2260 Mortality after the hospitalization of a spouse

The recent death of Dana Reeve, wife of Christopher Reeve, who with her husband established a foundation to battle spinal cord injuries, has reminded us again the terrible toll on the health of the care taker.

The February 16, 2006 issue of the New England Journal of Medicine published a study, "Mortality after the hospitalization of a spouse," in which it was shown that the negative effect on the caregiver spouse varies by the type of illness, length of time, and the gender. Mortality for a husband who has a wife who is hospitalized is higher in almost all cases than for wives whose husbands are hospitalized, but particularly for hip fracture and dementia.

Just the hospitalization (not the death) of a spouse puts the caregiver at risk for death almost as high as if the spouse had died--particularly within the first 30 days. But this would indicate the stress level of those with spouses who have serious illnesses. When I read the article I photocopied it for our UALC minister who works with our older members. My own theory on why this risk would be particularly high during the first 30 days is that it takes a while for the social and support network to kick in--for adult children to arrive to help, for friends to start doing what friends do, for church members to send cards, visit, and offer transportation and for the care giver to adjust to a new routine. Therefore, I think this article needs to be in the hands of every church that has a large percentage of older memers. Many public libraries carry NEJM--go take a look today.

From the abstract: "Results: Overall [of the 518,240 couples in the study], 383,480 husbands (74 percent) and 347,269 wives (67 percent) were hospitalized at least once, and 252,557 husbands (49 percent) and 156,004 wives (30 percent) died. Mortality after the hospitalization of a spouse varied according to the spouse's diagnosis. Among men, 6.4 percent died within a year after a spouse's hospitalization for colon cancer, 6.9 percent after a spouse's hospitalization for stroke, 7.5 percent after a spouse's hospitalization for psychiatric disease, and 8.6 percent after a spouse's hospitalization for dementia. Among women, 3.0 percent died within a year after a spouse's hospitalization for colon cancer, 3.7 percent after a spouse's hospitalization for stroke, 5.7 percent after a spouse's hospitalization for psychiatric disease, and 5.0 percent after a spouse's hospitalization for dementia. After adjustment for measured covariates, the risk of death for men was not significantly higher after a spouse's hospitalization for colon cancer (hazard ratio, 1.02; 95 percent confidence interval, 0.95 to 1.09) but was higher after hospitalization for stroke (hazard ratio, 1.06; 95 percent confidence interval, 1.03 to 1.09), congestive heart failure (hazard ratio, 1.12; 95 percent confidence interval, 1.07 to 1.16), hip fracture (hazard ratio, 1.15; 95 percent confidence interval, 1.11 to 1.18), psychiatric disease (hazard ratio, 1.19; 95 percent confidence interval, 1.12 to 1.26), or dementia (hazard ratio, 1.22; 95 percent confidence interval, 1.12 to 1.32). For women, the various risks of death after a spouse's hospitalization were similar. Overall, for men, the risk of death associated with a spouse's hospitalization was 22 percent of that associated with a spouse's death (95 percent confidence interval, 17 to 27 percent); for women, the risk was 16 percent of that associated with death (95 percent confidence interval, 8 to 24 percent).

Conclusions 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. Such interpersonal health effects have clinical and policy implications for the care of patients and their families."