Table 1.
Summary of Studies Examining Health Behaviors and Late-life Bereavement.
| Study | N | Mean Age (years) | % Female | Sample | Health Behaviors | Measurement Interval (months) | Findings |
|---|---|---|---|---|---|---|---|
| Prospective longitudinal | |||||||
| Avis et al., 1991 * | 2,500 (76 bereaved) | 51.0 | 100 | Subgroup of a population-based sample of women (Massachusetts Women's Health Study; McKinlay et al., 1987) | Health status including (1) exerciser/nonexerciser; (2) smoker/ nonsmoker; and (3) alcoholic beverage consumption | Pre- and post bereavement (NR) | Widows' health behaviors were similar to that of married women. |
| Eng et al., 2005 * | 39,731 (530 bereaved) | 63.7 | 0 | Subgroup of a convenient sample survey of male health professionals (Health Professionals Follow-up Study; Rimm et al., 1991) | (1) Dietary intake including daily intake (kcal) of 131 foods and alcohol; (2) Smoking status; and (3) leisure/physical activity | Pre- and post bereavement (48 months) | Compared to married controls, men who became widowed increased their alcohol consumption, decreased their vegetable intake, and decreased in BMI. |
| Janke et al., 2008a & 2008b | 154 | 68.9 | 89.7 | Subgroup of a nationally representative sample survey (American's Changing Lives Study; House et al., 2005) | Leisure activities, including (1) talking to friends/family; (2) visiting friends/family; (3) clubs/organizations; (4) religious activities; (5) walking; (6) gardening; and (7) sports/exercise | Pre- and post bereavement (NR) | Widow(er)s were most likely to increase their social activities with family and friends and less likely to increase physical activity and gardening activities. |
| Janke et al., 2008c * | 296 (148 bereaved) | 69 | 100 | Subgroup of a women from a nationally representative sample survey (American's Changing Lives Study; House et al., 2005) | Leisure activities, including (1) informal; (2) formal; and (3) physical leisure activities | Pre- and post bereavement (NR) | Widowed women increased their involvement in all activities, whereas continuously married women decreased their involvement in informal and formal activities. |
| Lee et al., 2005 * | 80,944 (8,047 bereaved) | 63.9 | 100 | Subgroup of a random sample survey of registered nurses (Nurses' Health Study2; Colditz et al., 1992) | (1) Dietary intake of 130 foods, including alcoholic; (2) weight change; (3) recreational physical activity (MET-hours/week); (4) smoking status; and (5) mammogram screen during past 2 years | Pre- and post bereavement (48 months) | Compared to married controls, women who became widowed decreased their BMI, increased their alcohol consumption, and decreased their vegetable intake. |
| Schulz et al., 2001 | 129 | 80.1 | 89.9 | Subgroup of a population-based cohort study of spousal caregivers (Caregiver Health Effects Study; Schulz et al., 2001) | (1) Missing at least 1 physician appointment during last 6 mo.; (2) not having enough time to visit physician; (3) not exercising; (4) forgetting medications; (5) not getting enough rest; and (6) not being able to rest | Pre- and post bereavement (48 months) | Compared to caregivers, noncaregivers experienced significant weight loss following bereavement. Caregivers who felted strained experienced a significant decline in health-risk behaviors following bereavement. |
| Shahar et al., 2001 * | 116 | 77.6 | 82.8 | A subgroup of a population-based cohort study (Cardiovascular Health Study; Fried et al., 1991) | (1)Dietary intake of 100+ items; (2)eating behavior and feelings related to eating; and (3) weight change | Pre- and post bereavement (NR) | Relative to married controls, mean weight loss was significantly higher among widowed participants. Widow(er)s ate more meals alone, more commercial meals per week, and enjoyed eating less. |
| Tran, 2007 b | 121 | 75 | 68 | Random sample of community-dwelling adults aged 65 years+ (Canada) | Health-promoting behaviors, including (1) exercise; (2) diet; (3) stress management; (4) Interpersonal relationships; (5) spirituality; and (6) health responsibility | Pre- and post bereavement (NR) | Among all caregivers, experiencing the death of a spouse did not change the frequency of engaging in healthy behaviors. |
| Wilcox et al., 2003 * | 72,247 (16,076 bereaved) | 64.1 | 100 | Subgroup of a nationally representative sample of postmenopausal women (Women's Health Initiative; Women's Health Initiative Study Group, 1998) | (1) Dietary intake, including fruits and vegetables, alcohol, and energy from fat; (2) smoking status; (3) duration of walking (kcal), and (4) duration of moderate to strenuous exercise (kcal) | Pre- and post bereavement (36 months) | Relative to married women, widows weight loss. Recent widows decreased fruit and vegetable intake, and increased fat intake. Longer-term widows slightly increased their physical activity and decreased their tobacco use. |
| Williams, 2004 * | 402 (203 bereaved) | NR | NR | Subgroup of a community representative sample survey (Changing Lives of Older Couples; Carr et al., 2006) | Risky health behaviors, including (1) rarely or never walks/exercises for pleasure; (2) unhealthy body weight; (3) smokes cigarettes; and (d) <7 hours of sleep/24-hr period | Pre- and post bereavement (18 months) | Compared to married controls, widows/widowers increased their engagement in health-risk behaviors following the death of their spouse. |
| Postbereavement longitudinal | |||||||
| Anderson, 1999 *b | 171 (99 bereaved) | 68.1 | 67.7 | Community-dwelling adults aged 60 years (Pittsburgh) | Sleep-related behaviors, including subjective and objective assessments of sleep quality, sleep latency, sleep duration, and sleep disturbances | Post bereavement (12 months), including a 2 week daily diary | Compared to married controls, bereaved elders reported poorer sleep quality. However, no significant differences emerged on objective assessments of sleep. |
| Byrne & Raphael, 1997 * | 114 (57 bereaved) | 74.5 | 0 | A convenience sample of community-dwelling men aged 65 years+ (Australia) | Sleep difficulties, including (1) lost much sleep over worry; and (2) had difficulty staying asleep once asleep | Post bereavement (6 weeks, 6 and 13 months) | Compared to married men, widowed men reported more sleep disturbances. |
| Byrne et al., 1999 * | 114 (57 bereaved) | 74.5 | 0 | A convenience sample of community-dwelling men aged 65 years+ (Australia) | Alcohol consumption, including (1) quantity: drinks/day; and (2) frequency: days/week | Post bereavement (6 weeks, 6 and 13 months) | Compared to married men, widowed men reported greater frequency and quantity of alcohol consumption. |
| Caserta et al., 2001 | 84 | 69 | 85.7 | Community-dwelling adults aged 50 years+ (NR) | Attendance at a health promotion program that included classes on self-care practices such as nutrition, physical activity, stress management, etc. | Pre- and post bereavement (NR) | Widow(er)s attended most of the health promotion classes (8/11) and attended because they were interested in learning how to improve their health. |
| Chen et al., 2005 | 200 | 66.3 | 73.5 | Subgroup of community-dwelling adults (Connecticut) | (1) Exercise (days/week); (2) nutritional supplements; (3) sleep (hours/night); (4) annual medical checkups (yes/no); and (5) caloric intake | Post bereavement (6 and 11 months) | Approximately half of widowed elders consistently slept 6.5-9 hours/night and monitored caloric intake during the first year postloss. Slightly more than half consistently exercised postloss. |
| McIntyre & Howie, 2002 a | 1 | NR | 100.0 | Case study of a spousally bereaved older woman (Australia) | Leisure activities, including daily routines, and social activities | Post bereavement (3 interviews) | Client highlighted that active participation in daily activities was a key factor in her adaptation to widowhood. |
| Monk et al., 2009 * | 47 | 72.3 | 80.9 | Community-dwelling adults aged 60 years+ (Pittsburgh) | Sleep behaviors, including (1) sleep quality; (2) sleep efficiency; (3) sleep latency; (4) wake after sleep onset; and (5) total sleep time | Postbereavement (2 week daily diary) | Compared to married controls, bereaved spouses reported significantly more sleep problems and sleep disturbances. |
| Nurriddin, 2008 b | 1,532 (250 bereaved) | 70.1 | 86 | Subgroup of a community representative sample survey (Changing Lives of Older Couples; Carr et al., 2006) | (1) alcohol consumption; (2) tobacco use; (3) exercise; (4) overeating; (5) drug use; and (6) excessive sleep | Postbereavement (6, 12, and 48 months) | Bereavement was associated with a lack of exercise, increased drinking, eating, excess sleep, and taking of medications. These health behaviors slightly declined with time. |
| Pasternak et al., 1992 | 28 (14 bereaved) | 6 8.1 | 78.6 | Convenience sample of community-dwelling adults aged 60 years+ (Pittsburgh) | Sleep quality, including subjective and laboratory assessments | Post bereavement (6, 10 months) | Bereaved elders showed clinically significant impairments in sleep quality. |
| Quandt et al., 2000 a | 145 | NR | 61 | Ethnographic study of rural adults aged 70 years+ (Rural Nutrition and Health Study; Quandt, et al.,1999) | Dietary interviews, including (1) ways adults obtain food; (2) how adults prepare food including meal type and frequency; and (3) how adults maintain food safety | Post bereavement (within 12 months) | Bereavement had a negative impact on nutritional strategies including meal skipping, reduced home food production, and less dietary variety. |
| Reynolds III et al., 1992 * | 61 (31 bereaved) | 71.8 | 54.8 | Convenience sample of community-dwelling depressed older adults (Pittsburgh) | Sleep efficiency, including subjective and laboratory assessments | Post bereavement (3 consecutive nights) | The sleep of the bereaved (without depression) was similar to that of healthy controls. Bereaved elders with depression had significantly lower sleep efficiency. |
| Reynolds III et al., 1993 * | 54 (27 bereaved) | 68.4 | 70.4 | Convenience sample of community-dwelling adults aged 60 years+ (Pittsburgh) | Sleep quality, including subjective and laboratory assessments | Post bereavement (3, 6, 11, 18, and 23 months) | Bereaved and control groups showed consistent differences over time in REM sleep (higher among bereaved), but were similar on all other sleep measures. |
| Wilcox & King, 2004 | 103 (NR bereaved) | 70.2 | 65.1 | Community-dwelling adults aged 65 years+ (Stanford-Sunnyvale Health Improvement Project II; King et al., 1994) | Participation in one of two health programs: (1) cardio endurance/strength; or (2) stretching/flexibility. Adults were encouraged to participate twice/week as well as two home sessions/week | Postbereavement (up to 12 months) | Across both programs, bereavement was negatively correlated to the number of home exercise sessions, but unrelated to the number or class-based sessions. |
| Cross-sectional | Length of bereavement at time of assessment | ||||||
| Barrett & Schneweis, 1980 | 193 | 74.4 | NR | Representative community sample aged 62 years+ (Wichita) | Nutrition, including mealtime experience and perception of healthy meals. (Note: only nutrition variables that emerged significant were included in the methods and results) | 10 months | Compared to longer-term widows/widowers, recently bereaved elders needed help with food preparation and did not believe they ate nutritional meals. |
| Fitzpatrick et al., 2001 * | 799 (373 bereaved) | 59.7 | 0.0 | Random sample of aging veteran men (Boston Veterans Affairs Normative Aging Study; Bosse, et al., 1984) | Leisure activities, including (1) social activities such as meeting with friends, volunteering; (2) solitary activities such as reading, watching TV; and mixed activities such as hobbies, sports | NR | Compared to married men, bereaved men did not differ on measures of leisure activity. |
| Johnson, 2002 *a | 22 (15 bereaved) | 72.0 | 69.0 | Community-dwelling adults aged 60+ (Canada) | Nutritional risk, including (1) following Canada's Food Guide to Healthy Eating, (2) diet meets nutritional needs, and (3) adequate vitamin and mineral supplementation | 30 months | Compared to married controls, bereaved individuals had a moderate risk for poor nutrition and had dietary problems including food acquisition and preparation, place/time for meals, and influence of social network. |
| Okun et al., 2011 * | 222 (39 bereaved) | 71.6 | 79.5 | Convenience sample of community-dwelling adults aged 60 years+ (Aging Well, Sleeping Efficiently; Hall et al., 2008) | (1) Sleep-related behaviors including wake time, bedtime, time in bed, total sleep time; and (2)Health-related behaviors including caffeine consumption, alcohol use, smoking status, and exercise status | NR | Compared to married controls, widow(er)s took fewer naps, had greater variability in total sleep time, and exercised less. Bereaved elders and controls did not differ on in regards to caffeine consumption, alcohol use, and smoking status. |
| Patterson, 1996; Patterson & Carpenter, 1994 | 60 | 64.0 | 71.7 | Non-probability sample of community-dwelling widow(er)s (Australia) | Leisure Activities Scale (LAS), including gardening, socializing, walking, playing sports, participating in organizations/clubs | 6-24 months | Widows and widowers most frequently participated in home-based activities and social activities with family and friends. Participation was lowest in outdoor leisure activities. |
| Rosenbloom & Whittington, 1993 * | 100 (50 bereaved) | 70.2 | 94.0 | Convenience sample of community-dwelling adults aged 60+ (Atlanta) | Eating behavior, including (1) eating along; (2) meal skipping; (3)adequacy of morning meals; and (4)food diversity | within 24 months | Widowhood altered the social meaning that eating held for older adults and produced negative effects on eating behaviors and nutrient intakes. |
| Schone & Weinick, 1998 * | 4,443 (1,720 bereaved) | 76.3 | 84.0 | Subgroup of a nationally representative sample of noninstitutionalized older adults (National Medical Expenditure Survey; Edwards & Berlin, 1989) | Health promoting behaviors, including (1) checking blood pressure annually; (2) engaging in moderate/ strenuous physical activity; (3) eating breakfast; (4) seatbelt use; and (5) not smoking | NR | Relative to married controls, widow(er)s were less likely to engage in physical activity, eat breakfast, wear a seat belts, and abstain from smoking. |
| Welte & Mirand, 1993* | 2,325 (674 bereaved) | NR | 66.0 | Representative community sample aged 60 years+ (Erie county, New York) | Alcohol consumption, including (1) quantity and frequency of beer, wine, and distilled spirits; (2) signs of alcohol dependence such as binge drinking | NR | Stressful life events, including bereavement were not associated with current alcohol consumption or late-onset problem drinking. |
| Wylie et al., 1999 a | 15 | 80.6 | 80.0 | Convenience sample of older adults with restricted mobility (United Kingdom) | Dietary interviews, including (1) meal patterns; and (2) food consumption | NR | Bereavement had a negative impact on food intake including forgetting to eat, eating less, and not wanting to prepare or eat food alone. |
NR = not reported; kcal = kilocalories; REM = rapid eye movement; BMI = body mass index.
*
Case-control design.
a
Includes qualitative methodology.
b
Published dissertation.