Mortality and function following widowhood among older adults with dementia, cancer, and organ failure (RP222)

Outcomes 1. Determine the impact of widowhood on function and mortality among older adults with dementia.2. Determine the impact of widowhood on function and mortality among older adults with cancer and organ failure. Key Message Widowhood is a disruptive social event that may impair function among those with dementia and cancer, and increase mortality among those with cancer. People living with illnesses associated with high caregiver burden, such as dementia and cancer, may be most adversely affected by spousal death. Importance The “widowhood effect,” in which function declines and mortality rises following spousal death [1], may be heightened in people with serious illnesses that have high caregiving support needs, such as dementia, cancer, and chronic organ failure. Yet there are limited data on widowhood that account for these illnesses. Objective(s) To determine the impact of widowhood on function and mortality among older adults with dementia, cancer, and organ failure. Scientific Methods Utilized Exposures: Status of dementia, organ failure, or cancer diagnosis Main Outcomes: Function score (0-11 independence in ADL/IADL) and 1-year mortality Methods: Retrospective cohort study among community-dwelling, married/partnered persons, ≥65 years, enrolled in the Health and Retirement Study, 2000-2018. We matched people with and without a widowhood event for each disease group and then used multivariate linear regression to evaluate changes in function before, at time of, and following widowhood. We used cox proportional hazards model to determine the 1-year mortality risk in people with dementia, organ failure, and cancer. Results There were 2,057 matched pairs of people with dementia (319 experienced widowhood), 2,758 matched for cancer (95 experienced widowhood), and 2,800 matched for organ failure (85 experienced widowhood). Compared to those without these illnesses, widowhood was associated with a decline in function immediately following the event (dementia: -1.0 function score, p<.000; cancer: -1.2 function score, p=.015; organ failure: -0.8 function score, p=0.51). Widowhood was associated with increased 1-year mortality among people with cancer (HR 1.49, 95%CI 1.02, 2.21), but not dementia (HR 0.98, 95%CI 0.80, 1.19) or organ failure (HR 0.92, 95% CI 0.66, 1.28). Conclusion(s) Widowhood is a disruptive social event associated with functional decline in older adults with dementia and cancer, and increased mortality in those with cancer. Conditions with high caregiver burden, such as dementia and cancer, may have an exaggerated widowhood effect. Impact Widowhood is a common, disruptive social event that may significantly alter the clinical and functional trajectory of older adults with serious illnesses, such as dementia and cancer. Further research is needed to determine whether greater mobilization of community or palliative resources may help to ameliorate these effects. Keywords Palliative care in chronic, non-malignant illness/Palliative care in oncology