An Account of the Life of Rosalynn Carter, Former First Lady of the U.S. 4:01

(CNN) -- At 99 years old, former U.S. President Jimmy Carter has been many things: aid worker, Sunday school teacher, carpenter, naval lieutenant, father, husband. Now he faces a role that is new to him but familiar to millions of older adults: that of a widower.

Carter's wife of 77 years, Rosalynn, died on November 19, 2023. The couple had been married for most of their adult lives.

Losing a spouse (and dealing with the pain that comes with it) is exhausting both mentally and physically. There have been concerns that the former president, whose health was already frail, will not be able to attend the planned three days of tributes that began Monday in Atlanta.

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"Rosalynn was my equal partner in everything I accomplished," former President Carter said. (Credit: David Goldman/AP)

Jason, the Carter grandson, said his grandfather planned to travel to Atlanta to attend a memorial service for Rosalynn Carter on Tuesday at a church on the campus of Emory University.

The Carters were extraordinarily close in life and work and, by all indications, were deeply in love.

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"Rosalynn was my equal partner in everything I 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 that someone loved me and supported me."

Rosalynn Carter died just two days after her family announced she would be entering hospice care, leaving many wondering how her husband might be coping with his loss, despite how resilient he has proven to be.

Carter, who turned 99 on Oct. 1, is also in frail health. He has been under home hospice care for unspecified health issues since February. The Carter Center and members of the Carter family declined to give further updates on his condition.

"When he first entered hospice facilities, we all thought we had a few days, and it turned out to be a huge blessing of several months," Jason Carter said in an interview with CNN's Jake Tapper in October to commemorate his grandfather's birthday. "It's fine, but of course he's still very limited physically."

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How to help a person who has lost a loved one? 1:12

Grief brings physical and emotional stress

The former U.S. president defied the odds time and time again: He was successfully treated for melanoma that spread to his brain in 2015, and he recovered 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 is always a very personal experience.

"For those who had a close-knit relationship, as the Carters clearly did — they were partners, they were soulmates, and they had 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, helper and soulmate is actually taken away from them." said Dr. Deborah Carr, a sociologist at Boston University who studies grief in older adults.

"I think really every aspect of his life, emotionally, will change," she said.

At the same time, sadness and longing to grieve 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 old 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.

Goodbye to Rosalynn Carter 2:44

The type of grief a person experiences and how well they cope depends on factors such as 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 source of faith from which to draw from. 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 on a daily basis.

The former president also has family members who help him, which is critical.

"I think when you look at grief research, the most important resource for overcoming grief is social support," said Deborah Carr of Boston University.

"They can be there to offer practical help, including things like helping them with their medications. But also to listen to him tell stories, share photos. That social support cannot be underestimated," he said.

Men and younger spouses may fare worse.

Even when a death is expected and a person is well supported, Carr says, almost everyone who loses a longtime partner will experience a significant increase in depressive symptoms and loneliness that can last for years.

"This is a person you share a home with," said Dawn Carr of Florida State University. "And it's their main source, especially in old age, of social engagement. And then you go from having one person you talk to about everything to having no one there, and hopefully that's going to be your mental health and make you feel less connected."

Grief seems to be especially men and younger widowers.

A recent study that looked at the health of nearly one million Danish adults over the age of 65 found that men who lost their spouse were more likely to die over the next year compared to those who didn't. The bond was strongest for those who were widowed at a younger age. Men between the ages of 65 and 70 who lost their spouse were about 70% more likely to die in the following year, while women in that age group had a 27% higher risk of death. Surviving spouses age 85 and older, on the other hand, were not at increased risk.

Men tend to have worse outcomes than women after their spouse's death, says Deborah Carr, because many lose the person who cooks for them and reminds them to go to the doctor and take medication. This is particularly true for older generations.

It can also be exhausting to be a full-time caregiver for your spouse. Many people who do the work of lifting, bathing and feeding a disabled spouse often find that they collapse after that person dies, said Boston University's Carr.

"If you were a particular caregiver, your physical health is especially vulnerable," she said.

Caregivers often set aside their own needs to care for a dying spouse and then catch up.

"They don't go to the doctor, and when their spouse finally dies, that's when they often see a big breakdown in their health. It's something that's been building up for a long time," Carr said.

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