El ingreso hospitalario de una persona mayor con una enfermedad grave que acaba con su vida puede ocasionar también la muerte de su marido o esposa, señala el mayor estudio realizado hasta la fecha sobre este tema.

El estudio concluye que entre las parejas de ancianos, el riesgo de desarrollar una enfermedad e incluso de morir tras el fallecimiento del compañero o de la compañera es especialmente grande, sobre todo durante el primer mes después de que el marido o esposa haya ingresado en el hospital.

El estudio fue realizado en Estados Unidos por el médico y sociólogo Nicholas A. Christakis, del Harvard Medical School, en Boston, y por el sociólogo Paul D. Allison, de la Universidad de Pennsylvania, en Filadelfia, Estados Unidos.

Los resultados han sido publicados por el New England Journal of Medicine(1). El Instituto Nacional de la Salud de Estados Unidos ha publicado asimismo un comunicado sobre esta investigación(2).

Estrés emocional

Ambos autores explican que esta situación se debe al estrés que produce en los maridos y esposas el hecho de perder un apoyo básico en varios terrenos de su vida: emocional, financiero e incluso práctico. El estado psíquico de sufrimiento provoca que el sistema inmunológico se debilite, provocando que las enfermedades y achaques preexistentes se intensifiquen.

En el estudio se analizaron las hospitalizaciones y las muertes de más de 500.000 parejas de casados de entre 65 y 98 años, entre los años 1993 y 2002. Además de confirmar que la salud de los miembros de las parejas de ancianos pueden condicionarse entre sí, el estudio descubrió que los viudos y viudas reaccionan peor o mejor según sus parejas sufran unas enfermedades u otras.

Las enfermedades que más afectan a la salud de la pareja sana son la demencia, las enfermedades psiquiátricas, las fracturas en el cuello del fémur u otras fracturas óseas, así como los infartos cerebrales o cardiacos. En el caso de una enfermedad cardiaca, por ejemplo, el riesgo de fallecimiento de la pareja se incrementa un 12%, mientras que en caso de la demencia el riesgo aumenta un 22% .

Los porcentajes derivados del estudio señalan que el 8,6% de los viudos murieron un año después de que su esposa fuese hospitalizada por demencia; un 7,5% murió un año después de que sus mujeres ingresaran con alguna enfermedad psiquiátrica, y un 6,9% falleció un año después de que sus esposas entraran en el hospital víctimas de un infarto.

Entre las mujeres, el 3% murió durante el primer año después de que su esposo fuese hospitalizado por cáncer de colon; el 3,7% falleció al año de que su esposo fuese hospitalizado con un infarto, y el 5,7% después de un año del ingreso de su marido por demencia.

Primeros meses, decisivos

En general, los ancianos incrementan su riesgo de muerte en 4,5% cuando es ingresada su compañera; y las ancianas lo incrementan en un 3%. Si, finalmente, el compañero fallece, este riesgo se multiplica por cinco: alcanza un 21% en el caso de los hombres, y un 17% en el de las mujeres.

El peligro aparece desde el momento en que uno de los dos miembros de la pareja cae gravemente enfermo. Sin embargo, comienza a decrecer en unos meses. Normalmente, son las mujeres las que suelen tener mayor apoyo social que los hombres, lo que podría explicar la diferencia en el riesgo que muestran los porcentajes.

El estudio demuestra que la ayuda es necesaria no sólo después de la muerte del compañero, sino desde que se presenta la enfermedad grave que puede costarle la vida. De hecho, la enfermedad ocasiona ya un aumento del peligro de muerte del marido o la esposa sanos muy similar al que origina el fallecimiento en sí.

El estudio abarcó exactamente a 518.240 parejas, más de un millón de personas, de edades comprendidas entre los 65 y los 98 años. A lo largo del estudio, 383.480 maridos (el 74%) y 347.269 esposas (el 67%) fueron hospitalizados al menos una vez, y 252.557 maridos (el 49%) y 156.004 esposas (el 30%) fallecieron. La edad media de los varones analizados es de 75 años, y la de las mujeres de 72.

(1) Mortality after the Hospitalization of a Spouse
Nicholas A. Christakis, M.D., Ph.D., M.P.H., and Paul D. Allison, Ph.D.

ABSTRACT

Background The illness of a spouse can affect the health of a caregiving partner. We examined the association between the hospitalization of a spouse and a partner's risk of death among elderly people.

Methods We studied 518,240 couples who were enrolled in Medicare in 1993. We used Cox regression analysis and fixed-effects (case–time–control) methods to assess hospitalizations and deaths during nine years of follow-up.

Results Overall, 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.

Source Information

From the Department of Health Care Policy, Harvard Medical School, and the Palliative Care Service, Department of Medicine, Massachusetts General Hospital — both in Boston (N.A.C.); the Department of Sociology, Harvard University, Cambridge, Mass. (N.A.C.); and the Department of Sociology, University of Pennsylvania, Philadelphia (P.D.A.).
http://content.nejm.org/cgi/content/abstract/354/7/719?hits=20&where=fulltext&andorexactfulltext=and&searchterm=Nicholas+A.+Christakis+&sortspec=Score%2Bdesc%2BPUBDATE_SORTDATE%2Bdesc&excludeflag=TWEEK_element&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT

(2) Spouse’s Hospitalization Increases Partner’s Risk of Death, New Study of a Half-Million Couples Shows

Most people have heard stories about an older person who “dies of a broken heart” shortly after their partner’s death. A new study finds that hospitalization of a spouse for a serious illness also increases their partner’s risk of death. Further, the risk is greater with certain diagnoses, such as dementia, stroke, and hip fracture. The study was sponsored by the National Institute on Aging (NIA) at the National Institutes of Health (NIH).

The report, by Nicholas A. Christakis, M.D., Ph.D., M.P.H., of Harvard Medical School, and Paul D. Allison, Ph.D., of the University of Pennsylvania, is the first to measure a link between a spouse’s hospitalization and increased mortality of their partner across a comprehensive range of spousal diseases. The findings, says Christakis, were striking. “When a spouse is hospitalized, the partner’s risk of death increases significantly and remains elevated for up to two years,” he notes. The study is published in the Feb. 16, 2006, issue of the New England Journal of Medicine.

“This highly innovative study — in an enormous sample of older people — demonstrates yet another important connection between social networks and health,” says Richard M.Suzman, Ph.D., Associate Director of the NIA for Behavioral and Social Research. “We don’t yet know the full extent to which social networks affect health. We need to explore the mechanisms behind the stresses associated with these hospitalizations as we look for ways to protect people when their central relationships are disrupted.”

Christakis and colleagues studied more than half a million couples over 65 years old who were enrolled in Medicare from 1993 through 2001. Over that period, the study found that, overall, having a sick spouse is about one fourth as bad for a partner’s health as having a spouse actually die. Some spousal diseases, such as hip fracture or psychiatric conditions, were nearly as bad for partners as it would be if the spouse actually died. The period of greatest risk is over the short run, within 30 days of a spouse’s hospitalization or death, the researchers noted, when the risk of death upon a spouse’s hospitalization is almost as great as that when a spouse dies. The mortality risk increased with age and, for women of a hospitalized husband, with poverty.

The illness responsible for the spouse’s hospitalization also matters. For example, among men with hospitalized wives, if their wife is hospitalized with colon cancer, there is almost no effect on the husband’s subsequent mortality. But if the wife is hospitalized with heart disease, the risk of death for a husband is 12 percent higher compared to the wife not being sick at all. If one’s wife is hospitalized with psychiatric disease, a partner’s risk of death is 19 percent higher. And if one’s wife is hospitalized with the principal diagnosis of dementia, mortality risk for the husband is 22 percent higher. Similar effects are seen in women whose husbands are hospitalized.

The more a disease that causes a hospitalization interferes with the patient’s physical or mental ability, regardless of the extent to which it is deadly, the more of an impact it may have for the partner of the ill person, the researchers suggest. “The study suggests that diseases that are more disabling are more likely to result in disease and death in the caregiving spouse,” Christakis says. Spousal illness might also deprive the partner of emotional, economic, or other practical support, or might impose stress on the caregiver which may contribute to their risk of death, the investigators theorize.

Christakis and his colleagues are interested in the health consequences of social networks. The impact of the death of one spouse on the mortality of the other is one well-known example. The impact of illness is a further example. “People’s health is interconnected,” Christakis says. “When we take care of people when they’re sick, we’re also taking care of the patients’ spouses. So helping one person might help others. Such benefits should be included in any cost-benefit analyses of interventions.

News releases, fact sheets and other NIA-related materials are available on the NIA Web site at www.nia.nih.gov.

The NIA leads the federal effort supporting and conducting research on aging and the medical, social and behavioral issues of older people. A substantial part of NIA's research involves ways to prevent frailty and reduce disability with age. For more information, call 1-800-222-2225 or go to the NIA website at www.nia.nih.gov.

The National Institutes of Health (NIH) — The Nation's Medical Research Agency — includes 27 Institutes and Centers and is a component of the U. S. Department of Health and Human Services. It is the primary Federal agency for conducting and supporting basic, clinical, and translational medical research, and it investigates the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit http://www.nih.gov.

Reference: NA Christakis et al. Mortality After Hospitalization of a Spouse. New England Journal of Medicine; vol. 354, issue 7, 719-730 (2006).
http://www.nih.gov/news/pr/feb2006/nia-15a.htm