Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
Division of Geriatrics, University of California, San Francisco.
JAMA Netw Open. 2024 Sep 3;7(9):e2432979. doi: 10.1001/jamanetworkopen.2024.32979.
The widowhood effect, in which mortality increases and function decreases in the period following spousal death, may be heightened in older adults with functional impairment and serious illnesses, such as cancer, dementia, or organ failure, who are highly reliant on others, particularly spouses, for support. Yet there are limited data on widowhood among people with these conditions.
To determine the association of widowhood with function and mortality among older adults with dementia, cancer, or organ failure.
DESIGN, SETTING, AND PARTICIPANTS: This longitudinal cohort study used population-based, nationally representative data from the Health and Retirement Study database linked to Medicare claims from 2008 to 2018. Participants were married or partnered community-dwelling adults aged 65 years and older with and without cancer, organ failure, or dementia and functional impairment (function score <9 of 11 points), matched on widowhood event and with follow-up until death or disenrollment. Analyses were conducted from September 2021 to May 2024.
Widowhood.
Function score (range 0-11 points; 1 point for independence with each activity of daily living [ADL] or instrumental activity of daily living [IADL]; higher score indicates better function) and 1-year mortality.
Among 13 824 participants (mean [SD] age, 70.1 [5.5] years; 6416 [46.4%] female; mean [SD] baseline function score, 10.2 [1.6] points; 1-year mortality: 0.4%) included, 5732 experienced widowhood. There were 319 matched pairs of people with dementia, 1738 matched pairs without dementia, 95 matched pairs with cancer, 2637 matched pairs without cancer, 85 matched pairs with organ failure, and 2705 matched pairs without organ failure. Compared with participants without these illnesses, widowhood was associated with a decline in function immediately following widowhood for people with cancer (change, -1.17 [95% CI, -2.10 to -0.23] points) or dementia (change, -1.00 [95% CI, -1.52 to -0.48] points) but not organ failure (change, -0.84 [95% CI, -1.69 to 0.00] points). Widowhood was also associated with increased 1-year mortality among people with cancer (hazard ratio [HR], 1.08 [95% CI, 1.04 to 1.13]) or dementia (HR, 1.14 [95% CI, 1.02 to 1.27]) but not organ failure (HR, 1.02 [95% CI, 0.98 to 1.06]).
This cohort study found that widowhood was associated with increased functional decline and increased mortality in older adults with functional impairment and dementia or cancer. These findings suggest that persons with these conditions with high caregiver burden may experience a greater widowhood effect.
丧偶效应是指在配偶去世后，死亡率增加，功能下降，这种效应在功能障碍和患有严重疾病（如癌症、痴呆或器官衰竭）的老年人中可能更为明显，这些老年人高度依赖配偶等他人提供支持。然而，关于这些人群中的丧偶情况的数据有限。
确定丧偶与痴呆、癌症或器官衰竭老年人的功能和死亡率之间的关联。
设计、地点和参与者：这是一项使用基于人群的、具有全国代表性的健康与退休研究数据库中的数据进行的纵向队列研究，该数据库与 2008 年至 2018 年的医疗保险索赔数据相关联。参与者为年龄在 65 岁及以上、患有癌症、器官衰竭或痴呆且存在功能障碍（功能评分<11 分中的 9 分）的已婚或伴侣关系的社区居住成年人，这些人匹配了丧偶事件，并在随访至死亡或退出研究。分析于 2021 年 9 月至 2024 年 5 月进行。
丧偶。
功能评分（范围 0-11 分；每项日常生活活动[ADL]或工具性日常生活活动[IADL]得 1 分；评分越高表示功能越好）和 1 年死亡率。
在 13824 名参与者中（平均[标准差]年龄为 70.1[5.5]岁，6416 名[46.4%]为女性，平均[标准差]基线功能评分为 10.2[1.6]分，1 年死亡率：0.4%），5732 人经历了丧偶。其中有 319 对匹配的痴呆患者，1738 对无痴呆患者，95 对匹配的癌症患者，2637 对无癌症患者，85 对匹配的器官衰竭患者和 2705 对无器官衰竭患者。与没有这些疾病的参与者相比，丧偶与癌症（变化，-1.17[95%CI，-2.10 至-0.23]分）或痴呆（变化，-1.00[95%CI，-1.52 至-0.48]分）患者的功能在丧偶后立即下降相关，但与器官衰竭（变化，-0.84[95%CI，-1.69 至 0.00]分）患者无关。丧偶还与癌症（风险比[HR]，1.08[95%CI，1.04 至 1.13]）或痴呆（HR，1.14[95%CI，1.02 至 1.27]）患者的 1 年死亡率增加相关，但与器官衰竭（HR，1.02[95%CI，0.98 至 1.06]）患者无关。
这项队列研究发现，丧偶与功能障碍老年人以及痴呆或癌症患者的功能下降和死亡率增加相关。这些发现表明，这些具有高 caregiver 负担的疾病患者可能会经历更大的丧偶效应。
