After a lifetime together, surviving spouses can be vulnerable in grief
At age 99, former President Jimmy Carter has been many things: humanitarian, Sunday school teacher, woodworker, naval lieutenant, father, husband. Now he's facing a role that's new to him but familiar to millions of older adults: that of a widower.
Carter's wife of 77 years, Rosalynn, died Nov. 19. The couple had been married nearly all of their adult lives.
Losing a spouse – and navigating the grief that comes with it – is exhausting both mentally and physically.
The Carters were extraordinarily close in life and work, and by all accounts deeply in love.
"Rosalynn was my equal partner in everything I ever accomplished," Carter said in a statement released by the Carter Center on Nov. 19. "She gave me wise guidance and encouragement when I needed it. As long as Rosalynn was in the world, I always knew somebody loved and supported me."
Rosalynn Carter died just two days after her family announced that she was entering hospice care, leaving many to wonder how her husband may be coping with her loss, even as resilient as he has proved to be.
Carter, who turned 99 on Oct. 1, has been in fragile health himself. He's been under the care of home hospice for unspecified health issues since February. The Carter Center and members of the Carter family declined to give any further updates on his condition.
"We all believed when he first went into hospice that we had a few days, and it's turned out to be this great blessing of several months," Jason Carter said in an interview with CNN's Jake Tapper in October to mark his grandfather's birthday. "He's doing OK but still, of course, very physically limited."
Grief brings physical and emotional stress
The former president has defied the odds again and again: He was successfully treated for melanoma that spread to his brain in 2015, and he bounced back after surgery to relieve pressure on his brain after a fall in 2019.
However, grief can be extraordinarily stressful physically and emotionally for the surviving spouse, although it's always a highly personal experience.
"For those who had a very close-knit relationship, like the Carters clearly did – they were partners, they were soulmates and been together since they were children – it's a profound loss because every aspect of everyday life changes for them, and the loss of their confidant and helper and soulmate, really, it's taken away," said Dr. Deborah Carr, a sociologist at Boston University who studies grief in older adults.
"I think truly every aspect of his life, emotionally, will change," she said.
At the same time, the sadness and yearning of grieving for your spouse can be physically stressful.
"What we know about widowhood is that it's one of the most difficult experiences you go through," said Dr. Dawn Carr, a gerontologist who studies grief in older age at Florida State University.
"The health impacts are significant, but they vary for different people," said Carr, who is not related to Deborah Carr.
The kind of grief a person experiences and how well they cope depends on factors like whether the loss was expected and whether they have resources to help them. Those resources can be financial, emotional and even spiritual.
The Carters certainly had a deep well of faith from which to draw. Until the pandemic, Jimmy Carter regularly taught Sunday School at Maranatha Baptist Church in Plains, Georgia, where both he and his wife served as deacons. The couple reportedly read the Bible together daily.
The former president also has family to help, which is critical.
"I think when you look at the research on grief, the most important resource for making one's way through is social support," said Boston University's Deborah Carr.
"They can be there to offer practical help, even things like helping them with his medications. But also listening to him retell stories, sharing photos. That social support cannot be understated," she said.
Men, younger spouses may fare worse
Even when a death is expected and a person is well-supported, Carr says, nearly everyone who loses a longtime partner will experience a significant increase in depressive symptoms and loneliness that can last years.
"This is a person that you're sharing a home with," said Dawn Carr of Florida State University. "And it's your primary source, especially in later life, of social engagement. And so you go from having a person that you talk to about everything to not having someone there, and it's expected that that will be hard on your mental health and make you feel less connected."
Grief seems to be especially hard on men and on younger widowers.
A recent study looking at the health of nearly 1 million Danish adults over the age of 65 found that men who lost a spouse were more likely to die within the next year compared with those who didn't. The link was stronger for those widowed at a younger age. Men ages 65 to 70 who lost a spouse were about 70% more likely to die within the next year, while women in that age group had a 27% higher risk of death. Surviving spouses 85 and older, on the other hand, had no increased risk.
Men tend to fare worse than women after the death of a spouse, Deborah Carr says, because many lose the person who cooks for them and reminds them to go to the doctor and take medicine. That's particularly true for older generations.
It can also be exhausting to be a full-time caregiver for a spouse. Many people who perform the labor of lifting, bathing and feeding a disabled spouse often find that they collapse after that person dies, Boston University's Carr said.
"If you were a caregiver in particular, your physical health is especially vulnerable," she said.
Caregivers often put their own needs on hold to care for a dying spouse, and then it catches up.
"They don't go to the doctor, and so then when their spouse ultimately dies, that's when they often see a big crash in their health. It's something that has been long accumulating," Carr said.