Abstract
It has been considered that widowed persons have a higher risk of death. This study intended to explore whether social participation could improve this trend. A longitudinal study database was constructed to explore the trend of survival and its change with social participation in widowed persons. The Taiwan Longitudinal Study on Aging (TLSA), based on four consecutive waves of longitudinal follow-up data in 1999, 2003, 2007, and 2011 was linked with the National Death Registry from 1999 through 2012. In total, there were 1417 widowed persons and 4500 nonwidowed persons included in this study, excluding divorced and never-married people. The survival trend analysis was carried out with social participation as the main predictive factor stratified for comparative analysis. Our results showed that the widowed were older than the nonwidowed, were female-dominant, had a lower education level, were more economically stressed, and were less likely to engage in regular exercise, and thus showed generally poorer health; for example, being more vulnerable to having chronic diseases, disability with the Activities of Daily Living (ADL), cognitive impairment with the Short Portable Mental State Questionnaire (SPMSQ), and depression with The Center for Epidemiological Studies-Depression (CES-D). The death risk of the widowed was significantly higher than that of the nonwidowed, but the death trend for those with social participation was significantly lower than that of their counterparts in both the widowed and nonwidowed. After matching with gender and age for widowed persons, the widowed with social participation had a significantly lower risk of death (adjusted hazard ratio (HR), 0.83; 95% confidence interval (CI), 0.71–0.98) compared to the widowed without social participation. It was concluded that social participation can improve the death risk for the widowed, and it is worthily included in health promotion plans and social welfare services for widowed persons.
Highlights
This study examined the effect of social participation on the mortality of older adults
Considering that gender and age were important confounding factors for the direct effect of social participation on the death risk trend of the widowed [4,7,8,9,11,24], after we divided the widowed into two groups, they underwent 1:1 propensity-score (PS) matching by age and gender, which might have covered the effect of related physical health confounders such as Activities of Daily Living (ADL) and Short Portable Mental State Questionnaire (SPMSQ)
Significant differences between the two groups were found in social participation, age, education level, self-reported health, self-perceived economic pressure, health behaviors, comorbidities, physical dysfunction, and depressive symptoms
Summary
Widowhood is a common phenomenon in an aging society [1,2]. According to the data released by Taiwan Department of Household Administration in 2021, by the end of 2020, the widowed aged 55–64 years old accounted for 5%, while the widowed over 65 accounted for 34%. Another characteristics of widowhood included being predominantly female and of older age, as the widowed rate of women over 65 years old accounted for 43.3%, which was much higher than that of 12% for men [3]. The elderly are more likely to experience retirement, children leaving home, widowhood, and other adverse
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