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The Feminization of Bereavement Among Community-Dwelling Older Adults
Abstract
We examined gender differences in frequency and sociodemographic predictors of spousal, non-spousal family, and friendship bereavement events among community-dwelling older adults using data from the UAB Study of Aging. Analysis involved a 30-month observation period of 893 subjects. There were significant differences between women and men for all types of loss. Significant differences were also found in the sociodemographic predictors of loss between and within gender categories. This study revealed the extent to which older women disproportionately bear the burden of loss and points to the need for greater attention to bereavement as a women's issue.
... Men and women often view friendship and react to loss in different ways (Parker & de Vries, 1993;Sherman, de Vries, & Lansford, 2000;Shimai, 2004;Williams, Baker, Allman, & Roseman, 2006), likely experiencing the loss of friends differently in terms of its psychological implications. Friendships of women usually feature an affective focus, such as self-disclosure, appreciation, and empathic understanding, whereas men's friendships are characterized by shared activity and avoidance of emotionality (Parker & de Vries, 1993;Sherman et al., 2000). ...
... When it comes to how the loss of friends may affect men and women differently, the findings are mixed. Some studies suggested the feminization of bereavement, noting that older women are more likely to experience loss due to the deaths of their spouses, relatives, and friends and that the impact of bereavement on physical and mental health is greater among women than men (Shimai, 2004;Williams et al., 2006). Other studies reported no gender difference or greater vulnerability among bereaved men than women (d' Epinay et al., 2010;Lee, Willetts, & Seccombe, 1998;Matthews, 1991). ...
... It is necessary to repeat the analysis among older adults in other ethnic populations, given the possible variations in defining friendships, perceiving loss, and coping with grief in different cultures and societies (Adams, Blieszner, & de Vries, 2000;Irish, Lundquist, & Nelsen, 2014). It is also worth examining the association between the loss of friends and depressive symptoms and the moderating effect of gender in other ethnic populations, although they were not significant among Chinese older immigrants (d 'Epinay et al., 2010;Parker & de Vries, 1993;Sherman et al., 2000;Shimai, 2004;Williams et al., 2006). More studies are needed to examine the mechanism of loss of friends and psychological well-being by incorporating the quality of relationships with lost friends, duration of friendship, socioeconomic status, and contextual factors (such as experiencing certain forms of stress). ...
Background and objectives: Focusing on a less studied aspect of friendship and an overlooked type of loss, this study examined associations between loss of friends and psychological well-being among older Chinese immigrants and whether such associations are moderated by age, gender, marital status, and social connection.
Research methods: This study used baseline data from the Population Study of Chinese Elderly in Chicago. Linear and logistic regressions tested whether the loss of friends was associated depressive symptoms, loneliness, and quality of life . Interaction terms were created to test the moderating effects .
Results: Losing friends was associated with a greater sense of loneliness but also a higher chance of reporting good quality of life. The association between the loss of friends and loneliness was stronger among married and young-old (59–69) participants . The association between the loss of friends and quality of life was stronger among young-old and old-old (70–79) participants and the participants with the high level of social connection.
Discussion and implications: Findings shed light on the importance of the loss of friends in shaping psychological well-being among older immigrants. More research is needed to understand the needs of older friend survivors and develop relevant interventions.
... Research on gender revealed that older widows are more likely than older widowers to suffer from multimorbidity (Agrawal & Keshri, 2014). Widows are more prone to poor health and financial insecurity (Williams, Baker, Allman, & Roseman, 2006). This is supported by three of the included studies (Perkins et al., 2016;Xu et al., 2017;Zhou & Hearst, 2016), especially in the eastern part of the world. ...
... Another methodological limitation that could increase bias involves emotions and the fact that the roles of widowers and widows are dynamic and socially constructed (Barrett, 2017;DiGiacomo et al., 2013;Williams et al., 2006). Gender differences are more apparent in societies with rigid gender roles such as South Korea, India, ...
Aim
To examine factors that influence the health of older widows and widowers. The review question was: What is the evidence of the relationship between widowhood and health in older adults?
Design
Systematic review.
Data sources
Academic Search Elite, CINAHL, Medline (Ovid) and PubMed were searched for articles published between January 2013–December 2017.
Review methods
A systematic review of quantitative research with a qualitative thematic analysis.
Results
The selection process resulted in 12 studies. One of the themes that emerged was: emotional challenges related to experiences of bereavement, depression and anxiety, which was based on the sub‐theme social support as the main strategy for coping with emotional pain and suffering. The second theme was: struggling with poor physical health. The findings indicate that healthcare professionals need knowledge and skills to deal with the health consequences of widowhood in old age. Building community teams can prevent emotional and physical health problems, as well as reduce mortality.
... A recent study has shown that the risk of bereavement is greater for older women (65 and over) than for men (Williams, Baker, Allman, & Roseman, 2006). This is a well-known fact as concerns spousal bereavement but, according to the authors, it applies also to the death of other relatives and even friends. ...
... We chose here to test the accuracy of the thesis put forward by Williams et al. (2006) on "feminization of bereavement" for older women. ...
... Widowhood is not just a passing stage of grief, bereavement, and adjustment, but instead it represents another developmental phase in which women can expect to live for an average of 15 years (Australian Bureau of Statistics [ABS], 2007). Although men also experience spousal bereavement, a gendered approach recognizes that roles of men and women are dynamic and socially defined constructs with unique internal and external expectations and vulnerabilities, shaped by social, economic, political, and cultural factors, rather than just biology (Williams, Baker, Allman, & Roseman, 2006). ...
... Whereas men have been found to be more at risk of death in the years following spousal bereavement (Bowling, 1994), older women are more prone to disability and financial insecurity upon widowhood and are described as more disadvantaged compared with older men (Lee, 2003;UN DESA, 2010). Studies have reported that women are particularly at risk for a range of chronic health conditions and economic deprivation, particularly upon spousal bereavement (Williams et al., 2006). Women survive their husbands and often there is no planning for when this happens (Lee, 2003). ...
Women comprise a larger proportion of the ageing population than men, often outlive their spouses, and face a variety of challenges upon widowhood. Discrete aspects of the health impact of widowhood have been described in the literature; however, the expanse of sociocontextual issues that impact on older women's adjustment is less prominent. We undertook a literature review to synthesize recent research and interventions and identify current trends and gaps in knowledge and services. Although many health, social, cultural, and economic factors impact on recently widowed older women throughout the world, we found that few interventions targeting this population incorporate these factors.
... A recent study entitled The feminization of bereavement among communitydwelling older adults (Williams, Baker, Allman, & Roseman, 2006) showed that older women (aged 65 and over) are more likely than men to be confronted with a bereavement. This " feminization of bereavement " was already well established in the case of spousal bereavement but the authors claim that it also holds true with reference to the loss of another relative or a friend. ...
... We choose here to test the validity for older women of the contention formulated by Williams et al. (2006) on the " feminization of bereavement. " Hypothesis 7: Older women are more at risk than men to suffer losses among their loved ones. ...
This article deals with the following two questions: In very old age, which are the main sources of bereavement? And what are the consequences of such losses on health and on relationships? The findings are based on the complete set of data compiled in the course of the Swiss Interdisciplinary Longitudinal Study on the Oldest Old (SWILSOO), which provided a 10-year follow-up of a first cohort (1994-2004) and a 5-year follow-up of a second (1999-2004). The data revealed that, in very old age, the great majority of the dear ones who died were either siblings or close friends. Taken as a whole, the bereaved suffered a marked and lasting increase in depressive symptoms, together with a short-term deterioration in their functional status; those bereft of a spouse or a child saw their functional status worsen and exhibited enduring depressive symptoms but they also benefited from support in the form of increased interaction; those bereft of siblings only suffered from a mild, short-term deterioration in functional status; those who had lost a close friend suffered a very significant increase in depressive symptoms. In the medium term, most of these effects disappeared, lending weight to the claim that the survivors manage to cope with the misfortunes of life.
... Background Late life spousal bereavement is predominantly experienced by women (Hesselberg Lauritzen, 2014;Williams et al., 2006), and about 30% of women aged between 60 and 74 are widowed (Martin-Matthews, 2011). Average age of the widowed women is shown to be 75 years, and they typically live another 15 years after the loss of their spouse (Moss et al., 2010). ...
Take good care of yourself is a regard often said to older bereaved women. However, what does it mean? Though self-care is a well-known phenomenon within health, it is not well understood in the context of late life spousal bereavement and widowhood. We undertook an integrative review to synthesize knowledge of older women’s self-care challenges, resources and activities when bereaved and in a healthy transition to widowhood. Good care refers to health-promoting self-care and can be explained as the older widows’ ability to access and mobilize resources and activities that are significant for a healthy transition to widowhood.
... Due to increasing life expectancies, widowhood has increasingly become an older person's issue, and in fact, an older women's issue. 11 A variety of demographic and gender-related socialisation factors influence the ways older men and women experience caregiving and widowhood. In a meta-analysis of caregivers, Pinquart and Sörensen 10 found that gender differences varied by caregiver age and year of publication, such that stronger gender differences emerged in older samples and in older studies. ...
Background:
Globally, most care for people with life-limiting illnesses is provided by informal caregivers. Identifying characteristics of caregivers that may have unmet needs and negative outcomes can help provide better support to facilitate adjustment.
Aim:
We compared characteristics, expressed unmet needs and outcomes for spousal caregivers, with other caregivers at the end of life, by gender and age.
Design:
The South Australian Health Omnibus is an annual, random, face-to-face, cross-sectional survey wherein respondents are asked about end-of-life care.
Setting/participants:
Participants were aged over 15 years, resided in households in South Australia and had someone close to them die from a terminal illness in the last 5 years.
Results:
Of the 1540 respondents who provided hands-on care for someone close at the end of life, 155 were widows/widowers. Bereaved spousal caregivers were more likely to be older, female, better educated, have lower incomes, less full-time work, English as second language, sought help with grief and provided more day-to-day care for longer periods. Spousal caregivers were less likely to be willing to take on caregiving again, less able to 'move on' with life and needed greater emotional support and information about illness and services. The only difference between widows and widowers was older age of spouse in women. Younger spousal caregivers perceived greater unmet emotional needs and were significantly less likely to be able to 'move on'.
Conclusion:
Spousal caregivers are different from other caregivers, with more intense needs that are not fully met. These have implications for bereavement, health and social services.
... Grief management can be a long process for survivors, especially for an intimate elderly partner, and for women in general, who seem to disproportionately bear the burden of a loss among family and friends (Williams et al. 2006;Leming and Dickinson 2011). Even if a partner was severely ill for months or years and some anticipatory grieving occurred before the death, the grieving process often endures for six to twelve months or more after the death. ...
... Those with limited support systems were depicted as more likely to isolate themselves with negative consequences on their life experience. This reflects some research of gendered experience in real life (Umberson et al. 1996;Peters and Liefbroer 1997;Thuen, Reime, and Skrautvoll 1997) but contradicts others (Bennett, Hughes, and Smith 2003;Summers et al. 2004;Williams et al. 2006). ...
This study evaluates the portrayal of sixteen recently widowed male characters in US mainstream film (2002-2011) through ethnographic content analysis. The depicted expectations for bereaved men in film largely fall in line with hegemonic norms. Characteristics of age, race, gender, and profession suggest a sustained preference for young, middle-class, and white depictions of characters. Young men were generally depicted as reserved with emotions and assertive. Films depicted older men as isolated, begrudgingly allowing family and acquaintances into their lives. Grief spurs men at any age into action-based plots of thrill and adventure though in reality widowers retain much of the same commonplace existence they had prior to a partner’s death. Understanding the gendered representation of grief can help to recognize the social construction of death and loss. These portrayals contribute to hegemonic norms of masculinity within mainstream media and to cultural understandings and expectations of grief, limiting the experience of bereavement to dichotomous genders.
... Social and economic ramifications of widowhood increasingly have been documented [8] as has recognition that this important life event is shaped by social, economic, historical, political, and cultural factors [9]. Economic risks faced by the current population of older women may reflect their longevity coupled with interrupted or lower level employment over a lifetime. ...
The feminisation of ageing and increasing number of widowed women in contemporary society has significant implications. Older women are at risk of poor health, social, and economic outcomes upon widowhood. The aim of the study was to describe women's experiences in the period soon after their husbands' death, including their financial issues and concerns, and the ways in which these experiences impacted on the transition to widowhood late in life.
This was a longitudinal study using serial in-depth semi-structured interviews with 21 community-dwelling women over the age of 65 in Australia. Verbatim transcripts underwent Interpretive Phenomenological Analysis.
Thematic analysis revealed: 1) administrative burden increases vulnerability; 2) gender roles impact on transitions; and 3) financial adjustments render housing insecurity and health risk. High administrative burden within the context of significant grief and mourning was a defining feature of the early bereavement period. Complicated protracted administrative processes, insensitive interactions, and reminders of loss contributed to distress, anxiety and feelings of demoralisation. Several women identified assumption of household financial management as the most difficult aspect of coping with their husband's death.
Older women may have unmet needs for assistance with administrative, financial, and legal issues immediately following spousal death and potentially for years afterward. Lack of familiarity and absence of instrumental support with financial and legal issues signal the need for policy reform, resources to improve financial literacy in women throughout the life course, increased advocacy, and consideration of different support and service models.
... Women scored significantly higher than men did on three subscales (Personal Competencies, Assessment Skills, and Treatment Skills). This difference may reflect a distinction between genders in the response to grief that has been previously identified in the literature (e.g., Bennett, 2007;Cochran, 2006;Schut, Stroebe, & van den Bout, 1997;Williams, Baker, Allman, & Roseman, 2006). However, it is important to note that the addition of gender into these equations, although statistically significant, contributed very little to the variance accounted for by the models, with standardized beta coefficients ranging from .05 to .19. ...
Grief is prevalent in counseling, but little is known about the current status of counselors’ preparation and competencies to provide effective care. This exploratory study surveyed counselors (N= 369) on grief training, personal and professional experiences with grief, and grief counseling competence. Multiple regression analyses found training and experience were statistically significant predictors of competence. The strong relationship between variables suggests these concepts may be understood as synonymous. Implications for training, practice, and research are discussed.
... 9 Although ongoing costs associated with a spouse's medical expenses may subside, implications of the loss of income, potentially in the form of pensions, combined with the significant coping demands associated with this life-altering event place older women at risk for a range of chronic health conditions and economic deprivation. 10 Early bereavement, within two years of spousal death, represents a period of significant upheaval and has been implicated as a period of increased health risk in older women. ...
Context:
Older women commonly assume a caregiving role for their husbands at the end of life and are more vulnerable to poorer health, well-being, and social and economic challenges.
Objectives:
The aim of this study was to ascertain older women's experiences of spousal caregiving at the end of life and the ways in which this experience impacts on the transition to widowhood.
Methods:
Longitudinal, in-depth, semistructured interviews were conducted with older women three times over a one-year period after the death of their husbands. This report focuses on the initial interviews that examined the transition from caregiving to widowhood. Transcripts were analyzed using interpretive phenomenological analysis methods. Participants were community-dwelling women older than 65 years who had recently been caregivers for their husbands who died within the past two years.
Results:
Older women caregivers described their caregiver role as taxing, particularly in light of their own chronic conditions that they failed to prioritize and address. They did not ask for help in managing their roles and health problems, but quietly endured. Hence, they did not communicate their needs or strains explicitly. The degree of perceived adequacy of communication and interaction with health professionals were important factors impacting on their bereavement.
Conclusion:
It is imperative for health professionals to appreciate that older women caregivers may need more supportive interaction and information during the end-of-life caregiving, they may have expectations of communication, and they may deny or fail to focus on their own health issues. A patient/family/carer-centered approach could negate this oversight and improve the outcomes for these women as they transition into widowhood.
... The reviewed conjugal bereavement studies represent mainly a female perspective, and limit conclusions about older persons in general. Such a gender focus may be a result of the fact that some consider widowhood a women's health issue due to the feminization of old age (Williams et al., 2006). Yet even researchers who aim to have a mixed sample may be likely to recruit more women than men into their studies because of the higher proportion of widowed women (Administration on Aging, 2011; Federal Interagency Forum on Aging-Related Statistics, 2012;Swiss Statistics, 2009). ...
BACKGROUND: Spousal loss can be a dramatic life event for older persons, and a difficult experience that affects everyday life. Research shows that bereavement influences health and well-being in old age and involves changes in social networks. However, the nature of the bereavement experience for older widows/ers remains unclear. OBJECTIVES: To determine key characteristics of the bereavement experience of older widowed persons. DESIGN: An integrative review of the literature was performed using the framework developed by Whittemore and Knafl (2005). DATA SOURCES: Research studies investigating aspects of the bereavement experiences of widowed older (>65) persons (n=39) were included. The electronic databases Medline, CINAHL, PsychInfo, Sociological Abstracts, and Cochrane Library and relevant journals were searched up to February 2011. REVIEW METHODS: The health sciences literature was searched systematically and iteratively to determine relevant studies. Data analysis and synthesis of primary sources of qualitative and quantitative research studies occurred through the processes of data reduction, display, comparison, conclusion drawing and verification (Whittemore and Knafl, 2005). RESULTS: A majority of the reviewed studies included more women than men as participants. The studies' findings suggest that daily activities and routines are disrupted in bereavement, while certain coping strategies seem to sustain older persons in their everyday life. Many older persons face a pervasive sense of loneliness and difficult daily and yearly times. Health concerns prevail or intensify, and older persons have to negotiate their independence and new identity as widow/ers in a social context. Findings show changes in relationships with close others, which are both a challenge and resource for older widow/ers. Moreover, many older persons maintain connections with the deceased spouse. CONCLUSIONS: This review suggests that constructing a new identity as widow/er and striving for independence in the face of disrupted everyday activities and routines, loneliness, health concerns and changed relationships within the family and social network are essential features of older persons' bereavement experience. While many of the identified characteristics of the bereavement experience may not be specific to later life, they need to be considered when working with this population given the concurrent challenges of the ageing process and declining health.
... The period of time before and after the loss of a spouse is an important aspect of the spousal loss experience (Bonanno, 2009;Burke, Shrout, & Bolger, 2007;Carr, 2004;Caserta, Lund, & Diamond, 1989;Choi, 1995). In previous research we examined how pre-widowed persons differed from other older adults, how women incur a higher frequency of spousal loss, and how widows are subject to negative health outcomes following the subsequent loss of another family member (Williams, Baker, & Allman, 2005;Williams, Baker, Allman, & Roseman, 2006;Williams, Sawyer, Roseman, & Allman, 2008). In this article, we characterize the concept of time since spousal loss to expand our understanding of the temporal scope of the spousal loss experience. ...
We examine how the passage of time since spousal loss varies by social and demographic characteristics, using data from the University of Alabama at Birmingham Study of Aging. In multivariate analyses, African American race, female sex, lower income, and higher risk of social isolation had significant and independent associations with variation in time since spousal loss. African American women were at highest risk for long-term widowhood. Accurate characterizations of widowhood among community-dwelling older adults must consider variation in the length of time individuals are living as widowed persons and socioeconomic concomitants of long-term widowhood.
... We interviewed each one of the parents separately based on literature regarding bereaved parents, which indicated the existence of tension between parents regarding different ways of grieving. Sometimes the parents try to protect each other by avoiding expression of pain (O'Neill & Keane, 2006;Williams, Baker, Allman, & Roseman, 2006). Interviewing each of the parents separately provided a safe place for each of them and exposed us to broader and deeper information. ...
This paper describes a qualitative study aimed at exploring the meanings that are given by parents to the loss of their children in terror attacks in Israel and examining how specific aspects of these meanings help or hinder them in coping with the loss. This paper focuses the collective context of loss, a theme that emerged from in-depth interviews with 16 bereaved parents who lost their children in different terror attacks. The collective context of loss includes three subthemes: (a) the loss in the context of Jewish and Israeli history; (b) assigning responsibility for the loss; and (c) using the collective meaning in the process of coping. Overall, the findings highlight the role of the sociocultural context in the bereavement process. The discussion raises possible explanations for the significance of this role, focusing on the reciprocal processes between the bereaved parents and society, which are functional and effective for both.
Objective
This study examined short- and long-term psychological adjustment to parental bereavement in later life for mothers and fathers.
Method
Using 9 waves of data from the United States (1998-2014 Health and Retirement Study), I estimated trajectories of mothers’ and fathers’ depressive symptoms surrounding child death in later life, highlighting gender differences in adjustment. Moderation analyses were performed to uncover heterogeneous trajectories across parental characteristics.
Results
Mothers were more likely to experience child death and reported higher depressive symptoms prior to parental bereavement than fathers. Mothers and fathers who lost a child reported an increase in depressive symptoms that diminished over time. The short-term elevation in depressive symptoms was marginally greater for mothers than fathers, but depressive symptoms declined at a faster rate for mothers than fathers in the years following the death. These counterbalancing changes resulted in mothers and fathers returning to their respective pre-bereavement levels of depressive symptoms between 2 and 4 years post-bereavement. Parental age moderated trajectories distinctly by gender, and the presence of surviving children buffered the impact of child death on depressive symptoms for mothers but not fathers.
Discussion
Mothers more often experience child death in later life and their adjustment process differs from that of fathers, underscoring the salience of gender in shaping how older parents respond to the death of a child. Older parents and mothers without surviving children are vulnerable to prolonged elevations in depressive symptoms following the death of a child in later life.
Introduction
Bereavement is common in older adults, but it remains unknown whether bereavement contributes to poor outcomes in the vulnerable population of older adults receiving home-based services. We examine whether recent bereavement was associated with worse physical or mental health, presence of abuse or neglect, and financial strain.
Research Design
Cross-sectional analyses of an assessment of functional and social vulnerabilities collected by the New York City Department for the Aging (DFTA), the largest Area Agency on Aging in New York. Assessments were completed on 5,576 New York City Department for the Aging long-term care program, recipients aged ≥60 who received services in 2012. Assessment also collected data on partner or child death in the last year.
Results
Logistic regression indicated that the recently bereaved were more likely than the nonbereaved to report both depression symptoms and financial strain.
Conclusion
Enhanced efforts to identify and address mental health and financial concerns in bereaved homebound older adults may be warranted.
To identify racial/ethnic differences in retention of older adults at 3 levels of participation in a prospective observational study: telephone, in-home assessments, and home visits followed by blood draws.
A prospective study of 1,000 community-dwelling Medicare beneficiaries aged 65 years and older included a baseline in-home assessment and telephone follow-up calls at 6-month intervals; at 4 years, participants were asked to complete an additional in-home assessment and have blood drawn.
After 4 years, 21.7% died and 0.7% withdrew, leaving 776 participants eligible for follow-up (49% African American; 46% male; 51% rural). Retention for telephone follow-up was 94.5% (N = 733/776); 624/733 (85.1%) had home interviews, and 408/624 (65.4%) had a nurse come to the home for the blood draw. African American race was an independent predictor of participation in in-home assessments, but African American race and rural residence were independent predictors of not participating in a blood draw.
Recruitment efforts designed to demonstrate respect for all research participants, home visits, and telephone follow-up interviews facilitate high retention rates for both African American and White older adults; however, additional efforts are required to enhance participation of African American and rural participants in research requiring blood draws.
À ce jour, peu d’intérêt a été porté à l’exploration des expériences et réalités spécifiques au sous-groupe et sous-culture des femmes âgées vivant seules dans la pauvreté. Dans ce contexte, le but de cette étude était d’explorer et d’analyser l’expérience de vieillir au quotidien de femmes âgées montréalaises vivant seules à domicile dans un contexte de précarité économique. La théorie de l’universalité et de la diversité du soin de Madeleine Leininger a été l'assise théorique de cette étude et une approche qualitative avec devis de type mini-ethnographie a été retenue pour répondre au but de l’étude. Sept femmes âgées de 65 ans et plus, vivant seules à domicile dans un contexte de précarité économique, ont été recrutées pour participer à l’étude. Une approche «boule de neige» a été sélectionnée pour effectuer le recrutement des participantes qui s’est réalisé avec l’aide de deux ressources communautaires de Montréal. La collecte de données a été effectuée auprès de ces femmes par l’entremise d’entrevues individuelles semi-dirigées, d’un court questionnaire sociodémographique ainsi que par la tenue d'un journal de terrain. L’analyse qualitative de contenu s’est basée sur les quatre étapes du guide d'analyse des données de Leininger, soit : l'analyse des données brutes, le regroupement de celles-ci en patterns récurrents, l’émergence des sous-thèmes et thèmes ainsi que la formulation des résultats de recherche sous forme d’énoncés théoriques ou de recommandations. Les résultats de cette étude renseignent sur l’expérience de vieillir au quotidien de ces femmes par rapport à six facteurs culturels de leur structure sociale soit l’environnement, les valeurs culturelles, le mode de vie, les relations humaines, le facteur économique et l’ethnohistoire de même que par rapport à leur expérience de santé/maladie et vieillissement et à leur relation avec le système de soins. Les résultats en lien avec les facteurs culturels permettent de conclure que cette expérience de vieillir s’ancre principalement dans l’environnement intime du domicile de ces femmes, se concrétise en des sentiments de liberté, d’indépendance et de contrôle, s’enrichit dans le don de soi, se délimite à l’intérieur d’un réseau social appauvri et s’épanouit dans une vision positive de la vie et le refus d’un statut de pauvreté et de dépendance. Quant aux résultats relatifs aux dimensions de l’expérience humaine et du système de soins, ils révèlent que l’expérience de vieillir de ces femmes s’inscrit dans une volonté de préserver la fonctionnalité de leur corps, de conserver leur autonomie et de se positionner comme l’experte sur leur santé dans leur rapport avec les soins professionnels reçus. Les résultats révèlent aussi des indices de leur autodétermination, de leur résilience, de leur pouvoir d’agir et du sens qu’elles donnent à la vie dans les différents aspects de leur expérience de vieillir. Finalement, les résultats de la présente étude soutiennent des recommandations cliniques promouvant des approches de soins infirmiers culturellement cohérentes et empreintes d’empowerment auprès de ces femmes. Little attention has been given to the investigation of experiences and specific realities of the sub-group and sub-culture of aging women living in poverty. In this context, the objective of this research was to explore and analyze the daily experiences of women growing old and living alone at home in poverty. To reach this objective, the theory of Culture Care Diversity and Universality of Madeleine Leininger was used as the theoretical foundation while a qualitative approach and an ethnonursing method were retained. The sample was collected by a “snowball” strategy in two community groups located on the Montreal territory. A total of seven women aged 65 years and over, living alone at home in poverty were recruited. Individual semi-directed interviews were conducted with each woman completed by a short socio-demographic questionnaire and field notes. The qualitative content analysis was structured according to the four steps of the data analysis guide proposed by Leininger. These steps are: (1) the raw data analysis, (2) the grouping of these in re-occurring patterns, (3) the emergence of subthemes and themes and (4) the formulation of the study results in the form of theoretical expressions or recommendations. Results from this research explains the daily aging experience of women according to six cultural factors of their social structure, namely: (1) environment, (2) cultural values, (3) lifestyle, (4) human relations, (5) economic factor and (6) ethnohistory; as well as in relation to their health/illness and aging experience, and their relation with the healthcare system. Results related to the cultural factors underline that the aging experience: (1) is settled mainly in the intimate home environment of these women, (2) provides a sense of liberty, control and independence, (3) is enriched by giving to others, (4) is bounded inside a small and weak social network and (5) blossomed through a positive vision of life and the refusal to be considered as poor and dependent. Results related to the human experience and healthcare system dimensions, reveal that the aging experience is embedded in a desire to maintain the body functionalities, to stay independent and to act as experts of its own health in relation with professional care received. The daily experience of growing old for these women relies on their autodetermination, their resilience and on the meaning they give to life. These results support clinical recommendations promoting nursing care that is based on an empowerment approach which is culturally coherent with the culture of these women.
The death of a significant other is seen as a major life disruption. What are the consequences when such a loss occurs during advanced old age? Based on observation of an octogenarian cohort over a period of five years (1994-1999), this study investigates the impact of losing a significant other (close relative or friend) on the health of elders and on their family and social life. The bereaved are compared with two control groups: one declaring no significant change in their life and the other reporting a loss unrelated to bereavement. Results show that the death of a significant other has no impact on the measures of functional and physical health, nor is it a factor of isolation. However, the loss of a close relative is associated with more depressive symptoms while that of a relative or friend is related to the survivor's feeling of loneliness.
This study examined whether widowhood was associated with physical and mental health, health behaviors, and health outcomes using a cross-sectional (N=72,247) and prospective (N=55,724) design in women aged 50-79 years participating in the Women's Health Initiative observational study (85.4% White). At baseline, married women reported better physical and mental health and generally better health behaviors than widowed women. Whereas women who remained married over the 3-year period showed stability in mental health, recent widows experienced marked impairments and longer term widows showed stability or slight improvements. Both groups of widows reported more unintentional weight loss over the 3-year period. Changes in physical health and health behaviors were inconsistent, with generally small effect sizes. Findings underscore the resilience of older women and their capacity to reestablish connections, but point to the need for services that strengthen social support among women who have difficulty during this transition.
Self-report measures of grief, depression, and general psychopathology were studied in widows and widowers over a 2.5-year period following death of their partner. A comparison sample of men and women was also followed for the same period. Differences in severity of depression and psychopathology previously reported at 2 months postloss (Gallagher, Breckenridge, Thompson, & Peterson, 1983) diminished to nonsignificant levels at 12 and 30 months. However, significant differences between bereaved and comparison subjects on measures of grief were still apparent 30 months after spousal loss. A main effect of gender for depression and psychopathology (but not for grief) was found at 2 and 12 months: Women reported more distress than men regardless of bereavement status. Results indicate that the experience of grief persists for at least 30 months in both older men and women who have lost their spouse.
Advances in medical technology and improvements in health behavior have greatly increased the proportion of Americans who survive into old age. Consequently, identifying environmental and behavioral factors that enhance or protect the health and functional capacity of older adults is an important goal. This study investigated the extent to which social interactions and physical activity can protect older adults from the declines in functional ability that typically occur with age and the extent to which they buffer the negative effects of widowhood on physical functioning. Data were from the Longitudinal Study of Aging, a six-year follow-up of over 7,000 respondents in the 1984 National Health Interview Survey. Using individual growth curve models which examine the effects of predictor variables on change over time, this study investigated how physical activity, social interactions, and widowhood are related to the rate of change in functional health over a six-year period. Results suggested that physical activity and social interactions each exerted independent effects on functional decline. In addition, physical activity and social interactions buffered the effects of widowhood on functional decline, especially in men who died before the end of the study. Results suggest a need for health promotion programs to encourage both physical and social activities in the elderly.
This study evaluated how levels of social participation change as a result of late-life widowhood. Social participation is a multidimensional construct incorporating both formal (e.g., meeting attendance, religious participation, and volunteer obligations) and informal (e.g., telephone contact and social interactions with friends) social roles.
Using data from the Changing Lives of Older Couples study, analyses compared widowed persons to continuously married control participants to evaluate whether widowhood affects older adults' levels of social participation.
Widowed persons had higher levels of informal social participation than nonwidowed persons, whereas formal social participation levels were comparable between the two groups. Social participation levels decrease before the death of a spouse, primarily because of poor spousal health, and increase following the loss, because of increased support from friends and relatives.
Maintaining continuity in the realm of social participation is a strategy older adults use to cope with spousal loss; however, not all widowed persons have the same resources to alter their levels of social participation.
Nearly 50% of American women will be older than 45 years by the year 2015. Because the life expectancy of women is anticipated to extend to an average age of 81 years by 2050, the aging woman will become the predominant patient seeking health care. These statistics reveal the importance for health care providers to become familiar with the health care needs of this segment of the population. Over their life span, women are more likely to experience disease and disability and subsequently require intervention and treatment. This review is an evaluation of the older woman in the primary care setting. In the first section, which is an overall assessment of the older woman, we introduce common geriatric syndromes that should be recognized by health care professionals. We include an approach to the older woman and specific clinical tools that may be useful for comprehensive evaluation in the outpatient setting. In the second section, we discuss sex-specific illnesses as they relate to the older woman. In the third section, we provide insights on end-of-life issues, cultural competence, and socioeconomic concerns. In the last section, we summarize the key components in the evaluation and management of the older woman. The goal of this article is to provide the health care provider with a clear understanding of factors that must be considered to provide optimal care to these patients.
Hierarchical linear modeling was used to examine the degree of individual change in friendship and family networks and support over time as a function of sociodemographic characteristics, rehabilitation use, and disability. Participants, 449 older adults, had age-related vision loss, a common, chronic impairment that tends to worsen over time. Three interviews were conducted (baseline and 6- and 18-month follow-ups). All network and support variables showed a decrease over time. Regarding factors predicting individual variation, age (younger) and education (lower) were associated with greater baseline friendship support, rehabilitation was related to maintaining a larger friend network, and disability was positively associated with family network and support. Results supported the importance of examining rates of individual change and factors associated with variability in multiple support components by relationship type.
Previous studies have indicated that married people have lower mortality and are generally healthier. Most previous studies have been cross-sectional and few studies investigated the effect of marital transition on health. With a prospective design and repeated measures of variables, we sought to analyse the temporal relation between marital transition and change in health behaviours.
We followed up 80 944 women aged 46-71 for 4 years (1992-1996). All information was self-reported. We used multivariate-adjusted linear and logistic regression models to examine the impact of changes in marital status on concomitant changes in health behaviours, controlling for potential confounders and baseline health behaviours.
Compared with women who remained married, women who divorced/widowed had body mass index (BMI) decreases of 0.65 kg/m(2) (P < 0.001) and 0.44 kg/m(2) (P < 0.001), respectively. Compared with women who remained unmarried, women who remarried had an increase in mean BMI of 0.41 kg/m(2) (P < 0.001). Women who divorced increased physical activity by 1.23 metabolic equivalent hours (MET)/week (P = 0.07) compared with women who stayed married. Among non-smokers and past smokers, women who divorced/widowed had more than a twofold increased risk of relapsing/starting smoking (OR = 2.47, 95% CI: 1.56, 3.89; OR = 2.08, 95% CI: 1.56, 2.76, respectively) than women who stayed married. Divorced and widowed women had decreased vegetable intake relative to women who stayed married (-2.93 servings/week [P < 0.001] and -1.67 servings/week [P < 0.001], respectively).
These patterns suggest both health-damaging and health-promoting changes accompanying divorce and widowhood, and generally health-promoting changes following remarriage.
The purpose of this study is to see if stressors arising in highly valued roles affect health by eroding an older person's sense of meaning in life. A second goal is to assess whether emotional support provided by social network members helps offset the deleterious effects of stress on meaning and health.
Interviews were conducted with a nationwide sample of older people. Survey items were administered to assess stressors in highly valued roles, meaning in life, and self-rated health.
The findings suggest that life events arising in roles that are valued highly are associated with less favorable health ratings. Moreover, the data reveal that stressors in highly valued roles affect health primarily by eroding an older person's sense of meaning in life. Finally, the results indicate that emotional support helps older people cope more effectively with stress by restoring their sense of meaning in life.
Researchers have devised a number of interventions to improve the health of older people by enhancing the functioning of their social networks. These interventions have met with mixed success. The findings from the current study suggest that focusing on meaning in life may help researchers devise more effective interventions.
The death of a spouse often requires widows to derive support from other people, but little is known about the adaptive significance of such substitute sources of support. Older women (N = 322) widowed 3-30 months were interviewed 7 times over 1 year to investigate social network substitution (derivation of support from alternative social ties) and compensation (derivation of psychological benefits from these alternative ties). Three forms of substitution (formation of new social ties, rekindling of dormant ties, and intensification of existing ties) varied with the duration of widowhood. Regardless of the duration of widowhood, however, greater substitution was related to worse psychological health. Social network substitution appears to occur in widowhood, but the compensatory benefits of substitute ties are more elusive.
This study examined how positive aspects of caregiving affect adaptation to bereavement among older adults who cared for a family member with dementia. The sample consisted of 217 caregivers who were part of the Resources for Enhancing Alzheimer's Caregiver Health Study. Using pre- and postloss data, hierarchical regressions were carried out to examine the effects of positive aspects of caregiving (caregiving benefit) on postloss depression and grief. Findings show that preloss caregiving benefit was associated with higher levels of postloss depression and grief, even after controlling for caregiver demographic characteristics, contextual factors, and caregiving burden. This effect was particularly strong for the relation between benefit and grief. Results demonstrate the importance of studying both positive and negative aspects of caregiving and their relation to bereavement outcomes.
RÉSUMÉ
Des différences existent entre les sexes dans les variables liées à la démographie, à la santé et aux réseaux sociaux, variables qui sont associés à un vieillissement réussi, mais on n'en trouve généralement pas en ce qui concerne la satisfaction face à la vie. La présente étude avait pour but premier de déterminer s'il y a des différences entre les hommes et les femmes par rapport à leur satisfaction dans des domaines particuliers et en général à l'égard de la vie. Ont également été examinées les différences dans la satisfaction face au parcours de la vie entre les hommes et les femmes. Dans un deuxième temps, nous avons procédé à une analyse de l'ensemble de données recueillies dans l'étude Vieillir dans la communauté (Béland et al., 1989) afin d'évaluer le bien-être des adultes francophones plus âgés ( N =958). Des analyses acheminatoires ont révélé une bonne concordance des modèles utilisés pour les échantillons masculins et féminins. Chez les hommes, la satisfaction face à la vie s'explique positivement selon l'âge, le revenu et le contrôle et négativement selon les erreurs de mémoire, la maladie et les limitations fonctionnelles. Chez les femmes, la satisfaction face à la vie s'explique selon l'âge, la scolarité, le revenu, la maladie, les limitations fonctionnelles, le soutien social, le contrô le et le mode de vie. Les résultats ont fait ressortir les aspects positifs et négatifs du soutien social pour les femmes. Tel que nous nous y attendions, les modèles de parcours ont indiqué que, même s'il existe des similitudes dans la satisfaction face au parcours de la vie chez les hommes et chez les femmes plus âgés, on retrouve également des différences importantes.
The loss of a spouse has been found to have a negative effect on physical and mental health and leads to increased mortality. Whether conjugal bereavement also affects memory functioning has largely been unexamined. The present study investigates the effect of widowhood on memory functioning in older persons.
The sample consisted of 474 married women and 690 married men aged 60-85 years in 1992, followed up in 1995 and 1998. During the study 135 (28%) of the women and 69 (10%) of the men lost their spouse. Linear regression analysis was used to examine whether widowed men and women differed from those who had not been widowed in rate of memory change over 6 years. Cross-domain latent-change models were subsequently used to evaluate the extent to which changes in memory are related to changes in other domains of functioning that may be affected by widowhood.
Older adults who lost a spouse during follow-up showed a greater decline in memory over 6 years than those who remained married. A higher level of depressive symptoms at baseline was related to lower levels of memory functioning and a greater decline. Memory decline was unrelated to changes in depressive symptoms and physical health.
Loss of the spouse is related to a greater decline in memory in older adults. The absence of an association with physical functioning and the weak association with mental functioning suggest that losing a spouse has an independent effect on memory functioning.
The interpersonal relationships of older adults have long been recognized as important determinants for their physical activity involvement. To date, researchers in this field have tended to focus on positive social influences, such as social support. Furthermore, in most studies, operational definitions of social support have stressed the source of the support (e.g., family support and friend support) rather than the nature of the support provided by these groups and individuals. In order to clarify the social context of physical activity among older adults, more attention should be paid to exploring both positive and negative social influences on physical activity. The objectives of this paper were to consolidate current findings concerning social influences and physical activity among aging adults, and to identify major positive and negative social influences from the literature that are associated with physical activity and health-promoting behaviors among aging adults. The development of a more comprehensive and representative method of measuring social influences in physical activity settings is advocated.
Depression is quite common among the elderly members of Hong Kong Chinese society. This study examined the impact of a series of common stressful life events (SLEs) on changes in depressive symptoms among the older people. The respondents were 260 people aged seventy years or older from a longitudinal study of a representative community sample of the elderly population in Hong Kong. Using multiple regression models, the authors found that, of eight SLEs examined, only widowhood was associated with depressive symptoms three years later, even after controlling sociodemographic, physical health status, and social support variables were applied. In addition, the SLE influenced the depression differently for men and women, as we found that the death of a spouse was associated with increased in depressive symptoms among elder women, and the moving out of children was associated with a decrease in depressive symptoms among old men. Finally, we also found a close relationship between number of SLEs and depression.
Predictors of loneliness were investigated in married, widowed, divorced, and never-married older adults. Contacts with adult children, siblings, friends, and neighbors showed a stronger negative relationship with loneliness in unmarried than in married adults. However, divorced and widowed adults were more likely to profit from contact with adult children, whereas never-married and childless unmarried respondents profited most from contacts with siblings, friends, and neighbors. A better functional status was associated with less loneliness in divorced, widowed, and nevermarried adults, but not in married adults. Furthermore, unmarried men showed higher levels of loneliness than unmarried women, whereas only small sex differences in loneliness were found in married respondents. Sex differences in the loneliness of divorced and never-married adults were eliminated by controlling for sex differences in contact with children, siblings, and friends. However, widowers were lonelier than widows even after controlling for sex differences in these contacts.
We examined the prevalence and correlates of recent nonspousal family loss among older adults using data from the University of Alabama at Birmingham Study of Aging, a stratified random sample of community-dwelling older adults living in central Alabama. Twenty-three percent of participants reported a recent nonspousal family loss. African American ethnicity, education <12th grade, functional difficulty, restricted life-space mobility, depressive symptomology, pain and other somatic symptoms were associated with recent nonspousal family loss. Compared to non-widowed participants, widows with family loss reported a higher proportion of mental health and activity-limiting physical problems as well as restricted life-space. Programs to improve physical function and enhance health and wellbeing in older bereaved spouses should be expanded to include older adults with nonspousal family loss, particularly targeting the mental health needs of previously widowed persons who lose another family member.
The world's older population has been growing for centuries; however, the pace of this growth is accelerating rapidly. According to the U.S. Census Bureau, by 2030, more than 60 countries will have 2 million or more older people. Population aging represents a “success story,” with increasing numbers of people worldwide enjoying additional years of life. However, the sustained increase in numbers of older people (usually defined as persons over the age of 65) poses many challenges to policy makers and health care providers around the world. As the world population ages, we are just beginning to understand the social, economic, and political implications of the “age wave.” The majority of older people are women, thus the implications of population changes for women and women's health are astounding. Nurses can take a national and world leadership role to adequately address the health care needs of increasing numbers of older women.
IN PREVIOUS studies [l] it has been established that a cluster of social events requiring change in ongoing life adjustment is significantly associated with the time of illness onset. Similarly, the relationship of what has been called ‘life stress,’ ‘emotional stress,’ ‘object loss,’ etc. and illness onset has been demonstrated by other investigations [2-131. It has been adduced from these studies that this clustering of social or life events achieves etiologic significance as a necessary but not sufficient cause of illness and accounts in part for the time of onset of disease. Methodologically, the interview or questionnaire technique used in these studies has yielded only the number and types of events making up the cluster. Some estimate of the magnitude of these events is now required to bring greater precision to this area of research and to provide a quantitative basis for new epidemiological studies of diseases. This report defines a method which achieves this requisite. METHOD
Using data from Americans' Changing Lives: Wave 7,1986, this study examined the long-term effects on the personal functioning
of older women and men following the death of an adult child or a spouse. Guided by Weiss's (1993) theoretical framework,
41 bereaved parents and 143 bereaved spouses were compared to 407 nonbereaved adults on measures of perceived health, self-efficacy,
depression, life satisfaction, and future orientation. Analyses revealed bereavement and gender effects and a consistent influence
of the sociodemographic characteristics of education, income, and duration of bereavement on functioning.
Older persons are the fastest growing segment of the American population, and older women significantly outnumber men. The health status of older women is influenced by disease and psychosocial factors. Comprehensive geriatric assessment is a tool which takes into account the many aspects of health and provides a framework for developing individualized goals of care. Cardiovascular disease, osteoporosis, hormonal treatment, urinary incontinence, mental health, sexuality, substance abuse, cancer and exercise are discussed.
This study contrasts the health and social needs of widowed older women with needs of married older women.
12,624 women aged 70-75 years across Australia completed baseline questionnaires for the Australian Longitudinal Study on Women's Health: 34.5% of the women were widowed, and 13.5% of these widowed women had lost their spouse within the past 12 months (recently widowed).
Recently widowed women had particular physical and mental health needs as well as financial and practical needs relating to managing on their income. They had the lowest self-rated health, were most likely to report they were stressed about their health, and scored significantly lower than married women on all 8 sub-scales of the SF-36. Women were more likely to say they make their own decisions about their life if they were widowed than if they were married. However, stress with relationships with children or other family members was more likely to be reported by widows than other women.
In spite of women's active involvement in a woman's health care movement, the mainline health care system continues to hold tight to its androcentric focus. If women are to be subjected to a health care system that employs sexist and ageist practices, the quality of life in their later years will continue to be jeopardized. The purpose of this paper is to first, recognize the existing health care practices which limit the health care opportunities and choices of older women; and secondly, to discuss how such basic feminist principles as education, egalitarianism, empowerment, and inclusion can be used to improve an older woman's experience.
Research of friendship in older people's lives has recently extended to examine the impact of social structural factors. This study compared the friendship support networks of a small sample of older African and White American women for influences of ethnicity. The comparison used a matched-pair sample which controlled for age, marital status, residence type, and disability. Examination of data from the women's diagrams and descriptions of current informal support networks and friendship life histories indicates ethnic differences in four related areas of friendship network organization: size, composition, recruitment strategies, and opportunities for support exchanges. Implications for research and practice are considered.
Friendship occupies an important place in the growing body of literature in child development and gerontological research. As such, it may be useful for researchers from both fields to consider what can be learned from work carried out in each tradition. Therefore, we present a selected review of topics in friendship research across the life span. Through discussion of the value of friendship, the development of friendship, challenges to friendship, the gendered nature of friendship, and the connection between friends and family, points of commonality and contrast are identified. We conclude by presenting possible avenues for future investigation for researchers interested in friendship at any point in the life span.
The complex interaction of medical, social, and economic factors that affect women's wellness as they age requires a new paradigm that bridges the gap between those who are concerned about aging issues and those concerned about women's health. In this article, we begin this endeavor by advancing three interrelated themes: (1) there is a gendered relationship between socioeconomic structures and health over time; (2) there are gender-specific implications of health care financing and policy; and (3) there are health consequences to the gendered nature of caregiving.
Older women experience a high burden of chronic illness, disability, and comorbidity, and this burden is highest among socioeconomically disadvantaged and minority women. The consequences of a mismatch between the organization, delivery, and financing of health care for older women and their actual needs fall disproportionately on low-income and minority women. New sources of data, such as the Medicare Health Outcomes Survey, a new quality measure for Medicare+Choice plans, will provide valuable information to practitioners about the health and functioning of older women in general and about socioeconomically disadvantaged and minority women in particular. This information can be used to develop and implement interventions to improve the quality and outcomes of care for vulnerable subgroups of older women. There is cause for optimism that by improving the quality of clinical preventive services and the management of common chronic conditions and geriatric syndromes it will be possible to improve functional health outcomes, prevent or postpone disability, and extend active life expectancy for all older women while making progress toward eliminating health disparities among the most disadvantaged.
This study evaluates the effect of spousal death on mortality among Israeli adults and examines differences in this effect by duration of bereavement, age, sex, education, ethnic origin, household size, and number of children. Data are taken from the Israel Longitudinal Mortality Study which is based on a linkage of records from a 20% sample of the 1983 census to records of deaths occurring during the period 1983-1992. The study population comprised 49,566 men and 41,264 women, of whom 4,402 (9%) and 11,114 (27%), respectively, were bereaved during the follow-up period. Excess mortality among the bereaved was evident among both men and women, especially after bereavement of short duration. During the first 6 months, the excess mortality was about 50% among women and about 40% among men. For men, the effect of bereavement on mortality decreased linearly with age, with a relative risk of 3 among younger men during early widowhood. Bereavement had a greater impact on the more educated men. The effect of bereavement did not vary by ethnic origin or household size.
This article uses data from the United Kingdom Medical Research Council Cognitive Function and Ageing study (MRC CFAS) to analyze morbidity associated with three areas of impairment. We use cognitive status, functional status, and physical illness to examine differences in the proportion of time that older women and men will spend with co-morbidity. We also analyze differences among various impairments, and investigate the relationship between missing data and sex. Women have a larger burden of impairment than men, and, by including cognitive impairment together with functional impairment, a very large impairment burden is highlighted at all ages. Policy implications of the findings from the perspective of older women in the United Kingdom are discussed.
This study examines the distribution of total, unimpaired, and impaired life for several groups of older women defined by race, education, and marital history. Using data from the 1984-1990 Longitudinal Study of Aging, we model transitions among functional statuses using discrete-time Markov chains, and use microsimulation to produce summary indices of active life. Remaining years of life and the proportion of remaining years with disability vary substantially, both within each group of women studied and between pairs of groups. Of all groups studied, never-married, more-educated white women live the longest, healthiest lives. Ever-married nonwhite women with low education have the shortest life expectancy, and experience the most disability. Our findings show that life expectancy is an incomplete indicator of the time women, in particular sub-groups, can expect to live with and without impairment. These findings highlight the heterogeneity of disability processes and life expectancy for older women.
In Japan, there has been limited research regarding lifestyle of elderly bereaved. The present study was conducted to clarify lifestyle characteristics in conjugal bereaved women compared to non-bereaved women.
Subjects consisted of 872 bereaved and 643 non-bereaved elderly women aged 65 or over in T prefecture. Bereaved subjects experienced the death of a spouse in 1994 and their family structure remained unchanged after the bereavement. Non-bereaved subjects were randomly selected from community registration lists in 1995 and matched for age and area of residence. Lifestyle characteristics were obtained by home visit and interview. For the analysis, we divided the subjects into 4 groups by age and family structure. Multiple logistic regression analysis was performed to identify lifestyle characteristics of bereaved elderly women, after adjustment for physical ability and disease, as confounding factors.
Bereaved elderly women were significantly associated with no roles at home, no hobbies, lack of contact with friends, physical inactivity, sleeplessness and irregular meal patterns compared to the non-bereaved. Analysis of the 4 groups revealed bereaved women living with family members have more unfavorable lifestyle characteristics than bereaved women living alone. Bereaved women living with family members had no roll at home and sleeplessness.
Bereaved women have unfavorable lifestyle characteristics. Those living with family members had more unfavorable lifestyle than bereaved women living alone. From the preventive point of view, interventions for bereaved women are needed. This is particularly the case for bereaved women living with family members. Not only health services but also social welfare services are needed to reconstruct favorable lifestyles and maintain health and well-being.
This study aimed to comprehensively investigate the comprehensive relationships between depression and the characteristics of lifestyle and quality of life (QOL) of healthy, community dwelling elderly, and compare them according to gender and age groups. 1302 subjects (657 males and 645 females) were used for analysis. The investigators in this study were researchers working at universities in each prefecture. Data collection was conducted in a general delivery survey and interview setting or an education class setting. The geriatric depression scale (GDS) consisting of 15 items with a dichotomous scale was used to assess depression symptoms in the elderly. In addition, 16 items selected from the four factors of economic situation, physical health, social activity, and personal status were used to assess lifestyle. Furthermore, this study investigated life satisfaction, morale, and physical function with the LSI scale, PGC morale scale and the ADL scale of the Ministry of Education, Science and Culture, respectively. According to our results, depression characteristics of the elderly differ between gender and age groups. Depression increases in the old-old elderly rather than in the young-old elderly and is highest in old-old females. The factors significantly related to depression in community dwelling elderly were the number of friends and morale. In particular, an increase in the number of friends was related to a decrease in depression. Depression in the old-old elderly was more significantly related to many lifestyle items compared with the young-old elderly, and especially in the old-old elderly, the extent of social activities related to a decrease in depression.
We explored the effect of morbidity, mortality, and occurrence of new disability on gender differences in activities of daily living (ADL) functioning in different age groups in the elderly population.
All 77+-year-old members of a community-based cohort were clinically examined by physicians, assessed by psychologists, and interviewed by nurses at baseline and after a 3-year interval. Diseases were diagnosed according to ICD-9 and the DSM-III-R criteria for dementia. The Katz index of ADL was used to measure basic functional status.
After adjustment for socio-demographic characteristics, the oldest women (90+ years) had higher disability prevalence and a tendency for higher long-term disability incidence. Women aged 85+ years also had higher morbidity prevalence. Mortality among disabled subjects was similar for both genders, whereas higher mortality was found in younger nondisabled men (77-84 years).
We conclude that gender differences in disability, morbidity, and mortality vary with age in the elderly population. Gender differences in morbidity and basic functional dependence were evident only in the oldest old. Based on current and previous findings, we speculate that more women may be at higher risk of developing severe disability than men in the advanced ages due to longer survival with slight disability earlier in adult life.
This study examines effects of recent widowhood on health for a nationally representative sample of older women in the United States. Mediating effects of social connectedness on the health of recently widowed women are also explored. Using data from the 1984-1990 Longitudinal Study of Aging and Medicare claims, discrete-time hazard models estimate the risk of hospitalization for any 30-day period for women who were married at the time of the baseline survey (n = 1,138). Compared to women who are not recently widowed, those recently widowed have a 40% higher risk of hospitalization. Social connectedness, measured by having phoned a friend/neighbor or family member in the period prior to the baseline survey, significantly decreases hospitalization risk for the recently widowed. The findings indicate that recent widowhood has a large adverse effect on the health of older women. Results highlight the need to provide additional support to recently widowed older women.
An examination of the demographics of Americans age 65 and older show several interesting trends. First of all, Americans are living longer. Secondly, the proportion of women to men increases significantly in the older age brackets, to the point where at age 85 and older, for every four people living, three are female and one is a male. Finally, in all age bands, females far outnumber males among Medicare recipients. When combined with the greater costs of care and medicine in the last few years of life, this sets the stage for a tremendous economic impact on older women. In the first article of a three-part series, the author examines the demographics of the issue. Coming articles will look at additional economic and social stressors on aging women.
Older women often have different physical and psychological health priorities compared to men, and health systems must strive to extend and improve health care delivery to meet older women's specific health care needs. The goal of this study was to obtain information from older women on how to improve health care services to best support their efforts to age successfully and receive optimal quality health care in later life.
Focus groups were conducted among women aged 65 or older recruited from the community in the Montreal, Quebec, area. A total of 36 women participated. The focus group sessions were audiotaped, and the transcripts of each session were analyzed for issues and themes emerging from the text. Content analysis using the framework approach was used to explore and understand the experience of the focus group participants. The data from the text were then coded according to the relevant and emergent ideas and concepts.
Participants felt that their physical health care needs were being met, but that a number of issues relating to psychological health were inadequately addressed by health care professionals. The importance of feeling validated as active participants in a health care relationship, recognition of fears and anxieties associated with aging, and the need for information-sharing and education were all viewed as important health care priorities for older women. Time and accessibility were identified as the most significant barriers towards receiving optimal health care in later life.
The current health care system does not meet the global health care needs of older women. Health care leaders must recognize that success in program development and delivery for older women will require designing clinical programs that address both the physiological and psychosocial requirements of women. Only when women feel that they are being cared for in a comprehensive manner, one that includes attention to physical, psychological and emotional health, are we likely to be delivering health care that optimally promotes successful aging.
Healthy aging is a multifaceted phenomenon, incorporating biological and psychosocial developmental factors. The population of older women is diverse in health, function, social context, and age. Health promotion strategies, therefore, should be customized accordingly to optimize the health of the varied subgroups of older women, according to their health trajectory and personal preferences. Research and evaluation of approaches to promote health among these subgroups is an important next step in understanding and influencing the health of older women.
The objectives of this study were to describe the changes occurring in depressive symptomatology over a 10-year period among 75-year-old residents of Jyväskylä, Finland. It also addressed the question of whether the mood disturbances detected were a permanent phenomenon or whether they had a more episodic nature. In addition, various associations with and predictors of low mood were studied. Depressive symptoms were screened with the Center for Epidemiologic Studies Depression Scale (CES-D).The cut-off point of 16 was used to distinguish depressed individuals from those classified as non-depressed. A baseline study was carried out in 1989 (n = 337). A 5-year follow-up was carried out with the same cohort in 1994 (n = 222) and a 10-year follow-up in 1999 (n = 131). The permanent versus episodic nature of depressed mood was studied by comparing the three-wave longitudinal depression score findings of different individuals. In the follow-up settings, multivariate logistic regression models adjusted for sex were used to find predictors of depressiveness. Looking at the prevalence of depressiveness we found a statistically significant increase in the figures for women particularly from age 80 to 85 years. The much lower mean scores recorded for men in earlier measurements reached the same level as for women at age 85 years. Loneliness, a large number of chronic diseases, poor self-rated health, poor functional capacity, poor vision and perceived negative changes in life predicted depressive symptomatology. It seemed that minor depression among the elderly was most typically an episodic phenomenon.
This study examined the differences in levels of social networks and social engagement between older Blacks and Whites and racial differences in rates of change in social resources over time.
The sample consisted of 5,102 Blacks and Whites, aged 65 and older, from the Chicago Health and Aging Project, who underwent up to three interviews during an average of 5.3 years of follow-up. Repeated measures of social networks were based on the number of children, relatives, and friends seen at least once a month. Social engagement was measured at each interview with four items related to social and productive activity. Random effects models were fitted to test the effect of race on social resources and change in resources over time.
Blacks had smaller social networks and lower levels of social engagement than Whites. Racial differences in these resources were stable during follow-up. Socioeconomic status reduced racial differences in social engagement but not social networks.
The findings provide evidence for lower levels of social resources among older Blacks. There was little evidence that racial differences were the result of greater decline during old age itself.
Until recently the focus of women's health research and policy has been on reproductive health, but new public health issues have emerged that must be addressed. Among them are a need to examine the basic biology of sex differences in health and disease; the elimination of disparities in health status and health outcomes among diverse populations of women; and a mandate to care for a growing population of aging women.
We analyzed the role of sociodemographic factors, chronic-disease risk factors, and health conditions in explaining gender differences in disability among senior citizens.
We compared 1348 men and women (mean age = 79 years) on overall disability and compared their specific activities of daily living, instrumental activities of daily living (IADL), and mobility limitations. Analysis of covariance adjusted for possible explanatory factors.
Women were more likely to report limitations, use of assistance, and a greater degree of disability, particularly among IADL categories. However, these gender differences were largely explained by differences in disability-related health conditions.
Greater prevalence of nonfatal disabling conditions, including fractures, osteoporosis, back problems, osteoarthritis and depression, contributes substantially to greater disability and diminished quality of life among aging women compared with men.
Social networks have emerged as important in the development and progression of disability in aging cohorts. We have previously reported that pain that interferes with daily activities is common and increases incrementally from middle age into later life. The current study has investigated whether pain interference in this age group is related to social network characteristics. 5215 community-dwelling adults aged 50 years and over participating in the North Staffordshire Osteoarthritis Project (NorStOP) and identified as currently experiencing pain formed the sample for the present analysis. Questions on pain-related interference and the number and frequency of contact with children, close relatives, close friends, and confidant were included in the baseline postal questionnaire. The number and frequency of contact for most social ties declined with age. Being widowed (Age-adjusted OR: 1.30; 95%CI: 1.10, 1.54), the absence of close friends (2.07; 1.64, 2.63), and the absence of close relatives for women (2.24; 1.66, 3.04) were associated with increased likelihood of pain interference with daily activities. The absence of children was linked to lower levels of pain interference (0.76; 0.64, 0.91). The associations with close friends and children were reduced but remained significant after adjusting for sociodemographic factors. The association with close friends became non-significant after adjusting for depression suggesting this may form part of the pathway linking close friends networks and pain interference. Pain-related interference shows similar associations with social networks as all-cause disability and may benefit similarly from a public health perspective.
The study examined cross-sectionally and longitudinally psychological wellbeing in the context of marital status, gender, and age.
Measures were taken eight years apart for three groups: married at both interviews; widowed at both interviews; and married at first interview but widowed at third. Data were analysed using multiple regression models: dependent variables were morale and social engagement; independent variables were marital status, gender and age.
Cross-sectionally significant differences were found for marital status and age for both morale and social engagement. Both widowed and newly widowed participants reported lower morale and social engagement than their married counterparts. In the longitudinal model, when prior levels of morale were taken into account, only age and being newly widowed contributed significantly to the variance (R2). The same pattern of results was found for social engagement. Gender was never significant.
The results illustrate the value of modelling both cross-sectional and longitudinal data. The latter demonstrated that the size of the effect differed between those who had recently widowed and those who had been widowed for longer. The study shows that age needs to be taken into account when examining widowhood.
Widowhood is a stressful event for women, often coinciding with health, financial, and relationship losses. Researchers have considered many aspects of women's adjustment to widowhood, typically including social support in analyses. This study analyzed relationships between social support and adjustment from 19 previous widowhood studies. Contrary to intuition and most researchers' assumptions, the majority of relationships did not show that social support positively impacted adjustment. Analyses examined whether type of support or study methods affected the likelihood of finding a significant relationship between support and adjustment. Chi-square statistics indicated that neither of these factors influenced the effect of social support on women's adjustment to widowhood.
This study describes depressive symptoms among caregivers following bereavement and connects these trajectories to earlier features of caregiving using life course and stress process theory. Data are from a six-wave longitudinal survey (five years) of spouses and adult children caring for someone with Alzheimer's Disease. The analytic subsample (N = 291) is defined by death of the care-recipient after the baseline interview. A latent class mixture model is used to identify distinctive clusters of depressive symptoms over time. Of the four trajectories identified, three represent stable symptom levels over time, with two-thirds being repeatedly symptomatic (medium symptom levels), compared to two smaller groups of repeatedly asymptomatic (effectively absent of symptoms) and repeatedly distressed (severe symptoms). In contrast, about one in five caregivers experiences improved emotional well-being over time, the temporarily distressed, who progress from severe to moderate symptom levels. Caregivers with few symptoms before bereavement tend to maintain these states afterwards, but emotionally distressed caregivers tend to become more distressed. Role overload before bereavement substantially increases the odds of following an unfavorable trajectory afterwards, whereas self-esteem and socioemotional support play protective roles. These results demonstrate that caregivers are not uniform in their emotional responses to bereavement, but follow several distinct trajectories. These trajectories are linked to their previous experiences as caregivers, in particular exposure to stressors and access to resources. These findings suggest that intervention during caregiving may facilitate adaptation following death of a loved one.
The death of a loved one: Impact on health and relationships in very old age Parental bereavement over the life-course: A theoretical intersection and empirical review
- D Epinay
- C J L Cavalli
- S Spini
D'Epinay, C. J. L., Cavalli, S., & Spini, D. (2003). The death of a loved one: Impact on health and relationships in very old age. Omega: The Journal of Death and Dying, 47, 265-284. de Vries, B., Dalla Lana, R., & Flack, V. (1994). Parental bereavement over the life-course: A theoretical intersection and empirical review. Omega: The Journal of Death and Dying, 29, 47-69.
Depressive symptoms in late life: A 10-year follow-up
- R L Heikkinen
- M Kaupppinen
Heikkinen, R. L. & Kaupppinen, M. (2004). Depressive symptoms in late life: A 10-year follow-up. Archives of Gerontology and Geriatrics, 38, 239-250.
Older Adults in the United States
- D Smith
- T Hava
Smith, D. & Hava T. (2000). Older Adults in the United States: March 1999. U. S. Cen-sus Bureau, Current Population Reports, Series P20-532. Washington, DC: U.S. Government Printing Office.