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      Increased risk for hip fracture after death of a spouse—further support for bereavement frailty?

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          Abstract

          Summary

          Death of a spouse is associated with poorer physical and mental health. We followed all married individuals, born from 1902 to 1942, during the period from 1987 to 2002, and found that widows and widowers had higher risk for hip fracture, compared with still married women and men.

          Introduction

          Spousal bereavement can lead to poorer physical and mental health. We aimed to determine whether married women and men had an elevated risk of hip fracture after death of a spouse.

          Methods

          In a retrospective cohort study, we followed all Swedish married individuals aged 60 to 100 years ( n = 1,783,035), from 1987 to 2002. Data are presented as mean with 95% confidence interval (CI).

          Results

          During the follow-up period, 21,305 hip fractures among widows and 6538 hip fractures among widowers were noted. The hazard ratio (HR) for hip fracture in widows compared with married women was 1.34 (95% CI 1.31 to 1.37) and for widowers compared with married men 1.32 (95% CI 1.29 to 1.35). The HR for hip fracture in the first 6 months after death of a spouse was in widows compared with married women 1.62 (95% CI 1.53 to 1.71) and in widowers compared with married men 1.84 (95% CI 1.68 to 2.03). The elevated risk was especially prominent in young widowers in the age range 60–69 years. During the first 6 months they showed a HR of 2.76 (95% CI 1.66 to 4.58) for a hip fractvure compared with age matched married men. Widows aged 60–69 years showed a HR of 1.59 (95% CI 1.26 to 1.99) compared with age matched married women.

          Conclusion

          Our observation of a higher hip fracture risk in both genders in connection with the death of a spouse indicates a possible effect of bereavement on frailty.

          Electronic supplementary material

          The online version of this article (10.1007/s00198-019-05242-w) contains supplementary material, which is available to authorized users.

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          Most cited references40

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          Symptoms of anxiety and depression in family members of intensive care unit patients: ethical hypothesis regarding decision-making capacity.

          Anxiety and depression may have a major impact on a person's ability to make decisions. Characterization of symptoms that reflect anxiety and depression in family members visiting intensive care patients should be of major relevance to the ethics of involving family members in decision-making, particularly about end-of-life issues. Prospective multicenter study. Forty-three French intensive care units (37 adult and six pediatric); each unit included 15 patients admitted for longer than 2 days. Six hundred thirty-seven patients and 920 family members. Intensive care unit characteristics and data on the patient and family members were collected. Family members completed the Hospital Anxiety and Depression Scale to allow evaluation of the prevalence and potential factors associated with symptoms of anxiety and depression. Of 920 Hospital Anxiety and Depression Scale questionnaires that were completed by family members, all items were completed in 836 questionnaires, which formed the basis for this study. The prevalence of symptoms of anxiety and depression in family members was 69.1% and 35.4%, respectively. Symptoms of anxiety or depression were present in 72.7% of family members and 84% of spouses. Factors associated with symptoms of anxiety in a multivariate model included patient-related factors (absence of chronic disease), family-related factors (spouse, female gender, desire for professional psychological help, help being received by general practitioner), and caregiver-related factors (absence of regular physician and nurse meetings, absence of a room used only for meetings with family members). The multivariate model also identified three groups of factors associated with symptoms of depression: patient-related (age), family-related (spouse, female gender, not of French descent), and caregiver-related (no waiting room, perceived contradictions in the information provided by caregivers). More than two-thirds of family members visiting patients in the intensive care unit suffer from symptoms of anxiety or depression. Involvement of anxious or depressed family members in end-of-life decisions should be carefully discussed.
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            Widowhood and Mortality: A Meta-Analysis

            Background While the "widowhood effect" is well known, there is substantial heterogeneity in the magnitude of effects reported in different studies. We conducted a meta-analysis of widowhood and mortality, focusing on longitudinal studies with follow-up from the time of bereavement. Methods and Findings A random-effects meta-analysis was conducted to calculate the overall relative risk (RR) for subsequent mortality among 2,263,888 subjects from 15 prospective cohort studies. We found a statistically significant positive association between widowhood and mortality, but the widowhood effect was stronger in the period earlier than six months since bereavement (overall RR = 1.41, 95% CI: 1.26, 1.57) compared to the effect after six months (overall RR = 1.14, 95% CI: 1.10, 1.18). Meta-regression showed that the widowhood effect was not different for those aged younger than 65 years compared to those older than 65 (P = 0.25). There was, however, a difference in the magnitude of the widowhood effect by gender; for women the RR was not statistically significantly different from the null (overall RR = 1.04, 95% CI: 1.00, 1.08), while it was for men (overall RR = 1.23, 95% CI: 1.18, 1.28). Conclusions The results suggest that further studies should focus more on the mechanisms that generate this association especially among men.
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              Psychosocial outcomes in informal caregivers of the critically ill: a systematic review.

              The objective of the review was to evaluate and synthesize the prevalence, risk factors, and trajectory of psychosocial morbidity in informal caregivers of critical care survivors.
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                Author and article information

                Contributors
                cecilie.hongslo.vala@gu.se
                Journal
                Osteoporos Int
                Osteoporos Int
                Osteoporosis International
                Springer London (London )
                0937-941X
                1433-2965
                12 December 2019
                12 December 2019
                2020
                : 31
                : 3
                : 485-492
                Affiliations
                [1 ]GRID grid.8761.8, ISNI 0000 0000 9919 9582, Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, , University of Gothenburg, ; 413 45 Göteborg, Sweden
                [2 ]GRID grid.1649.a, ISNI 000000009445082X, Region Västra Götaland, Geriatric Medicine Clinic, , Sahlgrenska University Hospital, ; 431 80 Mölndal, Sweden
                [3 ]GRID grid.411958.0, ISNI 0000 0001 2194 1270, Mary McKillop Health Institute, , Australian Catholic University, ; Melbourne, Australia
                [4 ]GRID grid.1649.a, ISNI 000000009445082X, Section of Haematology and Coagulation, Department of Internal Medicine and Clinical Nutrition, , Sahlgrenska University Hospital, ; 413 45 Gothenburg, Sweden
                [5 ]GRID grid.8993.b, ISNI 0000 0004 1936 9457, Department of Archaeology and Ancient History, , Uppsala University-Campus Gotland, ; 621 57 Visby, Sweden
                [6 ]Department of Orthopedics and Clinical Sciences, Skåne University Hospital, Lund University, 205 02 Malmö, Sweden
                [7 ]GRID grid.8761.8, ISNI 0000 0000 9919 9582, Center for Bone and Arthritis Research (CBAR), Sahlgrenska Academy, , University of Gothenburg, ; 413 45 Gothenburg, Sweden
                [8 ]GRID grid.8761.8, ISNI 0000 0000 9919 9582, Department of Psychology, , University of Gothenburg, ; 405 30 Gothenburg, Sweden
                [9 ]GRID grid.11835.3e, ISNI 0000 0004 1936 9262, Centre for Metabolic Bone Disease, Medical School, , University of Sheffield, ; Sheffield, S10 2RX UK
                Author information
                http://orcid.org/0000-0001-8932-9686
                Article
                5242
                10.1007/s00198-019-05242-w
                7075824
                31832693
                008db941-dd71-4fff-9e69-537b04fe7718
                © The Author(s) 2019

                Open Access This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License ( http://creativecommons.org/licenses/by-nc/4.0/), which permits any noncommercial use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                History
                : 9 July 2019
                : 19 November 2019
                Funding
                Funded by: ALF/LUA
                Award ID: ALFGBG722321
                Award ID: ALFGBG437971
                Funded by: FundRef http://dx.doi.org/10.13039/501100004359, Vetenskapsrådet;
                Award ID: 2017-02229
                Categories
                Original Article
                Custom metadata
                © International Osteoporosis Foundation and National Osteoporosis Foundation 2020

                Orthopedics
                bereavement,hip fracture,osteoporosis,widow,widower,widowhood
                Orthopedics
                bereavement, hip fracture, osteoporosis, widow, widower, widowhood

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