A husband's declining health could put Taiwanese women at risk for health issues

The death of a spouse undoubtedly brings with it stress, anxiety and uncertainty. Now, a report by Princeton University's Woodrow Wilson School of Public and International Affairs quantifies this stress, showing how a husband's declining health could put Taiwanese women at risk for health issues.

Using data from a longitudinal sample of Taiwanese older adults, the researchers found that the more a husband suffered, the more his wife's glucose levels increased. Yet, when a wife's health was declining, her husband's levels remained the same. Being widowed, however, increased glucose levels for men and women. The researchers, from the Office of Population Research (OPR) based at the Wilson School, published their findings in the Journal of Aging and Health.

"In East Asia, married women often encounter exceptionally high demands for caregiving - such as raising children, caring for a spouse and looking after aging partners," said lead author Chioun Lee, a Princeton postdoctoral research associate. "Since married men face fewer of these demands, caring for an ailing spouse may involve more personal health costs for women. Caregiving may be particularly challenging for older women who may themselves be experiencing declines in health."

Along with study co-authors Noreen Goldman, the Hughes-Rogers Professor of Demography and Public Affairs, and Germán Rodríguez, senior research demographer, both at OPR, and researchers from Georgetown University, Lee used data from the Social Environment and Biomarkers of Aging Study, a subsample of the Taiwanese Longitudinal Study of Aging. This nationally representative survey is designed to assess the health of older people in Taiwan. Lee and her colleagues used responses from 597 Taiwanese adults between the ages of 54 and 90 who participated in interviews and physical examinations in 2000 and again in 2006.

To evaluate changes in glucose levels, the researchers examined glycosylated hemoglobin (HbA1c), which is the average percentage of blood sugar in red blood cells, over a period of eight to 12 weeks. High levels of HbA1c indicate poor glucose control. Both in 2000 and 2006, medical professionals collected blood samples from participants and administered medical examinations. Participants also reported their spouse's health status on a five-point scale (very good to very poor). The death of a spouse between waves was also recorded.

The researchers found that changes in glucose levels vary greatly by gender. Women whose husbands suffered a decline over the six-year period experienced an increase in glucose levels. The more a husband's health declined, the more his wife's glucose levels increased. For men, they found no significant association between changes in glucose levels and declines in a wife's health, although losing a wife increased glucose levels.

"Our findings follow a well-documented pattern," said Goldman. "Spousal illness and disability in old age have greater negative impacts on women's health than men's. These differences can happen for a number of reasons. Older women who take care of their husbands may not allocate enough time to rest, exercise or seek routine medical care. Long-term or intensive caregiving may make a partner feel isolated and depressed, resulting in poor eating habits and inadequate glucose control."

The researchers recognize the limitations of their study, especially in terms of using data from Taiwan. Older Taiwanese likely lived in an era dominated by traditional caregiving attitudes, the researchers said.

"In a society with strong family ties and traditional gender roles, most older adults feel that women ought to be primary caregivers and that entering a nursing home is shameful," said Lee, who is from South Korea. "So, our findings may not be generalizable to younger people in Taiwan who may be more willing to utilize caregiving institutions. Gender norms regarding caregiving are also changing due to the rise of dual-career families."

Still, few studies have investigated the effects of declining spousal health on changes in glucose levels for older adults. Lee and colleagues' study is one of the first to use a nationally representative sample with biomarker data collected by medical professionals. The team's findings have several implications for health interventions and policies, especially for older adults.

"Health educators and medical professionals should be aware that older adults whose spouse falls ill or dies are at higher risk for developing diabetes," said Goldman. "Health care providers should consider targeting these older adults by encouraging regular medical check-ups to better detect and treat this disease. Counseling and therapy might also help caregivers and bereaved spouses control their glucose levels."

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