Exploring the meaning of a good life for older widows with extensive need of care: a qualitative in-home interview study

INTRODUCTION

Studies of older women's life transitions is rare but gains relevance as the aging population, with older women as the majority, expands.

PURPOSE

To explore the meaning of a good life for older widows with extensive home care needs.

MATERIALS AND METHODS

Semi-structured interviews were carried out with eleven women, aged 80 and over (82-95 years, mean 90) residing at home with extensive care needs (≥4 daily sessions, averaging 2.5-6 hours, mean 3). Data were analysed by reflexive thematic analysis.

RESULTS

The theme "This Day in My Home, the frame of my life" reflects the women's experience of a good life. A good day imbued them with hope, trust and security, carrying them forward with the assurance that night would usher in a new day. However, there were moments when life was merely about navigating daily challenges. During such days, the women felt trapped in time, unsafe and lonely.

CONCLUSION

A day at home may seem static, yet it mirrors life's dynamism, evolving with shifting circumstances. Older widows navigate challenges while maintaining their sense of self, independence, and connection to home. These findings have implications for aged care, recognizing the multifaceted aspects of life and the centrality of home.

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.

How does social support affect subjective well-being among Chinese widowed older adults?

Background

Social support (SS) is an important factor influencing subjective well-being (SWB) in older adults. This is especially true for the special group of widowed older adults (WOA). Widowhood means that older adults have lost their most important SS, and therefore, the search for a guardian from outside the spouse becomes a central issue in ensuring the SWB of WOA.

Methods

The data for this paper were obtained from CGSS 2021, a large national social survey in China. We operationalized SWB as an individual's overall perception of his or her experience of happiness using 'affective well-being' (i.e., emphasizing an individual's positive affective experiences), and scores were calculated using a Likert scale. This study used linear regression modeling to examine the impact of SS on the SWB of WOA (aged 60 and above).

Results

It was found that, first, this study presents the role of different circles of SS on the SWB of WOA, fully highlighting the importance of social context. Specifically, daughters, neighbors, and relatives constitute the guardians of the SWB for WOA in rural, whereas daughters and friends constitute the guardians of the SWB for WOA in rural. Second, the protective resources provided by the guardians not only serve as a buffer for WOA in distress but also reduce the likelihood of negative events occurring, thereby increasing WOA's SWB.

Discussion

This paper partially corroborates the findings of established studies on the topic of SS and SWB among older adults and the above findings not only help us to further explain the relationship between SS and SWB theoretically but also help us to rationalize the construction of SS for WOA practically.

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.

Widowhood and mortality risk in Taiwan: a population-based matched cohort study

BACKGROUND

Studying the causes of death among deceased spouses and surviving partners may provide insights into the underlying mechanisms of the association between widowhood and mortality. This study investigated the mortality risk of widowhood in Taiwan, examined the association of the cause of death between widowed individuals and their deceased spouses and explored potential modifying effects by age, gender and duration after widowhood.

METHODS

This matched cohort study utilized Taiwan's National Health Insurance claims database and National Death Registry. In total, 204 010 widowed men and 596 136 widowed women were identified with a mean follow-up period of 6.9 and 7.9 years, respectively, and 816 040 comparison men and 2 384 544 comparison women were selected.

RESULTS

Widowhood was associated with an increased mortality risk, with widowed men having a 1.32 increased risk and widowed women having a 1.27 increased risk. Age at spousal death and duration modified the associations after widowhood. The widowed individuals are more likely to die by the same cause as the deceased spouse if they died by suicide, accident, endocrine, gastrointestinal disorders or infection.

CONCLUSIONS

The study suggests that healthcare policies and interventions should be developed to improve widowed individuals' health and overall welfare.

Exploring an Extended Conception of Grief: Sense of Presence and Grief Reactions in German Widows

This study explores sense of presence (SOP) as an important feature of continuing bonds (CB) in the context of normal grief. A community sample of widows (N = 51) filled in a multidimensional grief questionnaire and a depression scale. A moderate positive association between sensing the deceased husband´s presence and cognitive and emotional impairments emerged. A positive relationship between SOP and guilt was found only if the influence of religiosity was controlled for statistically. There were no significant associations of SOP with long-lasting positive reactions to loss, such as personal growth and increase in sensitivity for others. Widows with clinically relevant depression indicated a stronger SOP than those with lower depression scores. These differentiated findings may stimulate the elaboration of an extended conception of grief beyond the focus on clinically relevant impairments.

Widowhood and bereavement in late life

Bereavement is a common and often challenging experience in late life. Evidence shows that while many older adults manage to adjust well and demonstrate resilience in response to the death of a close person, bereavement puts a substantial minority at risk of adverse mental and physical health impacts including mortality. Current research further indicates that 1) this is the case across different countries and cultures across the globe; 2) that the COVID-19 pandemic posed unprecedented challenges for coping with late-life bereavement; 3) that loneliness and social isolation among bereaved older adults tend to be prevalent and harmful, particularly under pandemic but also in nonpandemic circumstances; and, recently, 4) that bereavement may be a risk factor for cognitive decline in this population.

Economics of widowhood mortality in adult women in India

The economic consequence of widowhood on health is well-established, demonstrating that economic factors can significantly link with health outcomes, even the risk of mortality for widows. However, empirical evidence is restricted only to developed countries. Thus, this study assesses the role of economic factors (paid work, pension and household economic status) on the mortality of widows in broad age groups in India. We used two waves of the India Human Development Survey (IHDS), a nationally representative prospective dataset in India for 42,009 women (married and widows) aged 25 years and above at IHDS wave 1 whose survival status was observed between two waves. Further, 6,953 widows were considered for sub-sample analysis in this study. Logistic regression and propensity score matching (PSM) were applied to understand the association and causality between economic factors and mortality for widows. Poor household economic status, paid regular work, and receiving a widowed pension were significantly associated with lower mortality risk for young widows. In comparison, unpaid and paid regular work was linked with lower mortality risk for old widows. The result of causal analysis suggests that receiving a widows' pension had a slight impact on mortality reduction for young widows while engaging in paid regular work significantly reduced the mortality of old widows. This research confirms that the link between economic factors and mortality among widows is age dependent in the Indian context.

Loneliness Predicts Progression of Frailty in Married and Widowed, but Not Unmarried Community Dwelling Older Adults

BACKGROUND

Loneliness is highly prevalent among older adults and is associated with frailty. Most studies consider loneliness in isolation without consideration for structural and functional measures of social relationships - and longitudinal studies are scarce.

OBJECTIVES

This study examined longitudinal associations between loneliness and frailty and analyzed how structural and functional social measures influence these associations.

DESIGN

Linear mixed effects models examined longitudinal associations between loneliness and frailty assessed with the frailty index (scale 0-100). Models were adjusted for baseline age, gender, education, depressive symptoms, global cognition, and structural (e.g., social network, marital status), and functional social measures (e.g., social, cognitive, and physical activity, and social support).

PARTICIPANTS

Loneliness and frailty data from 1,931 older adults without dementia at baseline from the Rush Memory and Aging Project were examined (mean age 79.6 ± 7.7 years, 74.9% female).

MEASUREMENTS

Baseline loneliness assessed by the de Jong Gierveld Loneliness Scale was the predictor of interest.

RESULTS

Frailty increased significantly over a mean follow-up period of 4.6 years. Effects of loneliness on frailty were modified by marital status. Loneliness predicted an additional accumulation of 0.37 and 0.34 deficits on the frailty index per year in married and widowed individuals respectively, compared to those who were not lonely (married: p=0.009, CI 0.09, 0.64; widowed: p=0.005, CI 0.1, 0.58). Loneliness did not predict frailty progression in unmarried individuals.

CONCLUSIONS

Loneliness predicts frailty progression, highlighting the importance of social determinants on physical health in aging.

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.

From i-coping to we-coping: A retrospective qualitative study on parent-child dyadic coping in widowed families

In a widowed family, the surviving parent and children face the loss together. However, most previous research in bereavement has focused on individual experiences. Although the family perspective has been introduced into the field, neither theories nor empirical research has explored mutual interaction. Dyadic coping reflects the family perspective and has been proven to be an influential factor in couples facing life adversities. Nevertheless, it has not been explored in the context of bereavement-specific stressors, including loss- and restoration-related stressors, nor in the parent-child relationship. This research is the first exploration of parent-child dyadic coping in widowed families in the bereavement context and aims to form a comprehensive conceptualization of parent-child dyadic coping following bereavement. Qualitative semistructured interviews were conducted with 20 parents and children from widowed families in mainland China (11 surviving children and nine widowed parents, representing 19 families). Constructivist grounded theory was used to guide the analysis. The main themes identified were dyadic coping-related cognitions, loss-oriented dyadic coping, restoration-oriented dyadic coping, and contextual factors. Three foci (thou, we, and I) were identified for both loss- and restoration-oriented dyadic coping. A conceptualization model of bereavement dyadic coping within widowed families was developed. This study extends the single I-coping perspective in bereavement coping to a we-coping perspective, provides an interactional- and operational-level knowledge on dual-process coping, acknowledges the bilateral interaction in parent-child relationships, and offers implications for bereavement support practice for widowed families. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Understanding Nepali widows' experiences for the adaptation of an instrument to assess Prolonged Grief Disorder

The experience of grief varies across different cultures and contexts. Women in Nepal who lose their husbands confront discrimination, social isolation, and abuse that influence their experience of grief. Through eight focus group discussions with Nepali widows, we elicited socially sanctioned grief reactions and local idioms used to describe common cognitive, behavioral, and emotional symptoms of grief. Accordingly, modifications to an existing instrument for Prolonged Grief Disorder, the PG-13, are suggested to capture grief symptoms as experienced by Nepali widows. Items in the PG-13 were translated to colloquial Nepali and adapted to maintain comprehensibility, acceptability, relevance, and completeness. Based on the grief-related issues reported in the focus group discussions, the addition of five new items and a new criterion to capture symptoms related to social discrimination are proposed. Widows perceived elevated symptoms one year after the loss to be problematic. It is thus recommended that the duration criterion in the original PG-13 be adjusted from at least six months to at least one year after the loss. These proposed modifications to the instrument should be validated through future psychometric testing.

Widowed Young: The Role of Stressors and Protective Factors for Resilience in Coping with Spousal Loss

While distressing, late life spousal loss is considered a normative life event and most demonstrate resilient recovery from grief. However, for 5-7% of the population spousal loss comes early, before the age of 50, and little is known about the factors that influence adjustment in this population. We used the DPM integrative framework to examine correlates and predictors of mental wellbeing and grief intensity in an international sample of 603 young widows and widowers. Contrary to existing bereavement research, loss-orientated stressors (e.g., expectedness and cause of death) did not predict bereavement outcomes. Employment and financial wellbeing were the only statistically significant restoration-orientated stressors associated with coping, mental wellbeing and grief intensity. We found no significant associations between parental status and coping or bereavement outcomes. Loss-orientated coping, followed by inter and intrapersonal protective factors for resilience and financial wellbeing were the greatest predictors of grief intensity. Loss-orientated coping was highest in early bereavement, the greatest predictor of grief intensity and associated with being unemployed, financial insecurity and decreased protective factors for resilience. Restoration-orientated coping was highest in later bereavement, was a weak predictor of grief intensity and associated with being employed, increased financial wellbeing and protective factors for resilience. Overall, we found the young-widowed population is at heightened risk of poor adjustment. Almost two-thirds reported decreased functioning, probable depression with high rates of psychological distress. Nearly half met diagnostic criteria for prolonged grief disorder. We discuss implications for research and clinical practice.

Understanding evidence and provision of services around social isolation and loneliness of military widow/ers: A scoping review

BACKGROUND

Whilst the uniqueness of loneliness and social isolation is now recognised for members of the Armed Forces Community, there is currently a lack of evidence examining these experiences within the Military Widow/er population. Therefore, this scoping review aimed to search and synthesise the current evidence base exploring experiences of loneliness and social isolation in this community.

METHOD

Six databases were searched; ASSIA; CINAHL; ProQuest Dissertation & Theses Global; PsycArticles; Medline; Web of Science. Any article type was included if they focused on UK or international Military Widows and loneliness and social isolation. In the absence of loneliness and social isolation, related aspects were included, for example, social support.

RESULTS

A thematic synthesis was completed on the nine eligible papers, where key findings were coded and generated into four themes; Experiences of Loneliness and Social Isolation, The Uniqueness of the Military, Access to Social Support, and The Importance of Peer Support.

CONCLUSIONS

Evidence supports the need for military-specific support services with peers who recognise the individuals' unique experiences of loneliness and social isolation. None of the available evidence focused specifically on social isolation, however this was often prevalent in the results. All of the studies were carried out in the USA and Israel, with none including the views of widowers. Further evidence is required, particularly relating to a UK-context.

Examining sociocultural factors in widowhood and cognitive function among older Chinese immigrants: findings from the PINE study

Objectives: Although there is growing evidence on widowhood and cognitive function, existing studies have shown mixed results. Little is known about protective factors that may contribute to resilience, thereby ameliorate the adverse effect of widowhood on cognition among older Asian immigrants. This study explored potential moderators (i.e. social support, acculturation, leisure activities) in the association between widowhood and cognitive function among older Chinese immigrants.Method: The study sample included 2,515 adults aged 60 or older who completed two waves (2011-2013 and 2013-2015) of the Population Study of Chinese Elderly in Chicago. Cognitive function was indexed by global cognitive function and episodic memory. Linear regression analyses were conducted with interaction terms.Results: Our results show that social support moderated the relationship between widowhood and global cognitive function, and acculturation moderated the relationship between widowhood and episodic memory. The adverse effect of widowhood on cognitive function was more pronounced at lower levels of social support and acculturation.Conclusion: Our findings indicate buffering roles of social support and acculturation in cognitive health among older Chinese immigrants who experience widowhood. Providing supportive programs and interventions to increase social support and acculturation is suggested to promote cognitive function in this population.

Bonding against the odds: Male prairie vole response to the "widow effect" among females

Although pair bonding is the preferred mating tactic among socially monogamous prairie voles, naturalistic observations have demonstrated many males remain non-bonded. Moreover, although males readily re-bond after the loss of a partner, females do not (i.e., the "widow effect'). Few studies have attempted to address why so many males remain non-bonded or if a reluctance of re-bonding in females contributes to this outcome. We investigate how female bonding history impacts male pair bond formation. Specifically, we test two alternative hypotheses for how sexually naïve males will behave when paired with widow females. The fecundity hypothesis predicts males will avoid bonding with widow females and be more receptive to novel bond-naïve females. The preference to bond hypothesis predicts males will choose to bond and express a partner preference, irrespective of if a pair-mate is a widow or sexually naïve. Our results demonstrated that males expressed a partner preference for females regardless of their social history. These data support the preference to bond hypothesis and suggest natural variation in bonding may not be strongly due to males forgoing bonding opportunities.

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.

Widow spiders alter web architecture and attractiveness in response to same-sex competition for prey and mates, and predation risk

Female-female competition in animals has rarely been studied. Responses of females that compete context-dependently for mates and prey, and seek safety from predators, are ideally studied with web-building spiders. Cobwebs possess unique sections for prey capture and safety, which can be quantified. We worked with Steaoda grossa females because their pheromone is known, and adjustments in response to mate competition could be measured. Females exposed to synthetic sex pheromone adjusted their webs, indicating a perception of intra-sexual competition via their sex pheromone. When females sequentially built their webs in settings of low and high intra-sexual competition, they adjusted their webs to increase prey capture and lower predation risk. In settings with strong mate competition, females deposited more contact pheromone components on their webs and accelerated their breakdown to mate-attractant pheromone components, essentially increasing their webs' attractiveness. We show that females respond to sexual, social and natural selection pressures originating from intra-sexual competition.

Estimating healthcare expenditures after becoming divorced or widowed using propensity score matching

Becoming divorced or widowed are stressful life events experienced by a substantial part of the population. While marital status is a significant predictor in many studies on healthcare expenditures, effects of a change in marital status, specifically becoming divorced or widowed, are less investigated. This study combines individual health claims data and registered sociodemographic characteristics from all Dutch inhabitants (about 17 million) to estimate the differences in healthcare expenditure for individuals whose marital status changed (n = 469,901) compared to individuals who remained married, using propensity score matching and generalized linear models. We found that individuals who were (long-term) divorced or widowed had 12-27% higher healthcare expenditures (RR = 1.12, 95% CI 1.11-1.14; RR = 1.27, 95% CI 1.26-1.29) than individuals who remained married. Foremost, this could be attributed to higher spending on mental healthcare and home care. Higher healthcare expenditures are observed for both divorced and widowed individuals, both recently and long-term divorced/widowed individuals, and across all age groups, income levels and educational levels.

Effects of multimorbidity patterns and socioeconomic status on catastrophic health expenditure of widowed older adults in China

Background

The high multimorbidity and lower socioeconomic status (SES) of older adults, can lead to catastrophic health expenditures (CHEs) for older adults' households. However, whether widowed older adults will bear such a financial burden has yet to be explored. The aim of this study was to investigate the influence of multimorbidity patterns and SES on CHE in Chinese widowed older adults.

Methods

Data was obtained from the 2018 China Health and Retirement Longitudinal Study (CHARLS). This is a cross-sectional study. A total of 1,721 widowed participants aged 60 years and older were enrolled in the study. Latent class analysis was performed based on 14 self-reported chronic diseases to identify multimorbidity patterns. The logistic model and Tobit model were used to analyze the influence of multimorbidity patterns and SES on the incidence and intensity of CHE, respectively.

Results

About 36.72% of widowed older adults generated CHE. The incidence and intensity of CHE were significantly higher in the cardiovascular class and multisystem class than in the minimal disease class in multimorbidity patterns (cardiovascular class, multisystem class, and minimal disease class). Among SES-related indicators (education, occupation and household per capita income), respondents with a middle school and above education level were more likely to generate CHE compared to those who were illiterate. Respondents who were in the unemployed group were more likely to generate CHE compared to agricultural workers. In addition, respondents aged 70-79 years old, geographically located in the east, having other medical insurance, or having fewer family members are more likely to generate CHE and have higher CHE intensity.

Conclusion

Widowed older adults are at high risk for CHE, especially those in the cardiovascular and multisystem disease classes, and those with low SES. Several mainstream health insurances do not provide significant relief. In addition, attention should be paid to the high-risk characteristics associated with CHE. It is necessary to carry out the popularization of chronic disease knowledge, improve the medical insurance system and medical service level, and provide more policy preferences and social support to widowed older adults.

Comparing the effect of a multisectoral agricultural intervention on HIV-related health outcomes between widowed and married women

INTRODUCTION

Widowed women make up 18-40% of the 12 million women living with HIV in eastern and southern Africa. Widowhood has also been associated with greater HIV morbidity and mortality. We compared the effectiveness of a multisectoral climate adaptive agricultural livelihood intervention (called Shamba Maisha) on food insecurity, and HIV related health outcomes among widowed and married women living with HIV in western Kenya.

METHODS

We implemented Shamba Maisha (NCT02815579) using a cluster-randomized control trial design. The intervention arm received an US$175 in-kind loan to purchase a micro-irrigation pump, seeds, and fertilizer, and received eight training sessions on sustainable agriculture and financial management. Study outcomes were measured every 6 months over a 24-month follow-up period and trends in outcomes assessed using multilevel mixed-effects models.

RESULTS

The trial enrolled 232 (61.5%) married and 145 (38.5%) widowed women. Widowed women (mean age 42.8 ± 8.4 years) were older than married women (35.8 ± 9.0 years) (p < 0.01). Almost all widowed women (97.2%) self-identified as household heads compared to 10.8% of married women. Comparing widowed vs married women, reduction in food insecurity (-3.13, 95%CI -4.42, -1.84 vs. -3.08, 95%CI -4.15, -2.02), depressive symptoms (-0.21, 95%CI -0.36, -0.07 vs. -0.19, 95%CI -0.29, -0.08), internalized stigma (-0.33, 95%CI -0.55, -0.11 vs. -0.38, 95%CI -0.57, -0.19), and anticipated stigma (-0.46 95%CI -0.65, -0.28 vs. -0.35, 95%CI -0.50, -0.21) was similar for both groups. In contrast, improvements in social support (-2.22, 95%CI -3.85, -0.59 vs. -4.00, 95%CI -5.16, -2.84; p = 0.08) and reduction in enacted stigma (0.01, 95%CI -0.06, 0.08 vs. -0.14, 95%CI -0.20, -0.09; p < 0.01) were weaker for widowed than married women.

CONCLUSIONS

Our study is among the first comparing the effect of a livelihood intervention on HIV health outcomes among widowed and married women. Widowed women experienced similar benefits as married women on individual-level outcomes, but weaker benefit on outcomes dependent on their external environment like enacted stigma and social support. Future trials and programs targeting widowed women should bolster stigma reduction and social support.

Spousal loss and cognitive function: the importance of gender and multiple dimensions of marital quality

Objectives: Research suggests that the death of a spouse has an adverse effect on a widow(er)'s cognition. However, little research has examined how the marital context before widowhood and gender influence this association. Guided by the social ambivalence and disease (SAD) model, this study examined the associations between spousal loss and cognition , with moderating effects of gender and pre-loss marital quality.Method: We analyzed a national longitudinal data, Midlife in the United States (MIDUS), specifically MIDUS 2 (2004-2005) and MIDUS 3 (2013-2014). The analytic sample consisted of (1) 146 participants who experienced the death of their spouse between MIDUS 2 and MIDUS 3 and (2) 144 age- and gender-matched comparison participants who did not lose their spouse during the period.Results: Adverse influence of widowhood on cognition was more pronounced among bereaved men than bereaved women. Widowed individuals whose relationships with their deceased spouse were ambivalent had poorer cognition than widowed individuals who had aversive relationships with their deceased spouse.Conclusion: Findings suggest that the influence of spousal death on cognitive functioning depends on gender and pre-loss marital quality, emphasizing the importance of considering pre-loss marital relationship and gender dynamics in developing efficient interventions for the widowed.

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.

Does the presence of health insurance and health facilities improve access to healthcare for major morbidities among Indigenous communities and older widows in India? Evidence from India Human Development Surveys I and II

In this paper, we examine whether access to treatment for major morbidity conditions is determined by the social class of the person who needs treatment. Secondly, we assess whether health insurance coverage and the presence of a PHC have any significant impact on the utilisation of health services, either public or private, for treatment and, more importantly, whether the presence of health insurance and PHC modify the treatment use behaviour for the two excluded communities of interest namely Indigenous communities and older widows using data from two rounds (2005 and 2012) of the nationally representative India Human Development Survey (IHDS). We estimated a multilevel mixed effects model with treatment for major morbidity as the outcome variable and social groups, older widows, the presence of a PHC and the survey wave as the main explanatory variables. The results confirmed access to treatment for major morbidity was affected by social class with Indigenous communities and older widows less likely to access treatment. Health insurance coverage did not have an effect that was large enough to induce a positive change in the likelihood of accessing treatment. The presence of a functional PHC increased the likelihood of treatment for all social groups except Indigenous communities. This is not surprising as Indigenous communities generally live in locations where the terrain is more challenging and decentralised healthcare up to the PHC might not work as effectively as it does for others. The social class to which one belongs has a significant impact on the ability of a person to access healthcare. Efforts to address inequity needs to take this into account and design interventions that are decentralised and planned with the involvement of local communities to be effective. Merely addressing one or two barriers to access in an isolated fashion will not lead to equitable access.

Trend and factors associated with anemia among women reproductive age in Ethiopia: A multivariate decomposition analysis of Ethiopian Demographic and Health Survey

BACKGROUND

In developing countries like Ethiopia, anemia is a public health problem. Unfortunately, the progress of anemia reduction has been slow. Although the issue of anemia has received considerable critical attention nowadays, trends and factors associated with anemia among women of reproductive age have not been explored in Ethiopia.

OBJECTIVE

This study aimed to determine trends and factors associated with anemia among women of reproductive age in Ethiopia from 2005 to 2016.

METHOD

Data from three consecutive Ethiopian Demographic and Health Survey (EDHS) from 2005-2016 were analyzed in this study. EDHS is a two-stage cluster sampling survey. Data were weighted to correct sampling bias in all surveys. A total of 46,268 samples were analyzed using a fixed effect model. For a measure of proportion, differences and slopes were computed. Bivariate and multivariable logistic regression analyses were done to identify predictors of the trend of anemia among women. Adjusted odds ratio (AOR) with a 95% Confidence Interval(CI) was computed, and the p-value < 0.05 is considered significant.

RESULT

Prevalence of anemia among women was 68%, 20.3%, and 27.3% in 2005, 2011 and 2016, respectively. The trend of anemia was reduced by 47.7 percentage points from 2005 to 2011; however, it increased by 7% points again from 2011 in 2016. Lack of mobile phones (AOR = 1.4, 95%CI, 1.2,1.6), Afar women (AOR = 1.5, 95%CI, 1.1,2.3) and Somali women (AOR = 1.5, 95%CI, 1.1,1.9) were associated with anaemia among women. On the contrary, the history of heavy menstruation in the last six months (AOR = 0.9; 95%CI, 0.85,0.98) was a factor negatively associated with anemia in 2005. In 2011, single women (AOR = 0.8,95%CI,0.7,0.9), watching TV less than once per wk (AOR = 0.9,95%CI,0.7,0.95), watching TV at least once per week (AOR = 0.8,95%CI,0.7,0.98) were variables associated with anemia. On the contrary, widowed women (AOR = 1.7,95%CI,1.4,2.0) were affected by anemia. In 2016, the richest women (AOR = 0.7, 95%CI, 0.6,0.8) and single (AOR = 0.8, 95%CI, 0.7,0.9) were affected little by anemia. Women of traditional belief followers (AOR = 2.2,95%CI,1.6,2.9) were more highly influenced by anemia than their counterparts.

CONCLUSION

The prevalence of anemia declined rapidly from 2005 to 2011, and increased from 2011 to 2016. Stakeholders should develop policies and programs to enhance the socio-demographic status of women and basic infrastructure for the community. Furthermore, they should design strategies for extensive media coverage of the prevention of anemia. The federal government should balance the proportion of anemia among regions by ensuring health equality.

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.

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.

Linking widowhood and later-life depressive symptoms: Do childhood socioeconomic circumstances matter?

Objectives: Widowhood and adverse childhood socioeconomic circumstances (CSC) have both been linked to increased levels of depressive symptoms in old age. Beyond their independent impact on depressive symptoms, experiencing adverse CSC may also trigger a cascade of cumulative adversity and secondary stressors across the life course that shapes how individuals weather stressful life events later on.Method: We examine whether exposure to adverse CSC moderates the relationship between later-life widowhood and depressive symptoms using data from the Survey of Health, Ageing and Retirement in Europe (2004-2017).Results: Mixed-effects models revealed that both widowhood and adverse CSC were associated with increased levels of depressive symptoms among men and women. Associations between widowhood and depressive symptoms, however, were not moderated by CSC for both genders.Conclusion: Persisting differences in the levels of mental health in response to later-life widowhood did not further widen in the presence of disparities experienced early in the life course. This may reflect the life-altering impact of this age-normative, yet stressful life event across the social strata.

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.

Young Single Widow, Dynamics of In-Laws Interference and Coping Mechanisms: Simplicity-Parsimony Approach

The incidence of short marital duration due to the demise of a husband that often exposes young widows to in-laws' exploitation of the asset of the deceased spouses, without regard for negative health consequences and potential vulnerability to poverty has not been exhaustively investigated, especially in sub-Saharan Africa where 16% of adult women are widows. The study examined the coping mechanisms among the young widow (aged ≤ 40) who have experienced short conjugal relationships (≤5 years) and burdensome from in-laws. The research design followed a qualitative approach with the aid of semi-structured in-depth interviews among 13 young widows selected through snowballing and informant-led approaches in the purposively selected communities. Data collected were analysed using descriptive statistics and a thematic approach. The findings, among others, shows the median age of young widow as 29 years. All participants, except one, have faced exploitation from their in-laws over their husbands' assets. All the participants desired to re-marry in order to: have a father figure for their children, have their own children or have more children. There is an absence of government support, but a few have received support from religious organisations. The author proposed attitudinal-change campaigns targeting the in-laws through accessible media and legislature that could challenge the exploitation of widows and unhealthy widowhood rites.

Exploring the process of adjustment following partner death in younger, widowed individuals: A qualitative systematic review

Age influences the experience of widowhood and the likelihood of adverse outcomes. This review synthesizes 13 qualitative studies that explored adjustment following the death of a partner at a younger age, within a Western-cultural context. Thematic synthesis identified six analytical themes: unique challenges; identity changes; levels of distress; coping; support; and adapting following the loss. Bereavement challenges younger widow(er)'s life expectations, identity, and friendships. Social support, faith, and access to age-specific support may facilitate positive adjustment. The findings inform the development of effective interventions to support positive adjustment in younger widowhood.

Living with spousal loss: Continuing bonds and boundaries in remarried widows' marital relationships

The grief literature emphasizes widows' continuing bonds with their deceased spouses as a significant part of their grief process. Yet, little is known about what happens to those bonds when a widow remarries and there is a second spouse, and how these bonds are dealt with by the new family members. This study explored the continuing bonds of remarried Israeli widows, the role the second spouse plays in these processes, and the ambiguity and permeability of the boundaries between the first and the second marital relationships. Semi-structured interviews were conducted with 29 Israeli remarried military widows, over three decades after their first husbands' deaths. Data were analyzed by using thematic content analysis. Findings revealed that most of the women maintained continuing bonds with their deceased husbands, whereas a few of them severed these bonds. In all of the scenarios, however, the second husband played a major role, resulting in different levels of boundaries, from strict to blurred, between the first and the second marriages. These findings suggest that in order to obtain a full understanding of grief's impact on the second marital relationship, grief should be considered a couple-hood process in which the boundaries between the relationships are dynamic. The association between these patterns and personal and marital adjustment should be further explored.

Excess Mortality by Individual and Spousal Education for Recent and Long-Term Widowed

OBJECTIVES

The loss of a spouse is followed by a dramatic but short-lived increase in the mortality risk of the survivor. Contrary to expectations, several studies have found this increase to be larger among those with high education. Having a spouse with high education is associated with lower mortality, which suggests that losing a spouse with high education means the loss of a stronger protective factor than losing a spouse with low education. This may disproportionately affect the high educated because of educational homogamy.

METHODS

We use Swedish total population registers to construct an open cohort of 1,842,487 married individuals aged 60-89 during 2007-2016, observing 239,276 transitions into widowhood and 277,946 deaths. We use Poisson regression to estimate relative and absolute mortality risks by own and spousal education among the married and recent and long-term widows.

RESULTS

We find an absolute increase in mortality risk, concentrated to the first 6 months of widowhood across all educational strata. The relative increase in mortality risk is larger in higher educational strata. Losing a spouse with high education is associated with higher excess mortality, which attenuates this difference.

DISCUSSION

When considering the timing and the absolute level of excess mortality, we find that the overall patterns of excess mortality are similar across educational strata. We argue that widowhood has a dramatic impact on health, regardless of education.

Marital Loss and Cognitive Function: Does Timing Matter?

OBJECTIVES

This study examines the association between age at marital loss (i.e., divorce or widowhood) and cognitive function in later life and whether the association differs by gender.

METHODS

We used mixed-effects models, drawing on longitudinal data from the Health and Retirement Study (1998-2016). The analytical samples included older adults aged 51 and older who had ever been widowed (N=5,639 with 25,537 person-waves) or divorced (N=10,685 with 50,689 person-waves).

RESULTS

We find that those who were widowed at younger ages had lower cognitive function than their counterparts who were widowed at older ages, for both men and women, after controlling for covariates. Household income and health-related factors partially accounted for the positive association between age at widowhood and cognitive function. Those who divorced at younger ages also had lower cognitive function than their counterparts who divorced at older ages, but this association was only present among men, not women. Health-related factors partially accounted for the associations between age at divorce and cognitive function among men.

DISCUSSION

Findings highlight the importance of considering the role of timing of marital loss in cognitive health among older adults.

Distinct Psychological Characteristics Predict Resilience and Recovery Throughout Widowhood

The dual-process model proposes that early and later bereavement involves different types of stressors and adaptation processes (Stroebe & Schut, 1999, 2010). It is thus possible that different factors facilitate adaptation during the early months versus subsequent years following widowhood. Elevated depressive symptoms, though prevalent after widowhood, may indicate problematic adaptation, as they are associated with poor long-term physical and mental health outcomes. We predicted that neutral death acceptance would be associated with less increase in depression during early widowhood (when confronted with loss-oriented stressors), whereas perceived control would predict depressive symptom decline during later widowhood (when adapting to controllable restoration-oriented stressors). Older adults (N = 265) reported on neutral death acceptance, perceived control, and depression before widowhood and on depression 0.5, 1.5, and 4.0 years after the death of their spouse. Bilinear spline growth modeling revealed that, on average, depressive symptoms increased from before to 0.5 years after spouse death and fell from 0.5 to 4.0 years after spouse death. Neutral death acceptance predicted a smaller increase in depression from before to 0.5 years after spouse death, as well as a smaller subsequent decrease in depression from 0.5 to 4.0 years after spouse death. Perceived control predicted a larger decrease in depression from 0.5 to 4.0 years after spouse death. Neutral death acceptance and perceived control had unique associations with resilience and recovery throughout early and later widowhood. These variables may be fruitful targets in interventions for depression throughout the full course of widowhood.

Experiences of Black South African widows regarding mourning rituals following the death of their spouses: Upholding cultural practices or violating human rights?

Within South African cultures, bereavement rituals are intended to promote healing on the part of the widow and demonstrate respect for the deceased. We explored the experiences of 10 Black South African widows regarding cultural mourning rituals and whether they were perceived to violate human rights or were necessary cultural practices. Findings from telephone interviews revealed that the widows experienced restrictions on movement, certain activities, mode of dress, and seating arrangements; used separate utensils; and engaged in cleansing rituals. While they were aware of their rights being violated, they felt that cultural practices needed to be respected to appease their ancestors.

Partner bereavement when parenting dependent children: What factors influence adjustment?

Little is known about those who are widowed while raising dependent children. This study aimed to explore the factors which influence adjustment to partner death. Seven fathers and five mothers were interviewed, and constructivist grounded theory was used. Three interrelated themes were identified: Interpersonal influences, Intrapersonal influences, and Contextual influences. Dependent children meant sole responsibility and increased demands, yet ultimately provided widowed parents a purpose. Participants highlighted the need for increased awareness of young widowhood at a systemic and cultural level, to improve communication around death and young widowhood. Implications included social, financial and therapeutic interventions.

Family resilience, social support, and family coherence among Jewish, Muslim, and Druze widows who lost their spouses to sudden death

In this cross-sectional study, regressions and multivariate analyses of covariance were used to assess group differences regarding family resilience, family coherence, and social support among 184 widows from three cultural groups in Israel: Druze (n = 66), Jewish (n = 59), and Muslim (n = 59). Druze widows had the lowest social support, but no differences were found between groups regarding family resilience or family coherence. Social support was positively associated with education and living in a city, beyond group. Social support and family coherence were positively associated with family resilience, beyond group. The discussion addresses cultural changes among the three groups.

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.

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.

The impact of widowhood on wellbeing, health, and care use: A longitudinal analysis across Europe

OBJECTIVE

To estimate whether becoming widowed had a significant effect on individual's health status as well as on healthcare and non-healthcare resources use, compared to people who remained in a couple in Europe.

DATA AND METHOD

It was used the Survey of Health, Aging and Retirement in Europe from 2004 to 2015. The statistical technique used was genetic matching which analysed the differences in wellbeing, mental health, health status, risk of death, health care resources and long-term care utilization of people who have become widowed, comparing with people who remained married or with a partner. We considered shortterm and medium-term effects.

RESULTS

In the short term, those who became widowed had a worse wellbeing and mental health, in addition to a greater probability of receiving formal care and informal care from outside the household. There seems to be a significant effect in the use of formal and informal care from outside the household in the medium term.

CONCLUSIONS

The results might help to concentrate a major effort of any policy or strategy, not only in the field of health but also in the provision of long-term care, immediately after the negative shock occurs.

Spousal bereavement and the cognitive health of older adults in the US: New insights on channels, single items, and subjective evidence

This study provides novel insights into older adults' cognitive functioning before and after widowhood onset and possible effect channels. It further examines gender heterogeneity in the adaptation to (anticipated or actual) spousal bereavement, comparing objective evidence with subjective evidence of cognitive abilities. We used longitudinal data of up to 26,584 participants of the Health and Retirement Study, aged over 50 at recruitment, assessed biennially between 1998 and 2016. Two-way fixed effects with dynamic treatment effects were estimated for various cognitive measures, including six aggregated indices and six single item scales. After adjusting for effect channels including depression, social vulnerability, and stress, there remained significant widowhood effects on older adults' cognitive health. Using single item scales, we established the adverse contemporaneous and adaptation effects on bereaved older females' short-term memory, semantic memory, and numeracy. For bereaved older males, working memory and focus-of-attention deteriorated after widowhood onset. Meanwhile, subjective memory rating remained intact, contrary to objective evidence. We conclude that cognitive transitions to and from widowhood can exhibit distinctive patterns across objective and subjective cognitive domains. With the effect channels in mind, cognitive intervention for widowed older adults should be tailored to the temporal distance to spousal loss, gender, and task.

Social Participation and Survival in Widowed Persons: Results of the Taiwan Longitudinal Study on Aging

It has been considered that widowed persons have a higher risk of death. This study intended to explore whether social participation could improve this trend. A longitudinal study database was constructed to explore the trend of survival and its change with social participation in widowed persons. The Taiwan Longitudinal Study on Aging (TLSA), based on four consecutive waves of longitudinal follow-up data in 1999, 2003, 2007, and 2011 was linked with the National Death Registry from 1999 through 2012. In total, there were 1417 widowed persons and 4500 nonwidowed persons included in this study, excluding divorced and never-married people. The survival trend analysis was carried out with social participation as the main predictive factor stratified for comparative analysis. Our results showed that the widowed were older than the nonwidowed, were female-dominant, had a lower education level, were more economically stressed, and were less likely to engage in regular exercise, and thus showed generally poorer health; for example, being more vulnerable to having chronic diseases, disability with the Activities of Daily Living (ADL), cognitive impairment with the Short Portable Mental State Questionnaire (SPMSQ), and depression with The Center for Epidemiological Studies-Depression (CES-D). The death risk of the widowed was significantly higher than that of the nonwidowed, but the death trend for those with social participation was significantly lower than that of their counterparts in both the widowed and nonwidowed. After matching with gender and age for widowed persons, the widowed with social participation had a significantly lower risk of death (adjusted hazard ratio (HR), 0.83; 95% confidence interval (CI), 0.71–0.98) compared to the widowed without social participation. It was concluded that social participation can improve the death risk for the widowed, and it is worthily included in health promotion plans and social welfare services for widowed persons.

Prolonged grief and posttraumatic growth among middle-aged and older widowed persons: A latent class analysis and testing for the role of social support

Evidence has shown that symptoms of grief co-occur with posttraumatic growth following loss. Using latent class analysis among a Togolese sample of middle-aged/older widowed persons, we identified three classes along their experiences of grief-growth interaction (combined grief/growth, predominantly growth, and low-medium growth classes). The combined grief/growth class members were more likely to have lost their spouses recently and to report greater marital relationship satisfaction with their spouse before their death. The perceived social support from family was predictive of the predominantly growth class membership. The findings provide a nuanced understanding of grief, which is dominated by psychopathology and negative outcomes.

"Remarried military widows" grief in light of social policy upheavals

Military widows' remarriages and their consequences have scarcely been studied. We examined how legal changes enacted on behalf of remarried war widows, who regained their official rights after many years without them, impacted their life experience. Based upon 29 qualitative interviews, we found that the reinstatement of official recognition of widowhood validated participants' personal longitudinal grief but also revived painful loss-related feelings, which were expressed in interpersonal spheres. Policy changes allowed some widows a higher measure of independence, alongside upsetting the current couple's power balance. Social and clinical implications of such interruptions in the longitudinal grief course are discussed.

Differentiated routes to vulnerability: Marital status, children, gender and poverty

This study compares poverty risks between two types of transition involving family status, which the life course perspective considers risky events: divorce and widowhood. The case study is Israeli society, characterized by high fertility rates and a high risk of poverty. The study examines the relationship between marriage dissolution and the risk of poverty, distinguishing between divorce and widowhood, and how they are affected by the intersection of gender and number of children in the household. Based on unique administrative panel data, we studied all women and men in Israel, aged 18-60 in 2003, who married in 2003 and were widowed or divorced by 2015, as well as a random sample of 20 % of all women and men in Israel who married in 2003 and remained married until 2015. Fixed effects models calculated the probability of women and men becoming poor. Results revealed a gendered effect of entering into poverty that largely depends on how the marriage ended and the number of children in the household. Divorce increases poverty risks for women and decreases them for men. However, for both genders, the combination of divorce and more children at home increases poverty. In contrast, widowhood tends to increase poverty for men, but only for women does the poverty risk increase as the number of children rises. Findings are discussed in the context of high fertility rates, Israeli welfare policy and the economic vulnerability associated with parents' childcare responsibilities.

Dyadic Relationships between a Surviving Parent and Children in Widowed Families: A Systematic Scoping Review

The death of a family member affects not only individual family members but also their relationships and interactions. Grief has been studied mostly as an intrapersonal experience. Adopting the family perspective, this systematic scoping review focused on parent-child relationships in widowed families so as to identify what is already known on this topic and the research gaps for future study. The review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. Four databases (Web of Science, Psycinfo, PubMed, and CINAHL Plus) were searched. Search terms were combinations of two concepts: (1) loss of a parent (20 terms) and (2) parent-child (eight terms). 5,419 studies were identified during the search, of which 36 studies were included in the review following two rounds of screening. Four research themes emerged, and the aggregated findings were identified: (a) The surviving parent and children are likely to become closer following the loss of a parent, while other relevant factors need to be taken into account; (b) Better parent-child relationships play a protective role in children's adjustment to loss; (c) The surviving parent and children's adjustment to loss are interdependent; (d) Through parenting, communication style, coping strategy, and other attributes, the surviving parent can influence their children's adjustment. Gender and age differences were identified in parent-child relationships. The findings further justify the importance of a family perspective when conducting research and practice on bereavement. Several research gaps were identified. Existing studies paid insufficient attention to children's agency and bidirectional relationships, and the interaction process and its role underlying parent-child bidirectional causality. A conceptual framework of parent-child relationships in widowed families is proposed based on these findings.

Benefits and barriers: a qualitative study on online social participation among widowed older adults in Southwest China

BACKGROUND

With the development of digital media, online activities are increasingly becoming part of the daily life of older adults. Widowed older adults generally would face changes in social interactions and activities due to widowhood; thus, the importance of online participation may be more prominent in this population. However, a detailed evidence on the experiences of online social participation among widowed older adults is relatively sparse. This study aimed to explore widowed older adults' perceptions regarding online social participation in southwestern China.

METHODS

This study adopted a qualitative approach. Semi-structured, in-depth individual interviews were conducted with 19 widowed older adults between September-December 2020. Thematic analysis was applied to analyse the data.

RESULTS

Two major themes, "benefits" and "barriers" were identified from the original data analysis. Subcategories concerning the theme "benefits" were "benefit perception (convenience, flexible time, supplementation)", "health promotion", "emotional comfort", and "social connection". Subcategories of "barriers" were "worries: personal economic loss", "concerns: security of digital device", "troubles: the diversity of online social participation", and "difficulties: using digital media".

CONCLUSIONS

Social participation of widowed older adults in southwestern China has begun to be integrated into the digital world; however, it remains at an early stage with the simple purpose of engagement. The older adults may face many challenges for online social participation. Although there are barriers and challenges in online social participation, widowed older adults can reap its benefits, which can be used as an important measure to facilitate a fulfilling life and successful ageing. There is no doubt that online social participation will become a trend within the foreseeable future. Family, friends and health care professionals should pay more attention to the needs of online social participation in widowed older adults and provide adequate support for them to achieve a meaningful life.