| Popis: |
BackgroundThe process of aging renders older people susceptible for adverse outcomes upon stress. Various indicators derived from complex systems theory have been proposed for quantifying resilience in living organisms, including humans. We investigated the ability of system-based indicators in capturing the dynamics of resilience in humans who suffer the adversity of spousal bereavement and tested their predictive power in mortality as a finite health transition.MethodsUsing longitudinal register data on weekly healthcare consumption of all Danish citizens over the age of 65 from January 1st, 2011, throughout December 31st, 2016, we performed statistical comparisons of the indicators ‘average’, ‘slope’, ‘mean squared error’, and ‘lag-1 autocorrelation’ one year before and after spousal bereavement, stratified for age and sex. The relation between levels of these indicators before bereavement and mortality hazards thereafter was determined by time to event analysis and the added value for mortality prediction was estimated by the time dependent area under the receiver operating characteristic curve.ResultsThe study included 934,003 citizens of whom 51,890 experienced spousal bereavement and 2862 died in the first year thereafter. Values of all dynamic indicators were significantly higher with increasing age, in men compared to women, and except lag-1 autocorrelation, higher in the year after bereavement (all p-values < 0.001). All dynamic indicators before bereavement were positively related with mortality hazards thereafter (all p-values < 0.001). The area under the curve of the final model to predict mortality, including all relevant indicators, was 77.7% for males and it was 81.8% for females.ConclusionsIt is concluded that healthcare consumption is increased, more volatile and accelerating with aging and in men compared to women. High values of these dynamic indicators before bereavement indicate loss of resilience as manifested by their predictive value to predict mortality when mourning after spousal loss. |
