Thursday, February 23, 2006

Hospitalization of a spouse as a mortality risk factor; more on gum chewing

The New England Journal of Medicine has a fascinating article on hospitalization of a spouse as a risk factor for death. It looks at a huge cohort of older people (medicare beneficiaries) and used a 'case-time-control' method to determine elevated risk of death. I'll freely admit that this studies methods section completely overwhelmed me & I don't pretend to understand--other than superficially--how this study worked (please leave a comment if you can explain it succinctly). It looked at a huge number of people (over 500,000 couples) over a 9 year period, and found pretty consistent results: serious hospitalization of a spouse, or a spouse's death, increased the other spouse's mortality. The hazard ratio for death after a spouse's death was ~1.2. Interestingly, hospitalization with a cancer diagnosis did not elevate the risk of death.

The mechanism proposed by the authors is that this represents an effect of increased stress (whether physical, financial, psychological) on the non-hospitalized spouse. They conclude:
Our findings can also inform the delivery of support services. The training and assistance of spouses who serve as caregivers can lower costs and also improve the health of patients and partners alike. Our work suggests that such interventions might even decrease mortality among partners. Our work also suggests that such interventions are especially likely to be useful in certain diseases, such as stroke and dementia. Moreover, the timing of such interventions might optimally be matched to the riskiest times for partners — for example, just after hospitalization of the spouse. Finally, since seriously ill patients themselves care about the health of their loved ones, they have a substantial interest in mitigating any effects of their own illness on others.

There has recently been some discussion of preventive medicine in palliative care (here, and in a recent comment on this blog), and this area seems to me to be one in which it makes sense. Maybe we could all get back into the life-saving business (that was me being glib). What could be done, specifically, other than generally improving bereavement care I'm not so sure....

And finally--
More about the wonders of gum chewing--it may speed recovery from post-operative ileus.

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