(141) Spousal bereavement and four-year trajectories of medication use: a nationwide register-based study in Swedish older adults

Background: Spousal bereavement is a frequent and stressful life event during the older people’s life course. Medication use patterns can reflect health consequences of spousal loss as previously shown for psychotropic drugs, for which the increased use described around spousal loss was further linked to adverse mental health outcomes in cohort studies. However, medication use around widowhood has been poorly described for most medication classes.

Objectives: To describe the national patterns of use of the most frequently dispensed prescription drugs around spousal death in widowed individuals aged 65 years or over (65+), and based on their longitudinal patterns of use, identify the prescription drugs that could constitute proxies for health effects of spousal loss, using those observed for psychotropics as reference.

Methods: We used data from nationwide health registers (2008-2020) to describe the patterns of use of dispensed medications in all widowed Swedes aged 65+, followed between two years before and two years after spousal death. All prescription drugs used by at least 5% of the cohort were considered according to their therapeutic subgroups (Anatomical Therapeutic Chemical (ATC) classification system 2nd level). We used group-based trajectory models to cluster widowed individuals into up to 4 distinct longitudinal patterns of monthly medication use. In a hypothesis-generating analysis, the therapeutic subgroups with similar medication patterns were ranked according to their plausibility to reflect potential health effects of spousal loss, based on those observed for psychotropic drugs (psycholeptics, mainly anxiolytics, hypnotics and psychoanaleptics, mainly antidepressants).

Results: From 212,111 widowed older adults included (68% female and 70% aged ≥75 years), we observed a significant increasing trend in medication use, especially after spousal death, for 21 out of the 39 different therapeutic subgroups (most represented pharmacological groups: cardiovascular system, nervous system and alimentary tract and metabolism). This increasing trend often concerned only a small proportion of individuals, with varying magnitude and speed of change in medication use across therapeutic subgroups. The patterns of use of antiepileptics, laxatives, skin emollients/protectives, analgesics, and drugs for anemia, constipation or peptic ulcers, were the closest to those of psychotropics, displaying the largest changes in use, and were therefore ranked as the most likely to reflect potential health effects of spousal loss.

Conclusions: Our results confirmed the increase in psychotropic use in widowed older adults and identified several potential physical health effects of spousal loss that should be examined in future ad hoc studies.