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United unto death

A study concerning 520,000 couples shows how intense the impact of an illnessor death of a partner can be

As if couldn’t stand being far from his companion, the eighty year old husband dies weeks after his wife with whom he had lived three quarters of his life became ill, was hospitalized and died. This is not just one episode of one family or another, but a common situation, according to a study carried out with 518,240 North American couples between the ages of 65 and 98 years, followed up over a nine-year period. It is the effect of grieving .

In this survey, Nicholas Christakis, a doctor and sociologist from Harvard University, and the sociologist Paul Allison, from Pennsylvania University, have verified that there is a 21% greater probability that a man also will die after his companion passes away, no matter whether or not she is ill. Among women, the risk of also dying after the loss of a husband increases by only 17%. Only the hospitalization of one of an elderly couple is sufficient to elevate the risk of the other dying – also in this case, men respond more intensely (the risk of dying is 4.5% higher) than women (risk of 2.7% higher).

Free at last
At least in Brazil this difference could be explained because men and women confront widowhood in their own manner. For men, the death of their wives is the saddest moment in their lives, whilst for women the loss of a husband represents, quite frequently, the end of oppression of their conjugal life and the conquest of autonomy, according to studies carried out by the anthropologist Guita Grin Debert, from the State University of Campinas (Unicamp).

The picture observed by Christakis and Allison is not so simple, since the possibility of the loss of health varies according to that motivates the hospitalization or the death of a partner. The interning of a man or of his companion because of cancer of the intestine, practically does not affect the health of the other. If the reason for hospitalization were to be cardiac insufficiency, a hip fracture or a chronic lung illness such as emphysema, the probability of the death of the companion would have increased by between 11% and 15%.

But it was the mental illnesses that greatly jeopardizes the well being of couples. The hospitalization of a wife for a psychiatric disorder, an example being schizophrenia or because of dementia, the progressive loss of memory and the capacity to make judgments, elevates the risk of death of the partner by up to 32%. “Illnesses that provoke chronic suffering and drastic changes in the degree of independence of one of the partners end up affecting the health and survival of the other” comments the geriatric doctor Luiz Roberto Ramos, from the Federal University of São Paulo (UNIFESP), who is coordinating a study that has been accompanying the health of elderly couples in the the city of São Paulo since 1991, the project named Epidoso.

Greater fragility
From this study, published in the New England Journal of Medicine, there also emerged some information that indicates to the family members and doctors the moments in which they must give more attention to the recent widows. The most critical period is the first month after the death or hospitalization of the companion, when the risk of the other also dying could be 61% higher. “This risk remains elevated for up to two years” observes Christakis.

In his opinion, the reason for this increase is that both the illness and the death of the companion imposes on the other an elevated level of stress or the loss of social, emotional and even economic support. Another possible cause is the adoption of harmful habits, such as the exaggerated consumption of alcohol.

“As yet we don’t know to which manner the social networks affect health” comments Richard Suzman, the director of social and behavioral research at the National Aging Institute, one of the research centers of the National Institutes of Health (NIH) of the United States, which funded the research. “We need to investigate the mechanisms behind the stress associated with these hospitalizations while we search for forms of protecting the people when their social relationships break up.” What is certain is that after having shared a life with a partner during so many years both the man and the woman suffer the impact of solitude. In the Epidoso Project, the team led by Luiz Ramos has verified that the marriage works as a health protection factor.