Interaction of widowhood, gender, and age in predicting loneliness among older adults in China

BACKGROUND

Loneliness is a significant issue for the elderly, and widowhood is considered a major risk factor. However, research on the intersectional effects of gender, age, and widowhood on loneliness is limited, especially within the Chinese cultural context.

METHODS

Using six waves (2002-2018) of national longitudinal data from the Chinese Longitudinal Healthy Longevity Survey (N = 22,777), this study employed multilevel mixed-effects ordered logistic regression to analyze the impact of widowhood on loneliness. Moderating roles of gender and age were examined through interaction effects.

RESULTS

Widowhood significantly increased loneliness across genders and age groups, but this effect diminished with age. Widowed men experienced greater loneliness than women, but this difference converged by age 90. The buffering effect of age on the widowhood-loneliness link was less pronounced among older women.

CONCLUSION

The study unravels the complexity of how gender, age, and widowhood interact to shape loneliness in later life. Targeted interventions considering these intersections are needed to alleviate loneliness among Chinese widowed elderly.

Widowhood status, morbidity, and mortality in India: evidence from a follow-up survey

A known health effect of widowhood is an increased mortality risk among surviving spouses, with gender- and age-specific observations. While morbidity conditions with socio-economic factors may exacerbate the effect of widowhood on mortality, no research has attempted to predict mortality among the widowed over the married population with the presence of morbidity in India. Thus, the present study concurrently examines marital status and health in the Indian setting, bringing substantial empirical evidence to explore the link between marital status, morbidity, and mortality. The study used prospective data from India Human Development Survey (IHDS) wave 1 (2004-2005) and wave 2 (2011-2012). In total, 82,607 individuals aged 25 years and above were considered for the analysis. To present the preliminary findings, descriptive statistics and bivariate analysis were used. Using multivariable logistic regression, the interaction effect of marital status and morbidity status was estimated to predict the likelihood of mortality. Across all socio-economic groups, widowed individuals reporting any morbidity had a higher mortality proportion than married people. Young widowers with any morbidity are more susceptible to increased mortality. Asthma among young widowers and cardiovascular diseases among elderly widowers significantly elevate the probability of mortality. However, older widowed women with diabetes had a lower probability of mortality than older married women with diabetes. The widowers' disadvantage in mortality and morbidity may be attributable to less care-receiving and the greater incidence of unhealthy lifestyle practices during the post-widowhood period, indicating the need for more research.

The Role of Late-Life Work Among Widowed Adults in Korea: A Buffer or Burden for Widow(er)s' Health?

To examine the role of work in the bereavement process, we focused on health changes among widowed adults. We analyzed a sample of 518 adults (aged 52-95) from the Korean Retirement and Income Study (2011-2019) who experienced spousal loss during the study period. The widowed participants provided data on their employment status and perceived health at both pre-loss and post-loss. Widowed participants reported worse physical and mental health after the bereavement, but the significant health deterioration was not observed among employed participants. Adjusting for pre-loss health status and other covariates, employed widow(er)s showed a smaller decrease in physical and mental health, compared to their counterparts. The effect of employment on physical health changes was more pronounced for economically vulnerable widow(er)s. Work might serve as a restoring coping strategy for widowed individuals; economic benefits from the job may also contribute to their health and well-being.

Unraveling the Impact of Widowhood Duration on Depression: Does Time Heal All Wounds?

China's aging population has witnessed a surge in widowed older adults, raising concerns about their mental health. Losing a spouse is a profoundly distressing experience with enduring effects on well-being. Despite the proverbial belief in time's healing power, existing studies often neglect the potential decline in depressive symptoms during widowhood. Drawing data from the 2015 and 2018 China Health and Retirement Longitudinal Study, this study delves into the impact of widowhood duration on depression among 8370 older adults and uncovered significantly higher depression scores among widowed individuals, particularly in the initial 3 years. The research reveals that widowhood contributes to heightened depression levels even after accounting for sociodemographic factors. Although the depressive impact lessens over time, it persists beyond 3 years, underscoring the need for heightened awareness and support for this vulnerable population.

The Effects of Religiosity on Depression Trajectories After Widowhood

This longitudinal study analyzed data from the 2006-2016 waves of the nationally representative Health and Retirement Study (HRS). Trajectories of depression among older adults ≥ 50 years (N = 1254) were examined over time to explore patterns of depression among those entering widowhood and the potential impact of religiosity on depressive symptoms during various stages of widowhood. Ordinary least squares (OLS) regression analysis was used to examine the association between widowhood and depression and the role of religiosity as a moderator of this association. Older adults experienced a statistically significant increase in depressive symptomology after the onset of widowhood, and depressive symptomology decreased post widowhood, but did not return to pre-widowhood levels. Additionally, high religious service attendance and higher intrinsic religiosity were both associated with lower depressive symptomology. High religious service attendance moderated the relationship between widowhood and depression among widowed older adults living alone.

When 'the Happily Ever After Ends': The Grieving Process in Widowhoods

The loss of the spouse causes several secondary losses, such as loss of family and individual identities, and for that, it is considered a risk factor for complicated grief. Our objective was to investigate the possible specific aspects of widowing. Data collection occurred via an online questionnaire, during the new Coronavirus pandemic and the mixed design (both qualitative and quantitative) research had the participation of 93 individuals. The loss of the spouse was considered the worst loss experienced by the participants. Loneliness, routine, bureaucracy, and rituals were the main difficulties, while spirituality, family, and work were mentioned as protective factors. Signs of complicated grief were associated with age and time since the death of the partner. There was no significant difference between gender nor between the type of death. The manifestations of widowing are similar to other forms of bereavement, but there are specifications that should be taken into consideration by professionals in order to promote quality of life.

Estimating the Sex Gap in Depression-Free Life Expectancy Among Widowed Americans Aged 50 and Older: An Application Using the Interpolated Markov Chain Approach

OBJECTIVES

Using Interpolated Markov Chain software, we compare the length of life with and without depression among married individuals and widowers, and the related sex differences.

METHODS

We applied a multi-state life table approach to estimate depression-free life expectancy among recent cohorts of older married and widowed women and men in the United States, using data from the Health and Retirement Study over a 7-year period (2012-2018).

RESULTS

The study revealed that the difference in life expectancy between sexes widens in the context of widowhood. At age 50, the sex gap in depression-free life expectancy is 0.8 years among married people, whereas the gap almost doubles to 1.7 years among widowed people.

DISCUSSION

By quantifying disparities in the duration of life affected by depression between married and widowed women and men, policymakers could properly allocate resources specifically to address the mental health needs of these groups.

Relationship of depression and loneliness with quality of life in rural widowed elderly women living alone

OBJECTIVES

Rural widowed elderly women living alone may face higher risks of depression and loneliness than general elderly people, which will have an impact on their quality of life. This study aims to explore the correlation of depression and loneliness with quality of life among rural widowed elderly women living alone.

METHODS

A two-stage cluster sampling method was used to select 234 rural widowed older women living alone in Longshan county, Xiangxi autonomous prefecture, Hunan Province, and a questionnaire survey was conducted with the General Situation Questionnaire, the Geriatric Depression Scale-15 (GDS-15), the University of California, Los Angeles (UCLA) Loneliness Scale-8 (ULS-8), and the 36 Items Short Form Health Survey (SF-36).

RESULTS

The ages of 234 rural widowed older women living alone were (73.29±7.36) years. Among them, 103 (44.0%) women were detected as depressed, 114 (48.7%) were not lonely or mildly lonely, 111 (47.4%) were moderately lonely, and 9 (3.9%) were severely lonely. The total quality of life scores were 63.39±19.70. Depression and loneliness were negatively correlated with quality of life (all P<0.001). After adjusting for confounding factors, multiple linear regression analysis showed that age, number of acute and chronic diseases, personal monthly income, depression, and loneliness independently impacted the quality of life among rural widowed older women (all P<0.05).

CONCLUSIONS

Depression and loneliness can affect the quality of life of rural widowed older women living alone. In healthy aging efforts, the quality of life of these rural widowed older women can be improved by strengthening the management of underlying illnesses, increasing income, and alleviating depression and loneliness.

Relationship of widowhood with pulse pressure, fasting blood glucose, and mental health in older adults: a propensity matching score analysis

Background

Transitioning from marriage to widowhood presents inevitable and significant challenges for many older adults. This study explored the impact of widowhood on a range of mental health outcomes, including pulse pressure and fasting blood glucose levels, among older adults in nursing homes.

Methods

This cross-sectional study utilized cluster random sampling to recruit participants, with data analyzed from 388 older Chinese adults. Psychosocial traits were assessed using the Perceived Social Support from Family scale (PSS-Fa) for family support, the Generalized Anxiety Disorder 7-item scale (GAD-7) for anxiety symptoms, and the 9-item Patient Health Questionnaire (PHQ-9) for depressive symptoms and suicidal ideation. Propensity score matching (PSM) was employed to control for confounding factors. A multivariate linear regression analysis was performed to explore the relationship between widowhood, mental health outcomes, pulse pressure, and fasting blood glucose levels.

Results

After applying PSM, the sample size was refined to 268 (N = 134 for both married and widowed groups) from the initial 388, excluding 120 unmatched cases. Widowed older adults were found to have notably lower family support (β = -0.81, p = 0.002), increased depressive symptoms (β = 1.04, p = 0.043), elevated pulse pressure (β = 8.90, p < 0.001), and higher fasting blood glucose levels (β = 3.22, p = 0.027). These associations exhibited greater beta values compared to pre-matching analysis.

Conclusion

Our findings revealed that widowed participants had reduced family support, an increased risk of depressive symptoms, heightened pulse pressure, and elevated fasting blood glucose in comparison to their married counterparts. Interventions focusing on social support, mental health, and cardiovascular well-being could be advantageous for this at-risk group.

The Trajectory of Depression through Disenfranchised Grief in Young Widows in Times of COVID-19: A Case Report from Rural India

The COVID-19 pandemic was one of this century's deadliest and most widespread viral outbreaks, with higher mortality rates in men than women. Disruptions in funeral rituals and customs, no social recognition of the losses, and limited social support have complicated the grieving process and are linked to disenfranchised (not openly acknowledged, socially recognized, or publicly mourned) grief. Depression is also highly comorbid with complicated grief. Losing a spouse can be devastating, and this is more severe for women with limited or no resources, who are vulnerable because of the patriarchal society. In the current COVID-19 era, increased uncertainty and disenfranchised grief can worsen the clinical scenario and hamper interventions, as highlighted by the present case report on disenfranchised grief with depressive symptoms in a 30-year-old woman from rural India who, after a year of marriage, lost her husband due to COVID-19. This case study emphasizes the impact of multiple types of disadvantages due to sociodemographic and cultural determinants that can complicate the grieving process in the current context. The bioecological model of grief recovery considers individual features and societal/environmental factors to postulate the appropriate intervention. Finding meaning and purpose in life and restoration-oriented coping were successful for the clinical management of the patient.

Multiple types of distress are prospectively associated with increased risk of ovarian cancer

BACKGROUND

Few modifiable risk factors for epithelial ovarian cancer have been identified. We and other investigators have found that individual psychosocial factors related to distress are associated with higher risk of ovarian cancer. The present study examined whether co-occurring distress-related factors are associated with ovarian cancer risk.

METHODS

Five distress-related factors were measured repeatedly over 21 years of follow-up: depression, anxiety, social isolation, widowhood, and, in a subset or women, posttraumatic stress disorder (PTSD). Cox proportional hazards models estimate relative risks (RR) and 95% confidence intervals (CI) of ovarian cancer for a time-updated count of distress-related factors, in age-adjusted models, then further adjusted for ovarian cancer risk factors and behavior-related health risk factors.

RESULTS

Across 1,193,927 person-years of follow-up, 526 incident ovarian cancers occurred. Women with ≥3 versus no distress-related psychosocial factors demonstrated increased ovarian cancer risk (HRage-adjusted  = 1.71; 95% CI = 1.16, 2.52). No significant difference in ovarian cancer risk was observed in women with one or two versus no distress-related psychosocial factors. In the subsample with PTSD assessed, ≥3 versus no distress-related psychosocial factors was associated with twofold greater ovarian cancer risk (HRage-adjusted  = 2.08, 95% CI = 1.01, 4.29). Further analysis suggested that women at highest ovarian cancer risk had PTSD co-occurring with any other distress-related factor (HR = 2.19, 95% CI = 1.20, 4.01). Adjusting for cancer risk factors and health behaviors minimally impacted risk estimates.

CONCLUSIONS

Presence of multiple indicators of distress was associated with risk of ovarian cancer. When including PTSD as an indicator of distress, the association was strengthened.

Effect of widowhood on the risk of disability among the elderly in China

Background

The deteriorating health status of widowed elderly individuals becomes an important restriction factor affecting healthy aging in China. This paper aimed to find effective ways to reduce the risk of disability among the widowed elderly.

Methods

An empirical analysis was conducted by using four surveys from the China Health and Retirement Longitudinal Study (CHARLS) in 2011, 2013, 2015, and 2018. A fixed-effects model was performed to estimate the effect of widowhood on the disability risk of the elderly in China and its disparities in different groups, and influencing channels and moderating effects were further investigated.

Results

Widowhood significantly increased the risk of disability, and the results were robust. The risk of disability was higher among those who were male, living in urban areas, educated, and 60-to-70-years-old. Possible channels in the association were psychological stress and unhealthy behavior. Meanwhile, more financial support, contact from children, and social activities decreased the risk of disability.

Conclusion

The health risks of older adults after widowhood can be reduced by concerted efforts from society and government, including promoting the traditional Chinese virtue of filial piety and providing health interventions and social support services.

The Moderating Roles of Intrinsic and Extrinsic Religiosity on the Relationship between Social Networks and Flourishing: A Study on Community-Dwelling Widowed Older Adults in Malaysia

Widowhood affects the social networks and well-being of older adults. Religion might moderate the relationship between a stressor and well-being. This study aimed to identify the moderating roles of intrinsic and extrinsic religiosity on the relationship between social networks and flourishing among widowed older people and whether this relationship varied across gender. This study involved 655 community-dwelling widowed older Malaysians from Wave 1 (2012-2013) of "Identifying Psychosocial Risks and Quantifying the Economic Costs of Age-Related Cognitive Decline among Older Malaysians" in Peninsula Malaysia. The moderated hierarchical multiple linear regression analysis was conducted to examine the moderating roles of religiosity. Results showed that the moderating effect of religiosity on the relationship between social networks and flourishing was only observed for extrinsic religiosity, not intrinsic religiosity. In terms of gender differences, extrinsic religiosity moderated the relationship between social networks, flourishing only among widows but not widowers. Widows with low levels of extrinsic religiosity should join activities or programs that could expand their social networks to promote higher well-being despite widowhood.

Differentials in private and public healthcare service utilization in later life: do gender and marital status have any association?

The present study investigates whether the differentials in private and public inpatient healthcare utilization are associated with marital status for men and women aged 60 years and above in India. Binary logistic regression was applied to examine the association of private and public inpatient healthcare utilization with the marital status of the elderly. The study found that widowed men and women generally used public healthcare for hospitalization, while married men and women preferred private healthcare. Our findings also indicated that private inpatient health services expenditure was higher for married elderly than widowed elderly. After controlling all covariates, widowhood was significantly associated with higher use of public healthcare services for women but not for men. India's current health care policy and program may be required to focus on improving the infrastructure quality of current public healthcare systems. It also needs to be favorable for vulnerable sections of society, especially widowed women, to avail better treatment at an affordable cost.

How Do Marital Transitions Affect Self-Perceptions of Aging?

OBJECTIVES

We analyzed whether marital status and experiences of marital loss or gain were associated with self-perceptions of aging (SPA), a major psychosocial mechanism of healthy aging.

METHOD

We used data from 7028 participants of the Health and Retirement Study. Participants reported their marital status and their positive and negative SPA on two occasions 4 years apart. We ran general linear models to analyze differences in SPA between men and women who remained married, became divorced or widowed, or remarried following divorce or widowhood.

RESULTS

Participants who experienced marital loss had lower positive SPA than participants who remained marred. Participants who experienced marital gain had lower negative SPA than participants who remained married. None of the associations differed between men and women.

DISCUSSION

Results suggest that it may not be marital status itself, but rather the transition into or out of marriage, that impacts how people appraise their own aging.

Without Spouse: Phenomenology of Widowhood among Hindu Young Widows

When a woman is widowed, it is a traumatic moment in her life. The pain would aggravate a widowed woman whose husband died at a younger age. This paper attempts to depict the lived experience of widowhood from the perspective of young Hindu widows by using a descriptive phenomenological approach guided by Husserlian philosophy. The selected widows for this study were under 45 years old when they had lost their husbands. This paper excerpts from the author's empirical study for his doctoral thesis. The article will focus on four major themes that emerged from analysing the transcribed data collected from seventieth widows through personal face-to-face interviews. These themes are grief, restrictiveness, suspiciousness, and loneliness, which will discuss elaborately throughout this article. The article advocates that researching the lived experience through a phenomenological approach can enhance understanding of any traumatic phenomenon humans encounter. This way, specific initiatives can be taken by the community, non-governmental organisations, etc., for better counselling and redressing widows' mental issues.

Prevalence of and Factors Associated with Negative Psychological Symptoms among Elderly Widows Living Alone in a Chinese Remote Sample: A Cross-Sectional Study

(1) Background: Research indicates that most elderly widows are at a high risk of experiencing negative psychological symptoms. It is common for elderly women in rural and remote areas to live alone without family support to cope with stress due to the mass rural-to-urban migration of China’s youth labor force. Such a situation further worsens their psychological health and well-being. However, the prevalence of and risk factors associated with negative psychological symptoms (loneliness, depression, and anxiety) among remote elderly widows living alone in China are currently unclear; (2) Methods: A cross-sectional study was conducted in Hunan Province, China. The loneliness was assessed through the University of California at Los Angeles Loneliness Scale (ULS-8). The depression and anxiety were assessed with the Short Form Geriatric Depression Scale (GDS-15) and Generalized Anxiety Disorder Scale (GAD-7), respectively. The Chi-square test and correlation analysis were conducted to identify factors associated with negative psychological symptoms. Logistic regression was performed to predict risk and protective factors contributing to loneliness, depression, and anxiety symptoms. The significance level was set as p < 0.05; (3) Results: A total of 271 remote elderly widows living alone were enrolled in the present study. Additionally, 234 valid questionnaires were returned (valid response rate = 86.3%). The prevalence of loneliness, depression and anxiety was 8.1%, 44.0%, and 16.7%, respectively. Acute or chronic medical conditions, marital happiness, being the primary caregiver before widowhood and anticipating the death of the spouse differed significantly in the distribution of negative psychological symptoms. Logistic regression analysis predicted that participants who were satisfied with their marriage had a lower likelihood to experience loneliness, depression, and anxiety (p < 0.05). Being the spouse’s primary caregiver before widowhood was more likely to have symptoms of loneliness (p < 0.01). Those with various acute or chronic medical conditions were more likely to suffer from depression (p < 0.01); (4) Conclusions: Remote elderly widows living alone in China are prone to loneliness, depression, and anxiety symptoms. Being the primary caregiver before widowhood and having many acute or chronic medical conditions are risk factors for loneliness and depression, respectively. Marital happiness is the protective factor against negative psychological symptoms. To accomplish the goal of equitable access to mental health care in China, evidence-based policy and resource development to support psycho-social interventions that prevent and manage negative psychological symptoms for remote elderly widows living alone are urgently needed.

Social determinants of impaired functioning among Nepali widows: A mixed methods study

Despite considerable stigmatisation of widows in Nepal, little is known about factors affecting their ability to function in society. Using mixed methods, we studied psychosocial factors associated with impaired functioning among Nepali widows. For the qualitative analysis, we analysed 3 focus groups, 25 in-depth interviews, and 12 key-informant interviews. The quantitative analysis was based on data from 204 widows. Odds ratios were calculated linking psychosocial exposures to impaired functioning using adjusted logistic regression models. Low social support (aOR = 2.35, 95% CI: 1.2, 4.6, generally; aOR = 3.3, 95% CI: 1.7, 6.42, specifically from family members), experiences of discrimination (aOR = 2.97, 95% CI: 1.43, 6.14), and low life control (aOR = 4.3, 95% CI: 1.86, 10.1) were risk factors for impaired functioning. Qualitative findings suggested how discrimination and lack of control contribute to impaired functioning. Support from the husband's family appeared to be more important to a widow's functioning, compared to from her own parents. Knowledge about risk factors for impaired functioning can help inform interventions for Nepali widows.

Do Personality Traits Moderate the Effects of Cohabitation, Separation, and Widowhood on Life Satisfaction? A Longitudinal Test for Germany

The start and end of a romantic relationship are associated with substantial changes in life satisfaction. Yet, whether Big Five personality traits moderate these relationship transition effects is hardly known. Such knowledge helps to understand individual variation in relationship transition effects and provides the possibility to further test the stress and social support explanations of these effects. Our fixed effects regressions on 28 waves of the German Socio-Economic Panel 1991-2018 show that Big Five traits moderate the effects of relationship transitions on life satisfaction to a limited extent. More neurotic men display a more negative effect of separation, and more neurotic and more agreeable women reveal a more negative effect of widowhood on life satisfaction. Big Five traits do not moderate the effect of the start of cohabitation on life satisfaction. Our findings support the stress perspective of relationship transition effects most and identify emotionally unstable individuals as a particularly vulnerable group.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s10902-022-00573-8.

Can community-based care moderate widowhood's health impact? -A longitudinal study among older Chinese adults

The plethora of pathways leading to health problems of later life has made the causal assessment of widowhood on the health of older adults difficult. This research aimed to assess the short-term impact of widowhood on the objective health of older adults and to the moderating role of community-based care (CBC) in improving the health outcomes of older adults. In this study, the activities of daily living (ADLs) and number of hospitalisations of older adults were measured, and PSM-DID models were conducted. Widowhood had a significant negative impact on the objective health of older adults. Widowed adults had higher ADL scores (B = 0.569, 95 percent CI: 0.295 to 0.844) and more hospitalisations (B = 2.551, 95 percent CI: 1.189 to 3.914) than nonwidowed adults. Meanwhile, CBC in urban areas can significantly reduce ADL scores (B = -0.154, SE = 0.082) and the number of hospitalisations (B = -1.402, SE = 0.348) in older adults, whereas CBC in rural areas can only significantly reduce ADL scores (B = -0.197, SE = 0.087). Taken together, there is an urgent need to focus on the health of widowed and older adults and to provide CBC in both urban and rural areas equally.

The Widowhood Effect on Mortality in Older Patients with Hip Fracture

Objective

Widowed people have increased mortality than married people of the same age, a phenomenon known as the widowhood effect. This study aimed to investigate whether this effect exists in older patients with hip fracture.

Methods

Using our own hip fracture database, a total of 1101 hip fracture patients were consecutively included from January 2014 to December 2021. Marital status was stratified as married (n = 793) and widowed (n = 308). Patients survival status was obtained from medical records or telephone follow-ups, and the outcomes were all-cause mortality at 30 days, 1 year and at latest follow-up. Univariate and multivariate Cox proportional hazard models were used to assess the association between marital status and mortality, and subgroup analyses according to sex were also conducted.

Results

Compared with married patients, widowed patients were more likely to be older, female and intertrochanteric fracture, and were less likely to be urban area, smoking, drinking, and surgical treatment (P < 0.05). After a median follow-up of 37.1 months, the 30-day mortality was 4.3% (n = 47), 1-year mortality was 19.3% (n = 178), and total mortality was 34.2% (n = 376). Multivariate Cox analysis showed that widowed marital status remained an independent risk factor for 1-year mortality (HR = 1.437, 95% CI: 1.054–1.959, P = 0.022), and total mortality (HR = 1.296, 95% CI: 1.038–1.618, P = 0.022), whereas this association was not found in 30-day mortality (HR = 1.200, 95% CI: 0.607–2.376, P = 0.599). Moreover, subgroup analyses also found that the widowhood effect on mortality was present in both male and female.

Conclusion

Widowed marital status seems to be an independent risk factor for long-term mortality in older patients with hip fracture.

Psycho-Social Factors Associated with Intimacy Needs in Divorced and Widowed Older Chinese Women

The rapidly ageing population, the growing rate of divorce, and the longer life expectancy of women compared with men have resulted in a large proportion of older Chinese women being alone. The sexual health and intimacy needs of this group of women are ignored due to traditional Chinese cultural values that undermine older adults' needs for sex and intimacy, and the subordinate position of women in society. The present study used a quantitative survey method to investigate bio-psycho-social factors associated with divorced and widowed older Chinese women's sexual health and intimacy needs in two cities in Shanghai and Wuhan. The conceptual framework of this study was guided by cognitive stress theory, attachment theory, gender theory, socioemotional selectivity theory, objectification theory, and activity theory. We adopted a model involving demographic, biological, psychological, and social factors to unearth the mechanism influencing divorced and widowed older Chinese women's sexual health and intimacy needs. Data were collected between October 2020 and March 2021 via face-to-face surveys. A convenience sample of 278 (N = 278) divorced and widowed older Chinese women was recruited (166 in Shanghai and 112 in Wuhan). Sexual health and intimacy needs were associated with current relationship status, financial status, physical health, attachment style, neuroticism, mental health, social support, prior marital conflict, and gender norm attitude. Sexual behaviour was associated with age, number of children, financial status, physical health, attachment style, neuroticism, prior marital conflict, gender norm attitude, sexual knowledge, sexual attitude, and intimacy attitude as predictors. Most participants in this study seemed to have found new intimate partners with whom to continue participating in sexual activities after their divorce or widowhood. The present study is one of the first examples of empirical research to examine the sexual health and intimacy needs of older Chinese women who are divorced or widowed. The findings generated by this study will inform the design and implementation of appropriate social programs for this demographic, and provide invaluable insight for social workers, educators, sex therapists, healthcare professionals, community workers, and policymakers working with this population.

Associations of spousal and non-spousal caregiving with six-year trajectories of depressive symptoms among older women in the Caregiver-Study of Osteoporotic Fractures study

Objectives:Caregiving and becoming widowed are risk factors for depression in older adults, but few studies have examined their combined effect on depressive symptom trajectories. In a cohort of older women (mean age = 80.7 years) from the Caregiver-Study of Osteoporotic Fractures, we used latent class growth curve modeling to identify trajectories of depressive symptoms over approximately six years.Method:We used multinomial logistic regression to assess the relative odds of four depressive symptom trajectories (consistently low, consistently moderate, moderate/increasing, and consistently high), among three groups: spousal caregivers (n = 149), non-spousal caregivers (n = 157), and non-caregivers (n = 422). We also repeated this analysis with combined caregiving status and widowhood as the exposure.Results:Compared to non-caregivers, spousal caregivers had greater relative odds of consistently high versus consistently low depressive symptoms (adjusted odds ratio [aOR] = 3.6, 95% confidence interval [CI]: 1.9, 6.5). Non-spousal caregivers did not differ from non-caregivers in depressive trajectories. Compared to non-caregivers who did not become widowed, both widowed and non-widowed spousal caregivers had greater relative odds of consistently high versus consistently low depressive symptoms (aOR = 4.9, 95% CI: 1.9, 12.7 and aOR = 3.0, 95% CI: 1.5, 6.0, respectively). Non-widowed spousal caregivers, but not widowed spousal caregivers, had a non-statistically-significant trend toward increased relative odds of moderate/increasing depressive symptoms (aOR = 1.5, 95% CI: 0.7, 3.4).Conclusion:Spousal caregiving and widowhood, but not non-spousal caregiving, are associated with trajectories reflecting greater depressive symptoms over time. Informal caregiving is common among older women, and women caring for spouses should be monitored for depression, both during caregiving and after spousal loss.Supplemental data for this article can be accessed online at https://doi.org/10.1080/13607863.2021.1950611.

Dramatic effects but fast adaptation: Changes in life satisfaction and different facets of affective well-being around the death of a partner and death of a child

Although everyone would agree that bereavement is extremely stressful, surprisingly little is known about changes in different facets of affective well-being in the years surrounding the death of a loved one. On the basis of the Socio-Economic Panel Study, we examined changes in cognitive well-being (life satisfaction) and different facets of affective well-being (happiness, sadness, anxiety, and anger) in the years around the death of a partner (N = 989) and child (N = 276). Data on the death of a partner and child as well as cognitive and affective well-being were assessed yearly since 2007. Multilevel analyses revealed that both events were associated with very large well-being impairments (>1 SD) that were most pronounced for sadness, happiness, and life satisfaction in the first year of bereavement. Afterwards, bereaved individuals managed to recover impressively well: Levels of life satisfaction, happiness, and sadness were on average similar 5 years after losing a partner or child compared with 5 years before the respective loss. Our findings suggest (a) that many individuals tend to be capable to even cope with highly stressful loss experiences and (b) that Set-Point Theory not only applies to life satisfaction but also different facets of affective well-being around the death of a loved one.

Why Not Lonely? A Longitudinal Study of Factors Related to Loneliness and Non-Loneliness in Different Age Groups Among People in the Second Part of Life

Age-related changes and losses may lead to loneliness. However, some people do not become lonelier, even after negative life events. This study examines the development of loneliness based on Norwegian panel data (N = 2,315), age 40-80 years at baseline, and the impacts of partnership and health measured in 2002, 2007, and 2017. We ask: How does loneliness develop over time, and who resists becoming lonely? In the total group, loneliness decreased from 2002 to 2007 and then leveled off. In the eldest age group, 70-80 years at baseline, loneliness increased but only in the last period, from 2007 to 2017. In all age groups and at all three times, those who were not lonely more often had a partner and were more often in good health compared to those who were lonely. Period effects, cohort, and age-related changes influencing the development in loneliness over time are discussed.

Incidence of potentially disruptive medical and social events in older adults with and without dementia

BACKGROUND

Potentially disruptive medical, surgical, and social events-such as pneumonia, hip fracture, and widowhood-may accelerate the trajectory of decline and impact caregiving needs in older adults, especially among people with dementia (PWD). Prior research has focused primarily on nursing home residents with dementia. We sought to assess the incidence of potentially disruptive events in community-dwelling people with and without dementia.

METHODS

Retrospective cohort study of participants aged 65+ enrolled in the Health and Retirement Study between 2010 and 2018 (n = 9346), including a subset who were married-partnered at baseline (n = 5105). Dementia was defined with a previously validated algorithm. We calculated age-adjusted and gender-stratified incidence per 1000 person-years and incidence rate ratios of: 1) hospitalization for pneumonia, 2) hip fracture, and 3) widowhood in people with and without dementia.

RESULTS

PWD (n = 596) were older (mean age 84 vs. 75) and a higher proportion were female (67% vs. 57%) than people without dementia (PWoD) (n = 8750). Age-adjusted incidence rates (per 1000 person-years) of pneumonia were higher in PWD (113.1; 95% CI 94.3, 131.9) compared to PWoD (62.1; 95% CI 54.7, 69.5), as were hip fractures (12.3; 95% CI 9.1, 15.6 for PWD compared to 8.1; 95% CI 6.9, 9.2 in PWoD). Point estimates of widowhood incidence were slightly higher for PWD (25.3; 95% CI 20.1, 30.5) compared to PWoD (21.9; 95% CI 20.3, 23.5), but differences were not statistically significant. The association of dementia with hip fracture-but not pneumonia or widowhood-was modified by gender (male incidence rate ratio [IRR] 2.24, 95% CI 1.34, 3.75 versus female IRR 1.31 95% CI 0.92,1.86); interaction term p = 0.02).

CONCLUSIONS

Compared to PWoD, community-dwelling PWD had higher rates of pneumonia and hip fracture, but not widowhood. Knowing how often PWD experience these events can aid in anticipatory guidance and care planning for this growing population.

"Is There Room for Both Loves?": The Experience of Couplehood Among Women Living With a Widower With Young Children

Very few studies to date have explored the couplehood relationship in blended families with young children created after widowhood. This study sought to add to our knowledge of this issue by examining the couplehood experience of women who started a family with a widower with young children, with no children of their own. Semi-structured interviews were conducted with 30 Israeli women aged 32-78 years. The findings indicate that many participants feel that the deceased wife continues to be present in their partner's life and that she is an integral part of their couplehood relationship. The participants described two subsystems existing alongside the couple subsystem with their partner, namely, the partner's spousal subsystem with his first wife; and a triadic subsystem consisting of the woman, her partner, and his deceased wife. The perceived presence of the first wife raised poignant questions concerning the place of the two women in the partner's life. Participants' narratives revealed the dissonance between understanding and acknowledging their partner's continuing bond with and affection for his deceased wife on the one hand, and recognition of his love for them on the other hand. The findings shed light on the complexity inherent in a couple relationship with a widower and may assist professionals who provide support to blended families in understanding the unique challenges faced by these women. This would enable them to tailor their counseling and the therapeutic process to the particular needs of these women.

The Role of Purpose in Life in the Relationship Between Widowhood and Cognitive Decline Among Older Adults in the U.S

OBJECTIVES

The objective of this study was to examine the role of purpose in life in the relationship between widowhood and cognitive decline.

METHODS

This study used a sample of 12,856 respondents (20,408 observations) collected from a national panel survey, the 2006-2014 waves of the Health and Retirement Study (HRS), that sampled older adults aged 50 or older. The study estimated growth-curve models with years since spousal death, purpose in life, and interaction between the two to predict cognition using three measures-total cognition, fluid, and crystallized intelligence scores. We also estimated growth-curve models by sex, race/ethnicity, and education.

RESULTS

While years since spousal death negatively correlated with cognition, purpose in life positively correlated with cognition. Furthermore, purpose in life had a moderating effect on the relationship between years since spousal death and cognition. This effect was found by using total cognition (coef. = 0.0515; z = 2.64; p < 0.01) and fluid intelligence scores (coef. = 0.0576; z = 3.23; p < 0.05). The same effects were salient among females (coef. = 0.0556; z = 2.19; p < 0.05), Whites (coef. = 0.0526; z = 2.52; p < 0.05), and older adults with more education (coef. = 0.0635; z = 2.10; p < 0.05).

CONCLUSION

Higher purpose in life relates to the negative correlations between widowhood and cognition of older adults. Educational programs improving purpose in life are a possible avenue for reducing the adverse effect of widowhood on cognition and warrant future exploration.

A Scoping Review of Interventions for Spousal Bereavement in Older Adults

The loss of a spouse is a common and natural life event for older adults. Nearly one of four older bereaved spouses experience prolonged grief, impaired function or chronic depression. Mechanisms underlying these and other long-term health risks are not well understood. We conducted a scoping literature review to examine the interventions and outcomes that have been studied for late-life spousal bereavement to date. We identified 22 studies of group and individual-level interventions with most studies concerning grief processes within the first year. Nearly all studies evaluated emotional and psychological symptoms of loss and a small number evaluated the restoration of adaptive functioning. Four interventions addressed the treatment of complicated grief or grief with major depressive disorder. Qualitative studies explored themes of spirituality and mindfulness. There were 17 controlled studies, including 13 randomized controlled trials. Findings were eclectic, with evidence supporting mindfulness techniques in a group format for emotional and life satisfaction outcomes; an individual, function-based therapy addressing sleep to improve emotion and function; an individual, writing-based emotional expression therapy for short-term improvement in emotion and function; nortriptyline for the treatment of bereavement-related major depressive disorder; a group-based, complicated grief therapy for this condition; an internet-based CBT intervention for prolonged grief; and pharmacotherapy for cardiovascular changes during bereavement. These findings highlight the small literature of methodologically strong intervention studies addressing spousal bereavement in older adults and the need for greater exploration of relevant biological, social, cognitive and behavioral factors to improve short and long term health outcomes.

How widowhood status relates to engagement in advance care planning among older adults: does race/ethnicity matter?

OBJECTIVES

This study investigated whether and to what extent widowhood status is related to engagement in advance care planning (ACP), and further whether race/ethnicity moderated the relation.

METHODS

We analyzed a total of 11,257 older Americans from the Health and Retirement Study using random-effect regression models after controlling for covariates and year-fixed effects.

RESULTS

We found that both being a widow/widower ever and having been widowed for a longer period of time were associated with a higher probability of engagement in ACP. Specifically, we found that a one-year increase in the number of years since spousal death was associated with 1.02 (p < 0.05, 95% CI = 1.00, 1.03) changes in the odds ratios of informal ACP; however, inclusion of a quadratic term indicated that this association reversed after the peak. Moreover, our findings suggested a moderating effect of race/ethnicity on the relations of the length of time since spousal loss with engagement in ACP. Specifically, the odds of widowed non-Hispanic Blacks discussing with someone the care or medical treatment (informal ACP) and having a living will (formal ACP) were 0.96 (p < 0.05, 95% CI = 0.93, 1.00) and 0.88 (p < 0.05, 95% CI = 0.79, 0.97) times that of non-widowed non-Hispanic Whites. Compared with their non-Hispanic White counterparts, widowed non-Hispanic Blacks were less likely to engage in ACP, and the negative relations were exacerbated when they became widows/widowers.

CONCLUSION

We elaborated on these findings and discussed their implications for understanding the moderating effect of race/ethnicity on the relation between late-life widowhood and engagement in ACP. In order to develop programs that enhance engagement in ACP and reduce racial/ethnic disparities, research must incorporate intersectionality theory with attention to motivations and decision-making style among diverse widows/widowers. The findings from this study could help inform policy makers when developing public health programs and health care reimbursement programs that enhance engagement in ACP among widows/widowers.

A Body Now, Perhaps Once Someone

Description Personally driven by compassion in hospital medicine, I can't help but pen down certain emotions we experience as caregivers. It feels too selfish to not share some of those emotions, as profound as they are, though we seldom are aware that such feelings exist, even as they become palpable during adverse outcomes. Most of the time, thankfully the sick patients we encounter, recover and are discharged home. There are smiles of relief and gratitude to our profession as healers. But at times, with certain incurable conditions, we only can treat and try our best as doctors. There are tears, broken hearts, feelings of dread towards an approaching, certain end that we bitterly fight against, but lose. Commiserating with a patient in pain and with their loved ones is natural as a physician. And in this work, I share one of those unfortunate moments.

Psychological and Physical Health in Widowhood: Does Marital Quality Make a Difference?

We investigate how preloss marital quality is associated with changes in psychological distress and physical health among older widow(er)s. Using prospective data with a 2-year follow-up from the Health and Retirement Study, we selected 546 respondents who transitioned into widowhood. Respondents were classified as supportive, ambivalent, aversive, or neutral groups. The supportive and ambivalent group experienced greater increase in depressive symptoms compared to the aversive group, in widowhood. The aversive group showed greater increase in chronic conditions compared to the supportive group. Findings indicated that spousal loss may result in more psychological distress for those with supportive and ambivalent marital relationship. Yet, those with mostly negative accounts of their marriage may experience worsened physical health, albeit no increase in psychological distress. Understanding different benefits and challenges facing older individuals after a positive or negative marriage may help direct support and interventions efforts toward older couples during marriage and in widowhood.

Marital Transitions, Change in Depressive Symptomology, and Quality of Social Relationships in Midlife and Older U.S. Adults: An Analysis of the Health and Retirement Study

Preventing negative health outcomes following marital transitions can promote personal recovery and well-being. We used the Health and Retirement Study (HRS) (2012, 2014) to test whether social relationship quality moderated the association between marital transition and change in depressive symptomology among U.S. adults aged 50 and older (n = 3,705). Marital status transitions between 2012 and 2014 included remained married/partnered, divorced/separated, and widowed. Depressive symptomology was measured using the Center for Epidemiological Studies Depression Scale 8 Short Form (CES-D 8). Social support, social contact, and social strain were indicators of social relationship quality. Change in depressive symptomology was modeled using autoregressive multiple regression. Social relationship quality appeared to influence depressive symptomatology for those experiencing divorce/separation. Compared to individuals who remained married/partnered, depressive symptomatology in those experiencing separation/divorce decreased among those reporting low social support, increased among those reporting high social support, and increased among those who reported low social strain. Limitations and clinical implications are discussed.

Widowhood and Health Status Among Chinese Older Adults: The Mediation Effects of Different Types of Support

Although many studies have suggested that widowhood is related to worse health conditions among older adults, few have examined the mediation effects of social support between widowhood and health. Employing mediation analysis to a sample of data from the 2014 wave of China Longitudinal Aging Social Survey (CLASS), this study examined the mediation effects of social support, including emotional support, instrumental support, and companionship, in the widowhood-health association among older adults. The results indicated that the negative effect of widowhood on older adults' health was in part attributable to decreased emotional support and companionship. Specifically, emotional support exerted a significant role in the widowhood-mental health association, and companionship exerted a significant role in widowhood-physical health and widowhood-mental health associations. In the subsample analysis, the mediation effects were only significant among female older adults, and among rural older adults. Our findings highlight the importance of emotional support and companionship in maintaining health among widowed older adults and strategies should pay more attention to female and rural widowed older adults.

Parenting through grief: A cross-sectional study of recently bereaved adults with minor children

BACKGROUND

Grieving adults raising parentally-bereaved minor children experience persistently elevated symptoms of depression and grief. However, the factors associated with their mental health outcomes are not well understood.

AIM

To investigate the psychosocial and demographic characteristics associated with grief distress and depressive symptom severity in bereaved adults with minor children.

DESIGN

Cross-sectional, web-based survey.

SETTING/PARTICIPANTS

Eight hundred forty-five bereaved adults raising minor (age <18 years) children who had experienced the death of a co-parent. Primary outcomes were grief distress (Prolonged Grief Disorder-13), depressive symptoms (Patient-Reported Outcomes Measurement Information System-Depression), and widowed parenting self-efficacy (WPSES).

RESULTS

Mean grief scores were 33.5; mean depression scores were 58.3. Among the 690 individuals more than 6 months bereaved, 132 (19.3%) met criteria for prolonged grief disorder. In adjusted models, participants reporting higher grief scores were more recently bereaved, identified as mothers, non-Caucasian, had lower education and income, and had not anticipated their co-parent's death. The statistical modeling results for depression scores were similar to grief scores except that depression was not associated with anticipation of co-parent death. Parents reporting lower WPSES scores had higher grief and depression scores. Retrospective assessments of more intense parenting worries at the time of co-parent death were also associated with higher grief and depression scores.

CONCLUSIONS

For bereaved adults with minor children, unanticipated co-parent death was linked with higher grief distress but not symptoms of depression. Addressing parenting concerns may represent a common pathway for improving the mental health of parentally-bereaved families.

Professional Support After Partner Loss: Likelihood and Correlates of Help-Seeking Behavior

Intimate partner loss in later life can be one of the most stressful events in adulthood. Individuals who struggle to adapt to the new life conditions may need support from a mental health professional. However, less is known about the likelihood to seek professional help after separation, divorce, or bereavement in later life and associated factors. This study investigated professional help-seeking (PHS) for partner loss after a long-term marriage in separated, divorced, and bereaved individuals and examined the extent to which specific person and event-related variables, as well as depressive symptoms, increase its likelihood. The data were derived from the LIVES "Intimate Partner Loss Study." The self-administered questionnaires were completed by 388 adults. PHS was higher after separation (57%) and divorce (49%), compared to widowhood (18%). Higher likelihood of PHS was associated with separation and divorce, female gender, having someone to count on, loss unexpectedness, needing more time to overcome the loss, and more depressive symptoms. Informing individuals unlikely to seek help (e.g., males, bereaved, and individuals with no confidant) about PHS benefits may facilitate adaptation to partner loss.

Social Support Experiences of Spousally Bereaved Individuals in a South African Township Community: The Botho/Ubuntu Perspective

Bereavement is a deeply personal experience that is also shaped by one’s socio-cultural context. This qualitative study explored the social support experiences and needs of spousally bereaved individuals in a South African township. The botho/ubuntu philosophical framework was used to interpret participants’ experiences in this regard. Six ethnically diverse, bereaved spouses aged 55–67years, residing in a predominantly Setswana-speaking township in the North West Province of South Africa, were interviewed. Thematic analysis was used to analyze the data. An indigenous knowledge consultant was interviewed to situate participant experiences pertaining to mourning rites and traditions within the indigenous socio-historical and contemporary cultural context. The following themes were identified: (i) Sources of social support during bereavement; (ii) Inadequate social support after spousal death; (iii) The need for grief counseling; and (iv) Social restrictions and systematic isolation during the traditional mourning period: “It is as if you smell.” Broadly, bereaved spouses drew on their support networks at various stages of their bereavement, which included family members, in-laws, friends, burial societies, their surrounding communities, and religious communities and figures. However, some experienced ostracization and stigmatization during the mourning period, which was invariably longer for the widows in this study, in line with conventions across Black South African cultures. Some participants reported withdrawal of support by their in-laws and harmful attitudes and assumptions rooted in patriarchal ideology by family members and in-laws. As pertaining to botho/ubuntu, the study also showed that communality or relationality entailed both positive and negative aspects, including support, co-operation, care, lack of support, stigmatization, and ostracization. Unlike conventional conceptualizations of botho/ubuntu, the study findings illustrate the human experience as comprising varying dimensions of relationality, ranging from harmony to disharmony. Findings regarding the negative aspects of communality are compatible with those relating to relational interdependence in African and East Asian settings. The findings also expand our understanding of the nature of disharmony alongside harmony in interdependent socio-cultural contexts.

The Association between Widowhood and Cognitive Function among Chinese Elderly People: Do Gender and Widowhood Duration Make a Difference?

Few studies have examined the effects of widowhood on cognitive function in Chinese elderly individuals. We conducted a longitudinal study to assess the association between widowhood and cognitive function and further explored gender differences in this association and the impact of widowhood duration. The analytical sample consisted of 5872 Chinese elderly people who participated in the Chinese Longitudinal Healthy Longevity Survey (CLHLS) and were followed up from 2005 to 2014. We used the Chinese version of the Mini-Mental State Examination (MMSE) to assess cognitive function. Widowhood duration was calculated from the self-reported year at which the spouse passed away. Multilevel growth models were employed to estimate the association between widowhood and cognitive function while adjusting for many demographic and socioeconomic characteristics. Widowhood status was associated with cognitive decline among Chinese elderly individuals after adjusting for covariates (B = −0.440, 95% CI −0.727 to −0.152), and this association was only statistically significant among men (B = −0.722, 95% CI −1.104 to −0.339). Being widowed for 5 years or less (B = −0.606, 95% CI −1.112 to −0.100), 16–20 years (B = −0.937, 95% CI −1.685 to −0.190), and 21+ years (B = −1.401, 95% CI −1.967 to −0.834) predicted worse cognitive function in men, while being widowed for more than 21+ years (B = −0.655, 95% CI −1.186 to −0.124) was associated with cognitive decline in women. More attention should be directed towards widowed men and long-term widowed elderly individuals.

Regret and Repair: Experiences of Adult Children and Parents When a Father Remarries Soon After the Death of a Spouse

The purpose of this study is to better understand what happens to families when a parent remarries quickly after the death of a long-term partner. Men typically re-partner much more rapidly than women do after the death of a spouse. We used a qualitative, grounded-theory method to interview six parents (all men) and their adult children (12 participants total) about their experiences when fathers lost their spouse and re-partnered quickly. We found a variety of reasons for rapid remarriage, and a number of implications for parent-child relationships, including feelings of losing one parent in body and another in relationship, different expectations between parents and children related to holding on to memories of the deceased and finding ways to let go, remaining parents looking back with unexpressed regret, and finally experiences of repair. Clinical recommendations for therapists are provided.

The Role of Social Isolation and the Development of Depression. A Comparison of the Widowed and Married Oldest Old in Germany

Widowhood is common in old age, can be accompanied by serious health consequences and is often linked to substantial changes in social network. Little is known about the impact of social isolation on the development of depressive symptoms over time taking widowhood into account. We provide results from the follow-up 5 to follow-up 9 from the longitudinal study AgeCoDe and its follow-up study AgeQualiDe. Depression was measured with GDS-15 and social isolation was assessed using the Lubben Social Network Scale (LSNS-6). The group was aligned of married and widowed people in old age and education through entropy balancing. Linear mixed models were used to examine the frequency of occurrence of depressive symptoms for widowed and married elderly people depending on the risk of social isolation. Our study shows that widowhood alone does not lead to an increased occurrence of depressive symptoms. However, "widowed oldest old", who are also at risk of social isolation, have significantly more depressive symptoms than those without risk. In the group of "married oldest old", women have significantly more depressive symptoms than men, but isolated and non-isolated do not differ. Especially for people who have lost a spouse, the social network changes significantly and increases the risk for social isolation. This represents a risk factor for the occurrence of depressive symptoms.

Experiences of becoming widowed in old age - a cross-countries study with qualitative interviews from Denmark and quantitative measures of association in a Swedish sample

Purpose: Becoming widowed is a stressful health-threatening event causing major life changes. We explored how widowed people experience becoming widowed and examined if these experiences are quantitatively associated with widowhood.

Methods: A multi-methods study using an exploratory sequential mixed-methods approach including a qualitative descriptive study with widowed people from Denmark and a Swedish cohort study. Qualitative interviews (n = 9) were analysed using qualitative content analysis, describing experiences as explained by the widowed people. The quantitative association of the experiences was examined by identifying proxies for the qualitative experiences of widowhood in the cohort study and examining the occurrence in widowed people compared to married people (n = 1,095).

Results: Six categories of experiences emerged: the circumstances around spousal death, mental health and well-being, physical health, social relations, activities and practicalities. The quantitative examination showed a significant association with widowhood regarding mental and physical health problems.

Conclusion: The circumstances around spousal death and the time before spousal death, in general, were important to how participants felt being widowed. Being ill negatively affected mental health and well-being, partly because of the inability to participate in activities and social relations. This is important, as health problems are more common among widowed people than married people.

Factors Associated with Death Anxiety Among Rural Chinese Older Adults: The Terror Management Perspective

OBJECTIVES

The aim of this study was to examine how the factors suggested by the Terror Management Theory are associated with death anxiety among rural Chinese older adults.

METHOD

Data were derived from a longitudinal survey of older adults aged 60 and above, had at least one living child, and were living in rural areas of Anhui Province. The working sample included 1,362 older adults. Two-level random effects models were used.

RESULTS

Children's financial support was negatively related to death anxiety, whereas emotional closeness with children was positively related to death anxiety. Older women reported more death anxiety than older men. Functional limitations were positively associated with death anxiety, and the widowed reported less death anxiety than the married. We did not find a significant association between religious belief and death anxiety.

DISCUSSION

The study highlights the importance of culture in shaping death anxiety among older adults in rural China.

Trajectories of resilience among widows: a latent transition model

OBJECTIVES

In 2015 we identified three profiles of adaptation following spousal bereavement: Vulnerables; Copers and Resilients (Spahni, Morselli, Perrig-Chiello, & Bennett, 2015). However, adaptation to spousal bereavement is a dynamic process. Thus, we examine the trajectories of the same participants longitudinally over two years. We identify the stability and change in profiles of adaptation to widowhood; probability of stability and change; factors that influence trajectories in profile membership.

METHODS

Data stem from a longitudinal questionnaire study of 309 older widowed people. The questionnaire included five measures of well-being, serving as the dependent variables of this analysis, and measures of personal resources and contextual factors, including social support, marital happiness, psychological resilience, and demography. Data was analysed using latent transition analysis of the variables loneliness, hopelessness, depressive symptoms, life satisfaction, and subjective health.

RESULTS

The analysis replicated the three Wave 1 profiles as the best theoretical fit: Vulnerables; Copers; and Resilients. Stability was most common, but some participants moved to more or less adaptive profiles, the former being more frequent. Younger age, longer time since widowhood, new life perspectives facilitated adaptation. Those transitioning to less adaptive profiles were more likely to be women and older.

DISCUSSION

The path to adaptation was not linear. Many of the explanatory variables contributed both to positive and negative adaptation. These include previous caring experience, education, psychological resilience and personal strength. This suggests these explanatory variables do not act in isolation but are likely to interact with each other, and with other, yet not measured, factors.

I Am This Widow: Social Support in Friendship After the Loss of a Spouse in Mid-Life

This paper elaborates on relational processes of social support after widowhood in mid-life. It extends knowledge in effective support by examining themes of friendship communication between widows and their friends rather than widows' individual perceptions, and co-construction of support communication. Findings indicate that when social support is constructed between individuals with a focus on the specific relationship, support is highly valued. General support that does not consider the individual or relationship between widow and other is seen as unhelpful. It concludes by suggesting future research on social support take a dyadic approach.

LEAVES (optimizing the mentaL health and resiliencE of older Adults that haVe lost thEir spouSe via blended, online therapy): Proposal for an Online Service Development and Evaluation

Background

Loss of a spouse is a frequent occurrence in later life. While most older adults successfully process this loss and will return to a normal life, about 10% of the individuals are unable to cope, and progress to prolonged grief (PG). PG, in turn, can result in mental and physical problems including poor sleep, cardiovascular problems, depression, and suicidal tendencies.

Objective

LEAVES (optimizing the mentaL health and resiliencE of older Adults that haVe lost thEir spouSe via blended, online therapy) is an online bereavement program that will support the prevention and treatment of PG, so that elderly mourners can continue to lead an active, meaningful, and dignified life. LEAVES will cater to secondary end users (eg, family, informal caregivers) by reducing stress.

Methods

LEAVES will help older adults to process the loss of a spouse in an online environment, which consists of (1) an existing online grief self-help program LIVIA, (2) the Before You Leave program that allows for storing personal memories, (3) a virtual agent platform, and (4) an accessible front-end design. LEAVES can detect persons at risk for complications, reveal negative trends in their emotional life, and act to counter such trends. The service relies on online support whenever possible but is blended with telephone or face-to-face counseling when necessary.

Results

The project will take place between February 2020 and January 2023 and includes a real-life evaluation in which 315 end users will use the service across 3 countries (the Netherlands, Portugal, and Switzerland). The evaluation of LEAVES will focus on clinical effect, its business case, and technology acceptance. The results will pave the way for smooth integration into existing care paths and reimbursement schemes.

Conclusions

The LEAVES service aims to soften the mourning process, prevents depression or social isolation, strengthens widow(er)s resilience and well-being, and quickens one’s return to societal participation.

International Registered Report Identifier (IRRID)

DERR1-10.2196/19344

Personality and widowhood increase the risk for incident depression in the two years following the first acute coronary syndrome

Objectives: Incident depression, occurring after an acute coronary syndrome (ACS) in never depressed patients, exerts a negative effect on the cardiac prognosis. Nonetheless only a few studies have evaluated the risk factor for incident depression and, particularly, no study have investigated the role of personality disorders. Therefore, the aim of this study is to verify if personality disorders represent a risk for incident depression in patients at their first ACS.Method: The study sample was selected among never depressed patients who were consecutively admitted to the Coronary Intensive Care Unit, from January 2009 to March 2012, for the first ACS. The study sample included 262 patients. The presence of depressive disorder was assessed with the Primary Care Evaluation of Mental Disorders (DSM-IV criteria), whereas its severity was evaluated with the Hospital Anxiety and Depression Scale. Evaluations were collected at baseline and at 1, 2, 4, 6, 9, 12 and 24 months of follow-up. Moreover, at baseline personality disorders were investigated with the Structured Clinical Interview for DSM-IV Axis II disorders.Results: Out of 262 subjects, a depressive disorder was diagnosed in 56 patients (21%). At baseline risk factors for incident depression were being widowed, having a distress reaction and narcissistic personality traits.Conclusion: Clinicians should keep in mind these characteristics when facing patients at their first ACS, given the detrimental effect of depression on cardiac prognosis. A psychological support should prevent the onset of incident depression in these patients.

Helpful Approaches for Older Adults Living in a Retirement Community to Move Forward After the Death of a Significant Other

The loss of a significant other often creates emotional distress for family members that can hamper the ability to meet everyday challenges and pursue wellness. The aim of this qualitative study was to understand the challenge of losing a significant other for older adult family members and the approaches identified as most helpful to promote their own well-being after this person dies. Story inquiry method guided the interview process with 15 older adult bereaved family members residing in a continuing care retirement community. Theory-guided content analysis was used for data analysis. Two themes described the challenges: uneasiness that permeates everyday living and precious memories and patterns of disconnect that breed discontent. Appreciating the rhythmic flow of everyday connecting and separating and embracing reality as situated in one's lifelong journey are the themes that encompass the helpful approaches used by participants. This study provided insights about the benefits of living in this community such as social networking and a possible drawback such as the frequency of death among residents. Future research should continue to investigate social service resources that older adults find most helpful after a significant other dies and the use of reminiscence groups as a form of bereavement support.

Healthcare services and medication use among widowed partners of patients deceased due to cancer - results from the Survey of Health, Ageing and Retirement in Europe (SHARE)

OBJECTIVE

This study aimed to quantify the effect of a cancer death on healthcare and medication use among widowed individuals (Widowed-Cancer), by comparing this population with partnered individuals and with widowed individuals whose partners were deceased due to cardiovascular diseases (Widowed-CVD).

METHODS

Data were retrieved from the Sixth Wave of the Survey of Health, Ageing and Retirement in Europe - SHARE, conducted in 2015, in 18 countries. Widowed-Cancer were matched by country, sex, age and educational level with currently partnered individuals (1:2; n = 901 and n = 1802, respectively) and with Widowed-CVD (1:1; n = 606 and n = 606, respectively). Adjusted odds ratios (OR) and 95% confidence intervals (95%CI) were computed using logistic regression.

RESULTS

The use of drugs for sleep problems (OR = 1.42, 95%CI:1.12-1.80) and anxiety or depression (OR = 1.56, 95%CI:1.20-2.03) was more common among Widowed-Cancer than in partnered individuals; a tendency towards higher odds of being hospitalised in the previous year was also observed in Widowed-Cancer (OR = 1.20, 95%CI:0.98-1.47). Among participants whose partners were deceased in 2015, Widowed-Cancer were more likely than Widowed-CVD to report ≥10 contacts with medical doctors or nurses in the previous year (OR = 3.32, 95%CI:1.20-9.24; P for interaction = .042) and a higher use of drugs for sleep problems (OR = 14.43, 95%CI:1.74-119.84; P for interaction = .027).

CONCLUSION

Widowed individuals whose partners were deceased due to cancer had a higher use of healthcare, which highlights the importance of improving the quality of end-of-life care, even during widowhood.

Families in Later Life: A Decade in Review

Later-life families encompass the legal, biological, romantic, and kin-like relationships of persons ages 65 and older. Research on older families has flourished over the past decade, as population aging has intensified concerns regarding the capacities of families to care for older adults and the adequacy of public pension systems to provide an acceptable standard of living. Shifting patterns of family formation over the past half-century have created a context in which contemporary older adults' family lives differ markedly from earlier generations. Decreasing numbers of adults are growing old with their first and only spouse, with rising numbers divorcing, remarrying, forming non-marital romantic partnerships, or living single by choice. Remarriage and the formation of stepfamilies pose challenges and opportunities as older adults negotiate complex decisions such as inheritance and caregiving. Family relationships are consequential for older adults' well-being, operating through both biological and psychosocial mechanisms. We synthesize research from the past decade, revealing how innovations in data and methods have refined our understanding of late-life families against a backdrop of demographic change. We show how contemporary research refines classic theoretical frameworks and tests emerging conceptual models. We organize the article around two main types of family relationships: (1) marriage and romantic partnerships and (2) intergenerational relationships. We discuss how family caregiving occurs within these relationships, and offer three promising avenues for future research: ethnic minority and immigrant families; older adults without close kin ("elder orphans"); and the potentials of rapidly evolving technologies for intergenerational relationships and caregiving.

Mental health of older widows and widowers: Which coping strategies are most protective?

I examine: whether specific emotion-focused coping and help-seeking strategies adopted by older widow(er)s 6 months postloss affect depressive, anger, and yearning symptoms 1 year later; whether these effects are accounted for by psychosocial factors which guide the selection of coping strategies; and the extent to which patterns differ by gender. I estimate nested multivariate OLS regression models using data from the Changing Lives of Older Couples, a prospective multiwave survey of spousal bereavement (N = 164). Widows are more likely to use positive reframing, active distraction, help-seeking, and turning to God for strength, whereas widowers tend to use avoidant strategies, and are more likely to seek connection with their late spouse. Avoidant strategies like trying to forget and dulling the pain with alcohol increase depressive and anger symptoms; substance use is particularly consequential for men's anger symptoms. Positive reframing increases depressive symptoms yet mitigates against anger. Seeking comfort from God also protects against anger. Seeking help from a doctor increases anger and depressive symptoms in baseline models, although effects are accounted for by selection. Maladaptive coping strategies are linked with anger, whereas depression and yearning are relatively immune to coping strategies, reflecting the relatively short-lived time course of these two symptoms. The results carry implications for bereavement theories and mental health interventions targeting older widow(er)s. Older widowers who cope by turning to unhealthy behaviors are especially prone to anger, which has documented physical health effects and may alienate potential sources of social support.