Tracking death’s impact on public health

They say after the Rev. Homer Smith’s wife Annie Ruth died early this year, his only wish was to be with her.

Twenty-seven days later, his granddaughter Angela Burnett said, he died too, probably of a broken heart.

Indeed, research shows that not only can a broken heart, like the loss of a job and divorce, wreak havoc on our health; it can and often does kill us.

“Most researchers studying end-of-life issues focus on the person who’s dying,” said Toni Miles, director of the Institute of Gerontology in the University of Georgia’s College of Public Health. “And while that’s OK, we don’t know anything about what the death does to surviving friends and family.”

In an effort to find out how such loss can adversely affect our health, Miles earlier this year launched the “Mortality Project.”

While it is not unusual for spouses, for instance, to closely follow their loved ones in death, Miles said “it is usually regarded as a passing oddity. We are now in a new period where demography influences mortality.”

Currently in the United States, Miles said, almost 80 percent of all deaths in any given year are people age 40 and older.

“Never in human history have we seen that kind of mortality pattern,” she said. “If you go back to the early 1900s, take one year of deaths, you will see deaths occurring across all ages. That doesn’t happen anymore.”

And with 3 million boomers turning 65 every year, Miles said the numbers of ill and dying people will increase.

“Everybody will know someone who dies, boomers, in particular, because they tend to have many siblings,” she said. “They also have many friends so each one could potentially see five people die in a very short span of time. Public health research needs to understand the negative effect those deaths will have on survivors.”

So what are the public health consequences of living in a time when mortality is operating this way?

Miles believes grief and especially multiple losses drive many of the nation’s public health issues, including obesity, depression and heart disease.

Had her grandmother not died, Burnett believes her grandfather would not have either.

“He had been with grandmother for 73 years,” she said recently. “And for all of that time, they were inseparable. Once he told us if she hurt, he hurt.” When she died, Burnett said her grandfather, who up until then was relatively healthy even at age 103, lost his appetite for food and eventually his life.

“Some people take a long time to recover from the loss of a loved one and some never fully recover,” Miles said.

Andrea Shelton does not believe she would.

“I was wired at an early age to believe there is true love,” Shelton said. “It’s not an obsessive love but I couldn’t live without my husband.”

Shelton has a name for the phenomenon: Broken heart syndrome.

She said the subject comes up often with friends.

“It’s kind of morbid but I do think about it a lot,” she said.

Shelton recalled her great grandmother dying soon after losing a daughter.

“Her daughter lived with her and when Thelma died, that was the beginning of her decline,” Shelton said. “The motor slowed. The pep left.”

Miles said she first became interested in how personal loss translates into public health when she began reflecting on her own life course. Each year, in the past three years, she lost a close relative.

Then in 2012, a Centers for Disease Control report showed the numbers of deaths in the United States had increased each year since 1935.

“When researchers removed the effect of population aging, the death rates declined,” Miles said. “The good news is that fewer people die young. The bad news is that everyone knows someone who dies.”

That led Miles and her team at UGA to ask how big an impact unrecognized grief has on major public health issues such as obesity and depression.

“Our team is working to develop an answer soon,” she said.

Based on a UGA survey by Miles and colleagues, about 10 percent of the population or approximately 1 million people are newly bereaved each year in Georgia.

“That’s a lot of new grief; 400,000 of the newly bereaved have lost two or more relatives,” she said. “Our survey estimates are stable over 3 years.”

In addition, she said, people who are newly bereaved are more likely to need hospitalization during the year after the loss.

Duke University researchers have already proven that loss of a spouse increases your own short-term risk of dying. Studies by Mount Sinai doctors in New York show that when a loved one dies in the ICU, the survivors have a risk of post-traumatic stress disorder.

Miles said clergy could play an important role in unresolved grief by increasing compassion for survivors. Doctors could encourage the use of Medicare’s hospice bereavement benefit. which provides counseling to survivors after the death.

Miles said that she believes this research can help. Her biggest challenge to date is finding support for her research.

“Funding is key to developing effective interventions,” she said. “If you don’t get support, you can’t do the work.”