Chrostakis NA, Allison PD
N Engl J Med. 2006;354(7):719-730.
Background:
The health of people connected by a social tie may be interdependent. The effect of death of one spouse on the risk of death of the other (referred to as bereavement effect), as well as the effect of the illness of a spouse on the risk of illness of the partner (referred to as caregiver burden), are well-documented examples. Studying both phenomena in concert may advance the understanding of both.
Objective:
To examine the association between the hospitalization of a spouse with a serious illness and a partner's risk of death among elderly people.
Methods:
518,240 couples who were enrolled in Medicare (aged >=65 years) in 1993 were included in this cohort analysis. Using the Vital Status File, daily mortality follow-up was obtained through January 1, 2002. Using Medicare Provider Analysis and Review records, hospitalization admission dates and diagnoses were also obtained.
Results:
Overall, 383,480 husbands (74%) and 347,269 wives (67%) were hospitalized at least once, and 252,557 husbands (49%) and 156,004 (30%) wives died during the follow-up period. Mortality within one year after the hospitalization of a spouse varied according to the spouse's diagnosis. After adjustment for measured covariates, the risk of death for men was significantly higher after a spouse's hospitalization for stroke (HR = 1.06; 95% CI 1.03-1.09), congestive heart failure (HR = 1.12; 95% CI 1.07-1.16), hip fracture(HR = 1.15; 95% CI 1.11-1.18), psychiatric disease (HR = 1.19; 95% CI 1.12-1.26), or dementia (HR = 1.22; 95% CI 1.12-1.32). For women, the various risks of death after a spouse's hospitalization were similar. The death of a spouse is associated with an increase in the risk of death of 21% for men and 17% for women. For women, the effect of a husband's hospitalization increased with age and poverty, whereas for men, the effect of a wife's hospitalization increased only with age. Additional analyses also showed that the effect of spousal hospitalization or death on mortality of the partner was more pronounced within the first 30 days.
Discussion:
Among elderly people, hospitalization of a spouse is associated with an increased risk of death, and the effect of the illness of a spouse varies among diagnoses. Possible mechanisms are that spousal illness or death may impose stress on a partner or that spousal illness or death may deprive a partner of social, emotional, economic, or other practical support. Such interpersonal health effects have clinical and policy implications for the care of patients and their families.
Comment:
This study gives us cause to pause and consider the family as a unit when we take care of our patients. Man is a social creature, and hence, it should not be surprising that our health be intertwined with that of our loved ones. As we care for our elderly patients recovering from a cardiac event, it is customary to discuss home nursing care, fall/safety issues, exercise center availability, and others. Perhaps, we should also be looking into our patients' spouses, understanding that the health of one is integral to the health of both. Incorporating the spouse in cardiac rehabilitation, for instance, getting them involved in educational efforts and perhaps having them exercise alongside our patient, may actually benefit both partners.
ST