Journal of Behavioral Medicine

, Volume 37, Issue 4, pp 736–755 | Cite as

Changes in Routine Health Behaviors Following Late-life Bereavement: A Systematic Review

  • Sarah T. StahlEmail author
  • Richard Schulz


This systematic review examines the relationship between late-life spousal bereavement and changes in routine health behaviors. We review six behavioral domains/modifiable risk factors that are important for maintaining health among elderly populations: physical activity, nutrition, sleep quality, alcohol consumption, tobacco use, and body weight status. Thirty-four articles were identified, derived from 32 studies. We found strong evidence for a relationship between bereavement and nutritional risk and involuntary weight loss, and moderate evidence for impaired sleep quality and increased alcohol consumption. There was mixed evidence for a relationship between bereavement and physical activity. We identify several methodological shortcomings, and describe the clinical implications of this review for the development of preventive intervention strategies.


Routine health behaviors Lifestyle change Behavioral change Bereavement Widowhood Older adults 



Preparation of this manuscript was supported in part by Grants from NIH P30 MH090333-01A1, MHO19986, NR009573, NR013450, AG026010, AG032370, and NSF 0540865.


  1. *Anderson, B. (1999). The relationship of stress, sleep, and depression in an elderly cohort: Predictors, mediators, and moderators. (Doctoral dissertation). Retrieved from ProQuest Information & Learning. (AAI9945089).Google Scholar
  2. *Avis, N. E., Brambilla, D. J., Vass, K., & McKinlay, J. B. (1991). The effect of widowhood on health: A prospective analysis from the Massachusetts women’s health study. Social Science Medicine, 33, 1063–1070.Google Scholar
  3. *Barrett, C. J. & Schneweis, K. M. (1980). An empirical search for stages of widowhood. Journal of Death and Dying, 11, 97–104.Google Scholar
  4. Block, G., Woods, M., Potosky, A., & Clifford, C. (1990). Validation of a self-administered diet history questionnaire using multiple diet records. Journal of Clinical Epidemiology, 43, 1327–1335.PubMedCrossRefGoogle Scholar
  5. Bossé, R., Ekerdt, D. J., & Silbert, J. E. (1984). The Veterans administration normative aging study. In S. A. Mednick, M. Harway, & K. M. Finello (Eds.), Handbook of longitudinal research (Vol. 2, pp. 273–283)., Teenage and adults cohorts New York: Praeger.Google Scholar
  6. Bowling, A. (1987). Mortality after bereavement: A review of the literature on survival periods and factors affecting survival. Social Science & Medicine, 24, 117–124.CrossRefGoogle Scholar
  7. Brawley, L. R., Rejeski, W. J., & King, A. C. (2003). Promoting physical activity for older adults: The challenges for changing behavior. American Journal of Preventive Medicine, 25, 172–183.PubMedCrossRefGoogle Scholar
  8. Buysse, D. J., Reynolds, C. F., Monk, T. H., Berman, S. R., & Kupfer, D. J. (1989). The Pittsburgh Sleep Quality Index (PSQI): A new instrument for psychiatric research and practice. Psychiatry Research, 28, 193–213.PubMedCrossRefGoogle Scholar
  9. *Byrne, G. J. A., & Raphael, B. (1997). The psychological symptoms of conjugal bereavement in elderly men over the first 13 months. International Journal of Geriatric Psychiatry, 12, 241–251.Google Scholar
  10. *Byrne, G. J. A., Raphael, B., & Arnold, E. (1999). Alcohol consumption and psychological distress in recently widowed older men. Australian and New Zealand Journal of Psychiatry, 33, 740–747.Google Scholar
  11. Carr, D., Neees, R. M., & Wortman, C. (Eds.). (2006). Spousal bereavement in late life. New York: Springer Publishing Company.Google Scholar
  12. *Caserta, M. S., Lund, D. A., & Rice, S. J. (2001). Participants’ attendance at a health promotion program for older widows and widowers. American Journal of Health Education, 32, 229–236.Google Scholar
  13. *Chen, J. H., Gill, T. M., & Prigerson, H. G. (2005). Health behaviors associated with better quality of life for older bereaved persons. Journal of Palliative Medicine, 8, 96–106.Google Scholar
  14. Cohen, J. (1994). The earth is round (p < .05). American Psychologist, 49, 997–1003.CrossRefGoogle Scholar
  15. Colditz, G. A., Stampfer, M. J., Willett, W. C., Hunter, D. J., Manson, J. E., Hennekens, C. H., et al. (1992). Type of postmenopausal hormone use and risk of breast cancer: 12-year follow-up from the Nurses’ Health Study. Cancer Causes and Control, 3, 433–439.PubMedCrossRefGoogle Scholar
  16. DiMatteo, M. R., Lepper, H. S., & Croghan, T. W. (2000). Depression is a risk factor for noncompliance with medical treatment: Meta-analysis of the effects of anxiety and depression on patient adherence. Archives of Internal Medicine, 160, 2101–2107.PubMedCrossRefGoogle Scholar
  17. Edwards, W. S., & Berlin, M. (1989). Questionnaires and data collection methods for the Household Survey and the Survey of American Indians and Alaska Natives. National Center for Health Services Research and Health Care Technology Assessment. National Medical Expenditure Survey Methods 2, Rockville, MC: Public Health Service.Google Scholar
  18. *Eng, P. M., Kawachi, I., Fitzmaurice, G., & Rimm, E. B. (2005). Effects of marital transitions on changes in dietay and other health behaviours in US male health professionals. Journal of Epidemiological Community Health, 59, 56–62.Google Scholar
  19. *Fitzpatrick, T., Spiro, A., Kressin, N. R., Greene, E., & Bosse, R. (2001). Leisure activities, stress, and health among bereaved and non-bereaved elderly men: The Normative Aging Study. Omega, 43, 217–245.Google Scholar
  20. Forte, A. L., Hill, M., Pazder, R., & Feudtner, C. (2004). Bereavement care interventions: A systematic review. BMC Palliative Care, 3, 3–19.PubMedCentralPubMedCrossRefGoogle Scholar
  21. Fried, L. P., Borhani, N. O., Enright, P., Furberg, C. D., Gardin, J. M., Kronmal, R., et al. (1991). The cardiovascular health study: Design and rationale. Annals of Epidemiology, 1, 263–276.PubMedCrossRefGoogle Scholar
  22. Hall, M., Buysse, D. J., Norzinger, E. A., Reynolds, C. F, I. I. I., Thompson, W., Mazumdar, S., et al. (2008). Financial strain is a significant correlate of sleep continuity disturbances in late-life. Biological Psychology, 77, 217–222.PubMedCentralPubMedCrossRefGoogle Scholar
  23. Holmes, T. H., & Rahe, R. H. (1967). The social readjustment scale. Journal of Psychosomatic Research, 11, 213–228.PubMedCrossRefGoogle Scholar
  24. House, J. S., Lantz, P. M., & Herd, P. (2005). Continuity and change in the social stratification of aging and health over the life course: Evidence from a nationally representative longitudinal study from 1986 to 2001/2002 (Americans’ Changing Lives Study). Journals of Gerontology: Psychological Sciences, 60, 15–26.CrossRefGoogle Scholar
  25. Itzhar-Nabarro, Z., & Smoski, M. J. (2012). A review of theoretical and empirical perspectives on marital satisfaction and bereavement outcomes: Implications for working with older adults. Clinical Gerontologist: The Journal of Aging and Mental Health, 35, 257–269.CrossRefGoogle Scholar
  26. *Janke, M. C., Nimrod, G., & Kleiber, D. A. (2008a). Leisure patterns and health among recently widowed adults. Activities, Adaptation & Aging, 32, 19–39.Google Scholar
  27. *Janke, M. C., Nimrod, G., & Kleiber, D. A. (2008b). Reduction in leisure activity and well-being during the transition to widowhood. Journal of Women & Aging, 20, 83–98.Google Scholar
  28. *Janke, M. C., Nimrod, G., & Kleiber, D. A. (2008c). Leisure activity and depressive symptoms of widowed and married women in later life. Journal of Leisure Research, 40, 250–266.Google Scholar
  29. Jin, L., & Chrisatakis, N. A. (2009). Investigating the mechanism of marital mortality reduction: The transition to widowhood and quality of health care. Demography, 46, 605–625.PubMedCentralPubMedCrossRefGoogle Scholar
  30. *Johnson, C. S. (2002). Nutritional considerations for bereavement and coping with grief. Journal of Nutrition, Health, & Aging, 6, 171–176.Google Scholar
  31. Jones, M. P., Bartrop, R. W., Forcier, L., & Penny, R. (2010). The long-term impact of bereavement upon spouse health: A 10-year follow-up. Acta Neropsychiatrica, 22, 212–217.CrossRefGoogle Scholar
  32. King, A. C., Harris, R. B., & Haskell, W. L. (1994). Effect of recruitment strategy on types of subjects entered into a primary prevention clinical trial. Annals of Epidemiology, 4, 312–320.PubMedCrossRefGoogle Scholar
  33. Kobau, R., Safran, M. A., Zack, M. M., Moriarty, D. G., & Chapman, D. (2004). Sad, blue, or depressed days, health behaviors and health-related quality of life, Behavioral Risk Factor Surveillance System, 1995–2000. Health and Quality of Life Outcomes, 2, 40–48.PubMedCentralPubMedCrossRefGoogle Scholar
  34. Lee, M., & Carr, D. (2007). Does the context of spousal loss affect the physical functioning of older widowed persons? A longitudinal analysis. Research on Aging, 29, 454–487.Google Scholar
  35. *Lee, S., Cho, E., Grodstein, F., Kawachi, I., Hu, F. B., & Colditz, G. A. (2004). Effects of marital transitions on changes in dietary and other health behaviors in US women. International Journal of Epidemiology, 34, 69–78.Google Scholar
  36. Liberati, A., Altman, D. G., Tetzlaff, J., Mulrow, C., Gotzsche, P. C., Ioannidis, A. P., et al. (2009). The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evlaulate health care interventions: Explanation and elaboration. Annals of Internal Medicine, 151, 65–94.CrossRefGoogle Scholar
  37. Manzoli, L., Villari, P., Pirone, M., & Boccia, A. (2007). Marital status and mortality in the elderly: A systematic review and meta-analysis. Social Science and Medicine, 64, 77–94.PubMedCrossRefGoogle Scholar
  38. McIntosh, W. A., Shifflett, P. A., & Picou, J. S. (1989). Social support, stressful events, strain, dietary intake, and the elderly. Medical Care, 27, 140–153.PubMedCrossRefGoogle Scholar
  39. *McIntyre, G., & Howie, L. (2002). Adapting to widowhood through meaningful occupations: A case study. Scandinavian Journal of Occupational Therapy, 9, 54–62.Google Scholar
  40. McKinlay, J. B., McKinlay, S. M., & Brambilla, D. J. (1987). Health status and utilization behavior associated with menopause. American Journal of Epidemiology, 125, 110–121.PubMedGoogle Scholar
  41. *Monk, T. H., Germain, A., & Buysse, D. J. (2009). The sleep of the bereaved. Sleep and Hypnosis, 11, 18–26.Google Scholar
  42. National Center for Health Statistics (2009). Marital events of Americans: 2009 by Diana Elliot & Tavia Simmons. Available from: Accessed 3 October 2012.
  43. *Nurriddin, T. A. (2008). Weathering the storm: Self-efficacy, social support processes, and health-related coping strategies among the Detroit-area widowed. (Doctoral dissertation). Retrieved from ProQuest Information & Learning. (AAI3287311).Google Scholar
  44. *Okun, M. L., Reynolds III, C. F., Buysse, D. J., Monk, T. H., Mazumdar, S., Begley, A., & Hall, M. (2011). Sleep variability, health-related practices, and inflammatory markers in a community dwelling sample of older adults. Psychosomatic Medicine, 73, 142–150.Google Scholar
  45. Onrust, S., & Cuijpers, P. (2006). Mood and anxiety disorders in widowhood: A systematic review. Aging & Mental Health, 10, 327–334.CrossRefGoogle Scholar
  46. *Pasternak, R. E., Reynolds III, C. F., Hoch, C. C., Buysse, D. S., Schiernitzauer, M., Machen, M., & Kupfer, D. J. (1992). Sleep in spousally bereaved elders with subsyndromal depressive symptoms. Psychiatry Research, 43, 43–53.Google Scholar
  47. *Patterson, I. (1996). Participation in leisure activities by older adults after a stressful life event: The loss of a spouse. Journal of Aging and Human Development, 42, 123-142.Google Scholar
  48. *Patterson, I., & Carpenter, G. (1994). Participation in leisure activities after the death of a spouse. Leisure Sciences, 16, 105–116.Google Scholar
  49. Prohaska, T., Belansky, E., Belza, B., Buchner, D., Marshall, V., McTigue, K., et al. (2006). Physical activity, public health, and aging: Critical issues and research priorities. Journal of Gerontology, Social Sciences, 61, 267–273.CrossRefGoogle Scholar
  50. *Quandt, S. A., McDonald, J., Arcury, T. A., Bell, R. A., & Vitolins, M. Z. (2000). Nutritional self-management of elderly widows in rural communities. Gerontologist, 40, 86–96.Google Scholar
  51. Quandt, S. A., McDonald, J., Bell, R. A., & Arcury, T. A. (1999). Aging research in multi-ethnic rural communities: Gaining entrée through community involvement. Journal of Cross Cultural Gerontology, 14, 113–130.PubMedCrossRefGoogle Scholar
  52. Reczek, C., & Umberson, D. (2012). Gender, health behavior, and intimate relationships: Lesbian, gay, and straight contexts. Social Science and Medicine, 74, 1783–1790.PubMedCentralPubMedCrossRefGoogle Scholar
  53. *Reynolds III, C. F., Hoch, C. C., Buyssee, D. J., Houck, P. R., Schlernitzauer, M., Frank E., et al. (1992). Electroenchephalographic sleep in spousal bereavement-related depression of late life. Biological Psychiatry, 31, 69–82.Google Scholar
  54. *Reynolds III, C. F., Hoch, C. C., Buyssee, D. J., Houck, P. R., Schlernitzauer, M., Pasternak., R. E., et al. (1993). Sleep after spousal bereavement: A study of recovery from stress. Biological Psychiatry, 34, 791–797.Google Scholar
  55. Rimm, E. B., Giovannucci, E. L., Willett, W. C., Colditz, G. A., Ascherio, A., Rosner, B., et al. (1991). Prospective study of alcohol consumption and risk of coronary disease in men. Lancet, 338, 464–468.PubMedCrossRefGoogle Scholar
  56. *Rosenbloom, C. A., & Whittington, F. J. (1993). The effects of bereavement on eating behaviors and nutrient intakes in elderly widowed persons. Journals of Gerontology, Psychological Sciences, 48, 223–229.Google Scholar
  57. Rothman, A. J. (2006). Initiatives to motivate change: A review of theory and practice and their implications for older adults. In L. L. Carstensen & C. R. Hartel (Eds.), When I’m 64 (pp. 121–144). Washington DC: The National Academies Press.Google Scholar
  58. *Schone, B., S., & Weinick, R. M. (1998). Health-related behaviors and the benefits of marriage for elderly persons. The Gerontologist, 38, 618–627.Google Scholar
  59. *Schulz, R., Beach, S. R., Lind, B., Martire, L. M., Zdaniuk, B., Hirsch, C., et al. (2001). Involvement in caregiving and adjustment to the death of a spouse. Journal of the American Medical Association, 258, 3123–3129.Google Scholar
  60. *Shahar, D. R., Schulz, R., Shahar, A., & Wing, R. R. (2001). The effect of widowhood on weight change, dietary intake, and eating behavior in the elderly population. Journal of Aging and Health, 13, 186–199.Google Scholar
  61. Stroebe, M. (1994). The broken heart phenomenon: an examination of the mortality of bereavement. Journal of Community & Applied Social Psychology, 4, 47–61.CrossRefGoogle Scholar
  62. Stroebe, M. (2001). Gender differences in adjustment to bereavement: An empirical and theoretical review. Review of General Psychology, 5, 62–83.CrossRefGoogle Scholar
  63. Stroebe, M., Schut, H., & Stroebe, W. (2007). Health outcomes of bereavement. Lancet, 370, 1960–1973.PubMedCrossRefGoogle Scholar
  64. *Tran, M. H. B. (2007). The caregiving stress process: Examining the influence of the nature of the care-recipient illness, stress-buffering variables, mediating factors, and caregiving transitions on caregiver health. (Doctoral dissertation). Retrieved from ProQuest Information & Learning. (AAINR31877).Google Scholar
  65. Umberson, D. (1992). Gender, marital status, and the social control of health behavior. Social Science and Medicine, 34, 907–917.PubMedCrossRefGoogle Scholar
  66. Umberson, D., & Montez, J. K. (2012). Social relationships and health. Journal of Health and Social Behavior, 51, S4–S5.Google Scholar
  67. U.S. Department of Health and Human Services. (2008). Division of Health Interview Statistics. Health behaviors of adults: United States, 2005–2007 by Charlotte A. Schoenborn, & Patricia F. Adams. Available from: Accessed 20 September 2012.
  68. Utz, R. L., Caserta, M., & Lund, D. (2012). Grief, depressive symptoms, and physical health among recently bereaved spouses. The Gerontologist, 52, 460–471.PubMedCentralPubMedCrossRefGoogle Scholar
  69. van den Berg, G. J., Lindeboom, M., & Portrait, F. (2011). Conjugal bereavement effects on health and mortality at advanced ages. Journal of Health Economics, 30, 774–794.PubMedCrossRefGoogle Scholar
  70. *Welte, J. W., & Mirand, A. L. (1995). Drinking, problem drinking, and life stressors in the elderly general population. Journal of Studies on Alcohol, 5, 67–73.Google Scholar
  71. *Wilcox, S., Evenson, K. R., Aragaki, A., Wassertheil-Smoller, S., Mouton, C. P., & Loevinger, B. L. (2003). The effects of widowhood on physical and mental health, health behaviors, and health outcomes: The women’s health initiative. Health Psychology, 22, 513–522.Google Scholar
  72. *Wilcox, S., & King, A. C. (2004). The effects of life events and interpersonal loss on exercise adherence in older adults. Journal of Aging and Physical Activity, 12, 117–130.Google Scholar
  73. *Williams, K. (2004). The transition to widowhood and the social regulation of health: consequences for health and health risk behaviors. Journals of Gerontology: Social Sciences, 59, 5343–349.Google Scholar
  74. Witouck, C., Van Autreve, S., De Jaegere, E., Portzky, G., & van Herringen, K. (2011). The prevention and treatment of complicated grief: A meta-analysis. Clinical Psychology Review, 31, 69–78.CrossRefGoogle Scholar
  75. Women’s’ Health Initiative Study Group. (1998). Design of the Women’s Health Initiative clinical trial and observational study: The Women’s Health Initiative Study Group. Controlled Clinical Trials, 19, 61–109.CrossRefGoogle Scholar
  76. Wortman, J. H., & Park, C. L. (2008). Religion and spirituality in adjustment following bereavement: an integrative review. Death Studies, 32, 703–736.CrossRefGoogle Scholar
  77. *Wylie, C., Copeman, J., & Kirk, S. F. L. (1999). Health and social factors affecting the food choice and nutritional intake of elderly people with restricted mobility. Journal of Human Nutrition and Dietetics, 12, 375–380.Google Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Department of Psychiatry, University Center for Social and Urban ResearchUniversity of PittsburghPittsburghUSA

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