Heinz Ratke, aged 73 at the time of the killing, has pleaded guilty to murdering his wife Maria, 71, in their NSW Blue Mountains home, in December 2020.
Against the background of a 52-year marriage with no history of domestic violence, Ratke's actions have previously been described in court as "bizarre" and "defying explanation".
On Friday, a sentence hearing was told jail time could be "more onerous" for Ratke given he suffered from "extant health issues", including a gall bladder problem.
Ratke's health issues were "peculiar" to him and needed further investigation, the court heard.
"That's how I see it," Justice Richard Weinstein told the NSW Supreme Court.
The crown position was that Ratke's health issues ranked in the "normal sphere" of men his age, although it was conceded the offender was "not in peak of health".
The court has previously heard that Ratke's mental and financial health declined in the lead-up to the murder as the couple went broke.
Ratke, suffering impaired judgment, fatally stabbed his wife in their Katoomba home before unsuccessfully turning the knife on himself.
Ratke observed Friday's hearing via audio-visual link from a prison cell where he sat on a mobility aid.
Justice Weinstein adjourned the matter to November 3 for sentence.
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