Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Sep 3;7(9):e2432979.
doi: 10.1001/jamanetworkopen.2024.32979.

Mortality and Function After Widowhood Among Older Adults With Dementia, Cancer, or Organ Failure

Rebecca Rodin  1 , Alexander K Smith  2 , Edie Espejo  3 , Siqi Gan  4 , W John Boscardin  3   4 , Lauren J Hunt  5   6   7 , Katherine A Ornstein  8 , R Sean Morrison  1   9
Affiliations

Mortality and Function After Widowhood Among Older Adults With Dementia, Cancer, or Organ Failure

Rebecca Rodin et al. JAMA Netw Open. .

Abstract

Importance: 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.

Objective: 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.

Exposure: Widowhood.

Main outcomes and measures: 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.

Results: 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]).

Conclusions and relevance: 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.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Dr Morrison reported receiving personal fees from UpToDate outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Matched Spline Regression of Function Following Real or Simulated Widowhood Event for People With and Without Cancer, Dementia, or Organ Failure
Among people with cancer (A), there were no significant differences in the slopes for those with and without widowhood events (pre-event: P = .71; postevent: P = .07). Among people with dementia (B), there were no significant differences in the slopes for those with and without widowhood events (pre-event: P = .78; postevent: P = .11). Among people with organ failure (C), there were no significant differences in the slopes for those with and without widowhood events (pre-event: P = .90; postevent: P = .35). Dashed line represents time of actual or simulated widowhood event; shading, 95% CI.
Figure 2.
Figure 2.. Kaplan-Meier Survival Curves Following Real or Simulated Widowhood Event for People With and Without Cancer, Dementia, or Organ Failure
See this image and copyright information in PMC

References

    1. Ornstein KA, Wolff JL, Bollens-Lund E, Rahman OK, Kelley AS. Spousal caregivers are caregiving alone in the last years of life. Health Aff (Millwood). 2019;38(6):964-972. doi:10.1377/hlthaff.2019.00087 - DOI - PMC - PubMed
    1. AARP Public Police Institute; National Alliance for Caregiving . Caregiving in the U.S. Accessed December 19, 2023. https://www.caregiving.org/wp-content/uploads/2020/05/2015_Caregivingint...
    1. Jansson W, Nordberg G, Grafström M. Patterns of elderly spousal caregiving in dementia care: an observational study. J Adv Nurs. 2001;34(6):804-812. doi:10.1046/j.1365-2648.2001.01811.x - DOI - PubMed
    1. National Center for Health Statistics . Leading causes of death, United States 2021. Accessed March 11, 2024. https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm
    1. Murray SA, Kendall M, Boyd K, Sheikh A. Illness trajectories and palliative care. BMJ. 2005;330(7498):1007-1011. doi:10.1136/bmj.330.7498.1007 - DOI - PMC - PubMed

Publication types