In Sickness and in Death: Spouses’ ills imperil partners’ survival

Among elderly people, a spouse’s hospitalization for certain ailments substantially raises his or her partner’s likelihood of dying, according to the largest study ever to quantify such effects. The risk is especially great within the first month after the spouse enters the hospital.

Partners died most frequently following their spouses’ hospitalizations for particularly disabling conditions, such as dementia, psychiatric illness, and hip or other bone fractures,

say medical sociologist Nicholas A. Christakis of Harvard Medical School in Boston and sociologist Paul D. Allison of the University of Pennsylvania in Philadelphia.

“Our study shows that your chances of dying increase not just when your partner dies, but when your partner becomes seriously ill,” Christakis says. After climbing rapidly in the first weeks after a spouse’s hospitalization, a partner’s risk of death declines to slightly above normal for a few months before rising again for the rest of the time examined, the scientists report in the Feb. 16 New England Journal of Medicine. The length of the spouse’s hospitalization didn’t affect the death risk.

For elderly people whose spouse had been hospitalized, the short-term risk of dying approaches that of elderly people after a spouse’s death, Christakis and Allison assert. In the new study, a wife’s hospitalization increased her husband’s chances of dying within a month by 35 percent. A husband’s hospitalization boosted his wife’s mortality risk by 44 percent. In comparison, a wife’s death increased her husband’s 1-month mortality risk by 53 percent, and a husband’s death raised his partner’s risk by 61 percent.

A spouse’s illness or death may hasten a partner’s demise by causing severe stress and removing a primary source of emotional, financial, or practical support, Christakis suggests. These effects can undermine the body’s immune system and intensify preexisting health problems.

The researchers analyzed hospitalizations and deaths from 1993 to 2002 among 518,240 married couples, ages 65 to 98, who were enrolled in Medicare. Roughly three-quarters of the husbands and two-thirds of the wives were hospitalized at least once during the study period. About half the husbands and 30 percent of the wives died.

A partner’s risk of dying depended on the illness that afflicted his or her hospitalized spouse. For instance, among men, 8.6 percent died within 1 year of a spouse’s hospitalization for dementia, 7.5 percent died within 1 year of a spouse’s hospitalization for psychiatric disease, and 6.9 percent died within 1 year of a spouse’s hospitalization for stroke. However, in men whose wives had been hospitalized for most forms of cancer, mortality rates were close to the 5.6 percent death rate measured among men whose wives hadn’t been hospitalized.

A similar mortality pattern appeared among wives of hospitalized men, although their death rates were slightly lower than those of men.

The unprecedented size and scope of the new study make its findings “very exciting,” remarks sociologist Linda J. Waite of the University of Chicago.

Psychologist Camille Wortman of the State University of New York at Stony Brook regards the dramatically increased risk of death among partners of recently hospitalized spouses as “amazing.” Women tend to have more social support than men do, so it’s surprising that hospitalization of wives wasn’t harder on men in the short run than vice versa, she adds.

The new findings show that physicians and family members need to address the social and practical needs of elderly people whose spouses develop disabling illnesses, notes gerontologist Suzanne E. Salamon of Beth Israel Deaconess Medical Center in Boston.