Science seeks explanations

The bound destiny of an elderly couple can result in sharing times of death, be it the same day, week, month or year.

This seems evident reading the newspaper death notices and obituaries or walking through a graveyard. Just last week, Carlyn Gray died within 36 hours of her husband, William. The Towson couple had been married for nearly 60 years.


It turns out there is also scientific evidence for the phenomenon.

"People are interconnected, so their health is interconnected," said Nicholas Christakis, a professor at Harvard Medical School. "So we shouldn't be surprised that we see this kind of effect."


Christakis and others have teased out some of the causes. These include severe distress due to the death or illness of a spouse, the environment and habits that couples share and the fact that more often than not people partner with people like themselves.

Still others are what Christakis and a colleague call the "unmeasurable unstable attributes of couples," the mysteries that are part of the complex and varied aspects of love.

Country music legend Johnny Cash's song "Ring of Fire" was written by June Carter as a testament to the powerful feelings she had for him when they first met. Their 35-year marriage was chronicled last year in the movie Walk the Line. After her death in 2003 at 73 from complications after heart surgery, Cash was said to be devastated.

When he succumbed four months later to complications from diabetes at the age of 71, people were inclined to blame heartbreak.

It was a romantic notion that stands up to scientific inquiry. Heartbreak, another way of saying psychological stress, is one of the aspects of what experts call the "bereavement effect." It is the greater chance of an elderly person's dying after a spouse is hospitalized or dies.

Two studies in the 1990s found that an elderly person's risk of death increases under those circumstances.

Harvard's Christakis and a co-author published a study in The New England Journal of Medicine in February that found elderly people to be particularly at risk immediately after their spouse is hospitalized or dies.

When that happened, the other person had about a 20 percent greater chance of dying within a year, the study found. The most riskiest period was in the weeks immediately after the traumatic event. The danger began to subside within three to six months as, the authors surmised, the person adapted to the loss.


Christakis' study also found that some diseases take a greater toll on spouses than others. Cancer, for example, appeared to be less burdensome on spouses than dementia. Emphysema, an illness often associated with smoking, in which a person's lungs slowly cease to function, took a particularly severe toll.

The more a disease impairs a person's physical and mental function, the more harm it does to the health of the person's spouse, the authors found.

Experts suggest two broad ways that serious illness and death of a spouse can harm a person's health. First, the direct emotional stress can wear down elderly people, who often already have health problems. Second, a person may be deprived of the social, financial or emotional support key to well-being.

Many widows report being ostracized by other women after their husbands' deaths, said Judah Ronch, a geriatric mental health expert for Erickson Health, a Catonsville company that owns several retirement communities. "They say the other women view them as a threat or as a reminder of what could happen to them," Ronch said.

While bereavement plays a part, there are other reasons couples might die at the same time. One explanation is that married couples tend to share an environment, and good and bad habits of daily life.

"If my wife dies and I die shortly after, there is a question of whether her death caused my death," said Christakis. "On the other hand, we could pick up bad habits over the years; maybe we were both overweight. Or maybe we had radon gas in the basement."


Another example is people who for years breathe their spouses' second-hand smoke until the smoking habit harms them both.

Yet another explanation is that people tend to pair with people who are likely to die at the same time as they will.

This is not a case of divinely ordained destiny, like that portrayed in Kurt Vonnegut's novel Cat's Cradle, in which soul mates died within a week of each other. Rather, people with similar traits - hobbies, exercise habits, ethnicity, geographic location, age - are more likely to pair up, a tendency that sociologists call "assortative mating."

"We are talking about the probability of well people to become married to other well people," Christakis said. "And unhealthy people are more likely to marry unhealthy people."

The result, in some cases, is similar life expectancies.

Finally, there is the complicated weave of threads that make up the fabric of a couple's life together.


Factors such as family ties, community support and the nature of a couple's relationship are key to a person's health and ability to cope with the stress of illness and death, experts say.

Some people turn out to be much better caregivers than they thought they would be. "People sometimes reach into themselves and come up with a skill they didn't know they had," Ronch said.

"It's tough to characterize elderly couples with one description," he said.

"I've seen marriages of 60 and 70 years where you wondered why people stayed married to each other," he continued. "But their attachment is very strong."

Ronch is amazed that happy couples like the Grays, who met and married in their 20s, were able to make the right choice in a partner when they were so young.

"It seems to me that they made an accurate appraisal of that person beyond what was obvious at the time," he said. Over the years people often come to depend on each other, he said, which provides a sense of comfort and stability for both partners.


"People talk about a deepening of their relationship; it goes through stages," he said.

At the end of life, one of those changes may be deciding to join a partner who has died or is dying.

"Sometimes people decide it's OK to let go," he said. "That's not a very scientific concept, but we see it more and more."