Cognitive and functional trajectories among older widowed male Veterans: Findings from the Health and Retirement Study

Abstract: OBJECTIVES: Loss of a spouse increases risk for cognitive and functional decline in older age. However, literature examining bereavement effects on cognition and daily functioning in veterans is limited. This study therefore examined differences in cognitive and functional trajectories after spousal loss in older male veterans. DESIGN: Retrospective cohort study. SETTING AND PARTICIPANTS: Participants included 3339 male, community-dwelling veterans in the Health and Retirement Study aged >51 years who were married/partnered at enrollment and remained married (n = 2849) or became widowed (n = 490). METHODS: Participants completed biannual cognitive testing (Telephone Interview of Cognitive Status) and basic activities of daily living (ADL) and instrumental activities of daily living (IADL) questionnaires, and reported medical comorbidities and marital status. A generalized additive mixed-effects model compared annual rates of cognitive decline between married and widowed participants. Negative binomial regression evaluated associations between widowhood, ADLs, and IADLs. Poisson regression tested associations between widowhood and medical comorbidities. All models adjusted for age, race, ethnicity, years of education, depression, recent hospitalization, medical comorbidities, body mass index, years worked, income, and mortality. RESULTS: Results indicated greater cognitive decline after spousal loss between ages 64 to 76 years and after aged 84 years. Widowhood was associated with greater IADL difficulty [incidence rate ratio (IRR), 1.20; 95% CI, 1.01-1.43] and requiring IADL assistance (IRR, 1.38; 95% CI, 1.14-1.68). No associations were found between widowhood and basic ADL difficulty (IRR, 1.14; 95% CI, 0.97-1.34), requiring ADL assistance (IRR, 1.04; 95% CI, 0.77-1.41), or medical comorbidities (IRR, 0.99; 95% CI, 0.94-1.04). Sensitivity analyses including only widowers revealed greater post-loss ADL difficulty (IRR, 1.30; 95% CI, 1.04-1.63), ADL assistance (IRR, 1.76; 95% CI, 1.14-2.73), and medical comorbidities (IRR, 1.12; 95% CI, 1.05-1.20). CONCLUSIONS AND IMPLICATIONS: Compared with married veterans, widowers had greater rates of cognitive decline, greater difficulty completing IADLs, and increased medical comorbidities. These findings may inform access to mental health services addressing bereavement and other clinical outcomes after widowhood.