When Barbara Bush first saw her future husband, she was only 16. They were at a Christmas dance and had just been introduced by a mutual friend, reports The Washington Post.
“I thought he was the most beautiful creature I had ever laid eyes on,” she said. “I couldn’t even breathe when he was in the room.” They married four years later, in 1945.
Toward the end of her life, when she was hospitalized one last time, she still felt that same breathless attraction toward her husband, exclaiming, “My God, George, you are devastatingly handsome!” in the hospital room.
After their lifelong marriage, their deaths in quick succession call to mind what researchers call the “widowhood effect” ― a precipitous rise in the risk of death after the passing of a spouse.
In the first three months after a spouse’s death, a widow or widower is at 30 to 90 percent increased risk of death from any cause. Afterward, that excess risk drops to 15 percent, but remains elevated.
“The narrative that is easy to tell, and that is compelling and romantic, is that they die of a broken heart,” said Deborah Carr, a sociologist at Boston University. “Perhaps that’s part of it, but there are other realistic factors that contribute as well.”
In the year before her death, Barbara Bush had battled chronic obstructive pulmonary disease and congestive heart failure, reported CNN. And while George H.W. Bush’s cause of death was not immediately known, the former president had previously been diagnosed with vascular Parkinsonism, a movement disorder that affects the lower half of the body, reported The Associated Press.
The reasons for this increased risk of death may have to do with to a person’s deteriorating lifestyle after their spouse dies. Without a loving and caring partner to help monitor things like medication, diet, exercise and a social life, self-care starts to slip ― and so does health.
Other reasons could include that a caregiving spouse may dismiss their own symptoms while focusing on their partner’s needs, and the death of a spouse brings on stress that makes it impossible to ignore those symptoms any longer.
There’s also the fact that spouses tend to share their environments, and so whatever factors may have contributed to one person’s deteriorating health may also have an effect on the surviving spouse. However, a 1996 Finnish study of almost 1.6 million people finds that the widowhood effect remains, even after controlling for things couples share, like accidents that befall both spouses, socioeconomic status and resources and living environments.
And then there’s the sheer loss, and all that comes along with it.
“We know that humans are social animals and they need close contact and support,” said Felix Elwert, professor of population health sciences at the University of Wisconsin-Madison. “To go from decades of not being alone ― from being with someone who actually loves them to solitude ― it’s very difficult for people to manage.”
Researchers have known since the 19th century that people who are married tend to be healthier and live longer than those who were widowed, as well as those who were never married. Research in recent decades has drilled down to reveal that while dysfunctional marriages can have negative health consequences, broadly, the findings consistently show that people in happy, long-term relationships are also more likely to live longer and better lives than those who aren’t.
There is a complex set of reasons for this, but they tend to boil down to a couple’s ability to share financial resources and help one other to maintain a healthy lifestyle, said Elwert.
“Specifically for men, it’s quite clear that men benefit from direct caregiving that the wife typically provides, and wives benefit from the added income in this generation from the primary wage-earner,” he said, speaking of elderly couples like the Bushes.
When one partner dies, so do the benefits they brought to the relationship. For straight men especially, a spouse’s death can also mean the end of so many things that were keeping him happy and healthy.
“They lose the person that kept the social calendar filled. They lose the person that saw to it that they had a social life and saw friends, family, neighbors,” he explained. “They lose the person that cooked the meals, that either did or oversaw the cleaning of the house. That reminded them of their medications and put food on the table.”
Elwert was quick to point out that this likely doesn’t apply to the late President Bush, who had considerably more financial resources than the average American family (his net worth is estimated to be $23 million), and was not for want of health care or social connection; the Bushes are a famously large and tight-knit clan.
But for “regular folks,” even just a few days or weeks of inconsistent eating or lack of medication could spell doom, which is why family and friends of the bereaved need to reach out immediately after a death, Elwert said. It’s more than just being nice or thoughtful; it could save their life.
“Support them in the most mundane tasks of daily living, and for more than a single visit,” he advised. “For an extended period of time.”
If you’re the person who is bereaved, treat yourself kindly, said Carr. There’s no one way to feel after the death of a spouse. And while research does show that the death of a spouse can increase one’s risk of death, the memory of their love can also sustain, she said.
“It’s OK to talk to them after they die, ask their advice, or think about what they might think,” Carr said. “The extent that your romantic partner stays with you emotionally and spiritually after they’re gone really can be uplifting for some people.”
This article originally appeared on HuffPost.