokers (18 vs. 47%), of lower economic and education status, and more likely to have undergone coronary angiography for urgent/emergent indications (75 vs. 61%) (P<0.05 for all). There was a significant association between widowhood and the number of coronary arteries with more than 70% lumen stenosis. Consequently, such a high degree of lumen stenosis in those who were widowed was more likely to require coronary artery bypass graft surgery (38 vs. 16%; P<0.01). After adjusting for baseline differences, widowhood was associated with a significantly higher odds of CAD [adjusted odds ratio (OR) 3.6; 95% confidence interval (CI) 1.2-10.5] and multivessel disease (adjusted OR 4.6; 95% CI 2.2-9.6), but not left main disease (adjusted OR 1.3; 95% CI 0.5-3.1). All associations were consistent in men and women and not modified by age, community setting (urban vs. rural), employment, income, or educational levels (Pinteraction>0.1 for all). CONCLUSION Widowhood is associated with the severity and extent of CAD. The association is not modified by sex or socioeconomic status.
Collapse
|
25
|
Donovan NJ, Wu Q, Rentz DM, Sperling RA, Marshall GA, Glymour MM. Loneliness, depression and cognitive function in older U.S. adults. Int J Geriatr Psychiatry 2017; 32:564-573. [PMID: 27162047 PMCID: PMC5102822 DOI: 10.1002/gps.4495] [Citation(s) in RCA: 229] [Impact Index Per Article: 32.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 03/28/2016] [Accepted: 03/28/2016] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To examine reciprocal relations of loneliness and cognitive function in older adults. METHODS Data were analyzed from 8382 men and women, age 65 and older, participating in the US Health and Retirement Study from 1998 to 2010. Participants underwent biennial assessments of loneliness and depression (classified as no, low or high depression) determined by the Center for Epidemiologic Studies Depression scale (8-item version), cognition (a derived memory score based on a word list memory task and proxy-rated memory and global cognitive function), health status and social and demographic characteristics from 1998 to 2010. We used repeated measures analysis to examine the reciprocal relations of loneliness and cognitive function in separate models controlling sequentially and cumulatively for socio-demographic factors, social network, health conditions and depression. RESULTS Loneliness at baseline predicted accelerated cognitive decline over 12 years independent of baseline socio-demographic factors, social network, health conditions and depression (β = -0.2, p = 0.002). After adjustment for depression interacting with time, both low and high depression categories were related to faster cognitive decline and the estimated effect of loneliness became marginally significant. Reciprocally, poorer cognition at baseline was associated with greater odds of loneliness over time in adjusted analyses (OR 1.3, 95% CI (1.1-1.5) p = 0.005), but not when controlling for baseline depression. Furthermore, cognition did not predict change in loneliness over time. CONCLUSION Examining longitudinal data across a broad range of cognitive abilities, loneliness and depressive symptoms appear to be related risk factors for worsening cognition but low cognitive function does not lead to worsening loneliness over time. Copyright © 2016 John Wiley & Sons, Ltd.
Collapse
Affiliation(s)
- Nancy J. Donovan
- Center for Alzheimer Research and Treatment, Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA,Center for Alzheimer Research and Treatment, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Qiong Wu
- Institute of Social Science Survey, Peking University, Peking, China
| | - Dorene M. Rentz
- Center for Alzheimer Research and Treatment, Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA,Center for Alzheimer Research and Treatment, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA,Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Reisa A. Sperling
- Center for Alzheimer Research and Treatment, Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA,Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Gad A. Marshall
- Center for Alzheimer Research and Treatment, Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA,Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - M. Maria Glymour
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, USA,Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
| |
Collapse
|
26
|
ZAREI F, SOLHI M, MERGHATI-KHOEI E, TAGHDISI MH, SHOJAEIZADEH D, TAKET AR, MASOOMI R, NEDJAT S. Development and Psychometric Properties of Social Exclusion Questionnaire for Iranian Divorced Women. IRANIAN JOURNAL OF PUBLIC HEALTH 2017; 46:640-649. [PMID: 28560195 PMCID: PMC5442277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND Divorce, especially in women, could be assessed from socio-cultural perspective as well as psychological viewpoint. This assessment requires cultural adopted as well as valid and reliable questionnaire. This study aimed to develop and assess the psychometric properties of a questionnaire in order to address social consequences in Iranian divorced women. METHODS This was an exploratory mixed method study conducted during 2012 to 2014. According to the grounded theory approach in the first phase, social exclusion was extracted as a core of understanding process in participants. Based on, 47 preliminary generated items reliability and validity were assessed. In the second phase, the divorced women were recruited from a safe community center in Tehran through convenience sampling. RESULTS Exploratory factor analysis conducted on the questionnaires of 150 divorced women with mean age 41.76±8.49 yr, in that, indicated five dimensions, discriminative marital status, economic dependence on marital status, exclusionary marital status, and traumatic marital status health risks and, frightening marital status that jointly accounted for the 64% of the variance observed. An expert panel approved the face and content validity of the developed tool. The Cronbach's alpha coefficient and the Intra-class Correlation Coefficient were found to be 0.70 and 0.85, respectively. CONCLUSION The present study provided a valid and reliable measure as Social Exclusion Questionnaire in Iranian divorced women (SEQ-IDW) to address social post-divorce consequences, which might help to improve women's social health.
Collapse
Affiliation(s)
- Fatemeh ZAREI
- Dept. of Health Education and Health Promotion, School of Public Health, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Mahnaz SOLHI
- Dept. of Health Education and Health Promotion, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Effat MERGHATI-KHOEI
- Iranian National Center of Addiction Studies (INCAS), Sexual and Family Health Division, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Hossein TAGHDISI
- Dept. of Health Education and Health Promotion, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Davoud SHOJAEIZADEH
- Dept. of Health Education and Health Promotion, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Ann Rosemary TAKET
- Center for Health Through Action on Social Exclusion, School of Health and Social Development, Deakin University, Melbourne, Australia
| | - Razieh MASOOMI
- Dept. of Reproductive Health, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Saharnaz NEDJAT
- Dept. of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran,Corresponding Author:
| |
Collapse
|
27
|
Einiö E, Moustgaard H, Martikainen P, Leinonen T. Does the risk of hospitalisation for ischaemic heart disease rise alreadybeforewidowhood? J Epidemiol Community Health 2017; 71:599-605. [DOI: 10.1136/jech-2016-207987] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 12/15/2016] [Accepted: 02/10/2017] [Indexed: 12/26/2022]
|
28
|
Perkins JM, Lee HY, James KS, Oh J, Krishna A, Heo J, Lee JK, Subramanian SV. Marital status, widowhood duration, gender and health outcomes: a cross-sectional study among older adults in India. BMC Public Health 2016; 16:1032. [PMID: 27716203 PMCID: PMC5045657 DOI: 10.1186/s12889-016-3682-9] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 09/19/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Previous research has demonstrated health benefits of marriage and the potential for worse outcomes during widowhood in some populations. However, few studies have assessed the relevance of widowhood and widowhood duration to a variety of health-related outcomes and chronic diseases among older adults in India, and even fewer have examined these relationships stratified by gender. METHODS Using a cross-sectional representative sample of 9,615 adults aged 60 years or older from 7 states in diverse regions of India, we examine the relationship between widowhood and self-rated health, psychological distress, cognitive ability, and four chronic diseases before and after adjusting for demographic characteristics, socioeconomic status, living with children, and rural-urban location for men and women, separately. We then assess these associations when widowhood accounts for duration. RESULTS Being widowed as opposed to married was associated with worse health outcomes for women after adjusting for other explanatory factors. Widowhood in general was not associated with any outcomes for men except for cognitive ability, though men who were widowed within 0-4 years were at greater risk for diabetes compared to married men. Moreover, recently widowed women and women who were widowed long-term were more likely to experience psychological distress, worse self-rated health, and hypertension, even after adjusting for other explanatory variables, whereas women widowed 5-9 years were not, compared to married women. CONCLUSIONS Gender, the duration of widowhood, and type of outcome are each relevant pieces of information when assessing the potential for widowhood to negatively impact health. Future research should explore how the mechanisms linking widowhood to health vary over the course of widowhood. Incorporating information about marital relationships into the design of intervention programs may help better target potential beneficiaries among older adults in India.
Collapse
Affiliation(s)
- Jessica M Perkins
- Harvard Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Massachusetts Center for Global Health, Massachusetts General Hospital, Boston, MA, USA
| | - Hwa-Young Lee
- JW LEE Center for Global Medicine, Seoul National University College of Medicine, 71 Ihwajang-gil, Jongno-gu, Seoul, 110-810, Korea
| | - K S James
- Jawaharlal Nehru University, New Delhi, India
| | - Juhwan Oh
- JW LEE Center for Global Medicine, Seoul National University College of Medicine, 71 Ihwajang-gil, Jongno-gu, Seoul, 110-810, Korea
| | - Aditi Krishna
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jongho Heo
- JW LEE Center for Global Medicine, Seoul National University College of Medicine, 71 Ihwajang-gil, Jongno-gu, Seoul, 110-810, Korea.,Public Health Joint Doctoral Program, San Diego State University & University of California, San Diego, CA, USA
| | - Jong-Koo Lee
- JW LEE Center for Global Medicine, Seoul National University College of Medicine, 71 Ihwajang-gil, Jongno-gu, Seoul, 110-810, Korea. .,Department of Family Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - S V Subramanian
- Harvard Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| |
Collapse
|
29
|
Abstract
BACKGROUND Previous studies on mortality of widowed individuals have produced varying estimates of mortality after the death of a spouse. This variation is because of the various data types used and methodologies applied, as well as to the failure to account for sources of bias. METHODS We followed all married individuals in Norway (1,801,456 individuals) for 32 years, and information on marital status and death was collected for use in a new application of survival analysis in this field of research. RESULTS We compared mortality of widowed individuals with that of married individuals. Widowed men and women had hazard ratios of 1.34 (95% confidence interval 1.31, 1.36) and 1.29 (1.26, 1.31), respectively, for the first year after spousal death. For the same period, values were highest in ages 60-64 years with 1.78 (1.57, 1.98) in men and 1.50 (1.35, 1.65) in women. Values dropped gradually with age and more rapidly in men than women to a low for ages 85-89 years of 1.24 (1.19, 1.29) in men and 1.25 (1.20, 1.31) in women. The risk was much higher 1 to 7 days after spousal death (1.69 [1.49, 1.88] in men and 1.76 [1.56, 1.96] in women), then it dropped during the first year and from then on remained stable to year 10, which was the last year considered. CONCLUSION A considerable excess mortality risk was observed in widowed men and women from immediately after the loss of a spouse and for the next 10 years.
Collapse
|
30
|
Vable AM, Subramanian SV, Rist PM, Glymour MM. Does the "widowhood effect" precede spousal bereavement? Results from a nationally representative sample of older adults. Am J Geriatr Psychiatry 2015; 23:283-92. [PMID: 24974142 PMCID: PMC5511695 DOI: 10.1016/j.jagp.2014.05.004] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 05/09/2014] [Accepted: 05/13/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Increased mortality risk following spousal bereavement (often called the "widowhood effect") is well documented, but little prior research has evaluated health deteriorations preceding spousal loss. DESIGN Data are from the Health and Retirement Study, a nationally representative sample of Americans over 50 years old. METHOD Individuals who were married in 2004 were considered for inclusion. Outcome data from 2006 on mobility (walking, climbing stairs), number of depressive symptoms, and instrumental activities of daily living (IADLs) were used. Exposure was characterized based on marital status at the time of outcome measurement: "recent widows" (N=396) were bereaved between 2004 and 2006, before outcomes were assessed; "near widows" (N=380) were bereaved between 2006 and 2008, after outcomes were assessed; "married" individuals (N=7,330) remained married from 2004 to 2010, the follow-up period for this analysis. Linear regression models predicting standardized mobility, depressive symptoms, and IADLs, were adjusted for age, race, gender, birthplace, socio-economic status, and health at baseline. RESULTS Compared to married individuals, recent widows had worse depressive symptoms (β=0.71, 95% confidence interval (CI): [0.57, 0.85]). Near widows had worse depressive symptoms (β=0.21, 95% CI: [0.08, 0.34]), mobility (β=0.14, 95%CI: [0.01, 0.26]), and word recall (β=-0.13, 95%CI: [-0.23, -0.02]) compared to married individuals. CONCLUSIONS Health declines before spousal death suggests some portion of the "widowhood effect" may be attributable to experiences that precede widowhood and interventions prior to bereavement might help preserve the health of the surviving spouse.
Collapse
Affiliation(s)
- Anusha M. Vable
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, USA
| | - S. V. Subramanian
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, USA
| | - Pamela M. Rist
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, USA,Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA,Division of Preventive Medicine, Department of Medicine, Brigham and Woman’s Hospital, Harvard Medical School, Boston, MA, USA
| | - M. Maria Glymour
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, USA,Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco
| |
Collapse
|
31
|
Arizmendi BJ, O'Connor MF. What is "normal" in grief? Aust Crit Care 2015; 28:58-62; quiz 63. [PMID: 25716103 DOI: 10.1016/j.aucc.2015.01.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 12/24/2014] [Accepted: 01/26/2015] [Indexed: 10/24/2022] Open
Abstract
Research conducted over the past two decades has revealed that grief, a common phenomenon experienced by many people following the loss of a loved one, is rarely experienced as a steady progression from high acuity (intensity) to eventual resolution. Instead of this single "traditional" path, four distinct trajectories are supported by empirical data: resilience, chronic grief, depressed-improved, and chronic depression. Furthermore, a small subset of individuals never fully integrate the loss into their life, and continue to experience severe disruption in daily life many years after the loss event, a phenomenon known as Complicated Grief (CG). Continued empirical research will help further our understanding of the normative grief process and CG as a disorder. This information is crucial for informing clinicians of best practices when attending to those suffering from loss.
Collapse
Affiliation(s)
- Brian J Arizmendi
- Department of Psychology, University of Arizona, 1503 E. University Boulevard, Room 430, Tucson, AZ 85721, United States
| | - Mary-Frances O'Connor
- Department of Psychology, University of Arizona, 1503 E. University Boulevard, Room 430, Tucson, AZ 85721, United States.
| |
Collapse
|