Widowhood and the end of spousal care-giving: relief or wear and tear?

Challenges and Coping Strategies in Transitioning From Caregiving to Widowhood: A Systematic Review

Ninety-one percent of surviving spouses in the U.S. cared for their spouses before they died. This review explores the challenges of the transition from caregiving to widowhood and different coping strategies used by widowed spousal caregivers. A systematic review of literature on the transition from caregiving to widowhood was conducted using four major academic search engines. Overall, 280 articles were identified, with 22 meeting the inclusion criteria. Challenges for widowed caregivers included experiencing care burden, letting go of the caregiver role, grief, and triggers. Widowed caregivers' coping strategies included social support and services use, filling the time gap, finding spirituality, and engaging in unhealthy behaviors. Future research is needed to determine the efficacy of widowed caregivers' coping strategies. Concerted and collaborative action by health professionals, community organizations, and policymakers is needed to develop programs and other approaches to support widowed caregivers.

Can cessation of caregiving for parents relieve family caregivers' psychological distress? A longitudinal study using 17-wave nationwide survey data in Japan

BACKGROUND

Informal caregiving of older parents adversely affects the mental health of family caregivers. However, the psychological effects of caregiving cessation and the trajectories of these effects have rarely been examined in Japan. This study addresses this gap.

METHODS

Based on a 17-wave nationwide population-based survey in Japan, we analyzed longitudinal data from 8,280 individuals aged 50-59 years in 2005 who started caring for their older parents in 2006 or later and ceased caregiving by 2021. We identified the timings of caregiving onset and cessation and examined the trajectory of psychological distress (PD), defined as a Kessler score ≥ 5 on the 6-item Kessler scale (range 0-24). Linear mixed models were used to assess the trajectory of PD that evolved after caregiving cessation over the subsequent three years.

RESULTS

After adjusting for covariates, the probability of PD decreased by 5.6 percentage points (from 40.8%; 95% confidence interval [CI], 4.1-7.0) for female caregivers and by 1.9 percentage points (from 31.7%; 95% CI, 0.3-3.5) for male caregivers at caregiving cessation, remaining stable in subsequent years. For women, higher PD risks related to co-residence with a care recipient diminished quickly upon cessation of caregiving, while the unfavorable impacts of no social activity, extended duration of care, and long-hour daily care persisted in subsequent years. For male caregivers, the impact was generally more limited.

CONCLUSIONS

These results suggest that changes in mental health following caregiving cessation warrant serious consideration when developing support programs for former family caregivers.

Transition to bereavement: A prospective longitudinal study of health-related quality of life in informal caregivers of oldest-old individuals

INTRODUCTION

Experiencing bereavement may be challenging. Despite the oldest-old population increase, a subgroup at greater risk of death, few studies focus on the grieving process of informal caregivers (ICs). This study analyzed the transition to bereavement of ICs of oldest-old individuals (≥80 years) over 1-year and compares the evolution of the health-related quality of life (HrQoL) between those experiencing bereavement and those who continued care through the study period.

MATERIALS AND METHODS

A prospective longitudinal observational study was conducted enrolling 204 ICs of the Metropolitan Area of Porto (North Portugal), of which 36 experienced the death of care receiver (CR). ICs' health profile and burden were assessed. CRs' functional and cognitive status were also appraised.

RESULTS

Bereaving caregivers were mostly female, CRs' children, and had on average 60.4 years at baseline. Caregivers spent a mean of 10.1 h/day (SD = 7.7) caring, for 80.6 months (SD = 57.5). The time elapsed since CR's death was 6 months (SD = 3.5) from entering in the study. CRs who died had a mean age of 88.3 (SD = 5.4) years at baseline, and were very dependent. Over a 1-year follow-up, bereaving caregivers showed a significant decrease in mental health following CR's death; on the other hand, caregivers who continued caring improved mental health [F(1, 159) = 4.249, p = 0.041].

DISCUSSION

Ending the caregiver career was marked by a decline in mental health whereas to continue caring was marked by an improvement in this outcome. While it is highly expected that the CR's death will be perceived as a relief considering both the caregiver's characteristics (e.g., medicines) and the CR condition (e.g., high dependence levels), the results suggest an opposite direction. CRs' death seems to arise an emotional burden for IC, at least during the first year, possibly triggering feelings of loneliness and a life without purpose that seems to aggravate mental health issues.

CONCLUSION

The transition to bereavement among ICs seems to lead to a caregiver mental health decline while those who continued caring (and thereby, experiencing caregiving stressors) seems to improve in this outcome. Ceasing caregiving stressors does not seem to contribute better experiencing bereavement among ICs, suggesting the need for support throughout this phase.

Widowhood and cognition among older women in India: New insights on widowhood duration and mediators

Background

Widowhood, a marital status that disproportionately affects older women, has been associated with poorer health compared to married individuals. However, relatively little is known about the association between widowhood in later-life and cognitive health in low- and middle-income countries.

Methods

To address this research gap, we used data from the Longitudinal Aging Study in India (2017-19) to investigate the widowhood disparity in cognitive health among mid-aged and older women in India, including how this relationship varies by the duration of widowhood. We further examined the extent to which economic, social, and health conditions mediate this association.

Results

Cognition scores for widowed women were on average lower by almost 0.1 standard deviations compared to married women. Overall, this disparity increased with widowhood duration, with non-linearities in this association. The disparity in cognition scores increased with widowhood duration up to twenty years but did not increase further among those with longer widowhood duration. Worse physical and mental health were found to mediate almost thirty percent of the total association between widowhood and cognition. These mediators were most useful in explaining the association between lower cognition and widowhood among women who experienced widowhood for ten years or longer.

Conclusion

The study highlights the significant disadvantage in cognitive functioning among older widowed women in India. The study also provides evidence on potential mediators, suggesting differential effects of mediators at different stages of widowhood.

Spousal caregiving, widowhood, and cognition: A systematic review and a biopsychosocial framework for understanding the relationship between interpersonal losses and dementia risk in older adulthood

Accumulating research suggests that stressful life events, especially those that threaten close intimate bonds, are associated with an increased risk of dementia. Grieving the loss of a spouse, whether in the form of caregiving or after the death, ranks among 'life's most significant stressors', evoking intense psychological and physiological distress. Despite numerous studies reporting elevated dementia risk or poorer cognition among spousal caregivers and widow(er)s compared to controls, no review has summarized findings across cognitive outcomes (i.e., dementia incidence, cognitive impairment rates, cognitive performance) or proposed a theoretical model for understanding the links between partner loss and abnormal cognitive decline. The current systematic review summarizes findings across 64 empirical studies. Overall, both cross-sectional and longitudinal studies revealed an adverse association between partner loss and cognitive outcomes. In turn, we propose a biopsychosocial model of cognitive decline that explains how caregiving and bereavement may position some to develop cognitive impairment or Alzheimer's disease and related dementias. More longitudinal studies that focus on the biopsychosocial context of caregivers and widow(er)s are needed.

"The Internal Police Officer Has Not Retired but Has Slowed Down": Israeli Women Reframe Their Aging Experiences in the Second Half of Life

Compared with gains, losses have received a substantial amount of research and public attention. The present study aims to shed light on the positive gains associated with older age from the perspective of older women. Five focus groups with 19 Israeli women over the age of 54 were conducted. Trailers of three different films were used to stimulate discussion about old age and aging and allow for reflections on societal norms in light of personal experiences. Focus group interviews were analyzed thematically. Respondents identified four contexts, characterized by reframing their experiences against societal norms. These included gender stereotypes, physical appearance, interpersonal relations, and employment. This study represents an opening to a different discourse around old age, which is characterized by gains and possibilities brought about by changes in reframing one’s experiences, while distancing oneself and exerting free will vis à vis social norms.

Racial, ethnic, and neighborhood income disparities in childhood posttraumatic stress and grief: Exploring indirect effects through trauma exposure and bereavement

Previous findings suggest that experiences with systems of oppression that disproportionately affect individuals based on race and neighborhood residency (e.g., systemic racism, neighborhood income disadvantage [NID]) can be associated with higher odds of developing psychological problems following traumatic events. Although race/ethnicity and NID residency are often associated, they are separate concepts that play unique roles in mental health outcomes among youth. Residents of Black, Latinx, and income-disadvantaged communities also have an increased risk of exposure to polyvictimization and the loss of multiple loved ones. Studies have not carefully delineated the potential relations between race/ethnicity and NID residency, polyvictimization, accumulated losses, and trauma and grief outcomes in youth. We examined mediation models to investigate whether polyvictimization, the loss of multiple loved ones, and exposure to violent death were potential mechanisms through which race/ethnicity and NID would predict trauma and grief outcomes in youth. Participants (N = 429) included Black (19.9%), Latinx (36.0%), and White (27.3%) children and adolescents who were assessed through a routine baseline assessment at a trauma and grief outpatient clinic. Black youth reported significantly elevated posttraumatic stress and maladaptive grief symptoms through higher polyvictimization and violent death exposure relative to White youth, βs = .06-.12, ps <.001. Latinx identity and NID were positively and directly associated with specific domains of maladaptive grief reactions, βs = .10-.17, ps < .001. If replicated longitudinally, these findings suggest that polyvictimization and violent death exposure may be mechanisms through which Black youth develop more severe traumatic stress and grief reactions.

Interdependent transformations: Integrating insights from relationship science to advance post-traumatic growth and personality change research

People have a tremendous ability to grow and change for the better following adverse life events. This capacity for growth has captured the attention of psychologists interested in understanding the mechanisms underpinning both personality and well-being. This paper advocates for a greater integration of relationship science into this area of study as a means of advancing post-traumatic growth and personality change research. Relationships, both as an impetus for change and as evidence of growth, have featured consistently in the post-traumatic growth and adversity literatures. Drawing from interdependence theory in particular, this paper highlights how the unique structure of close relationships and relationship dynamics can be applied to address outstanding theoretical questions related to the advancement of post-traumatic growth research as well as offers a critique of the practice of using relationship outcomes (e.g., connection) as evidence of post-traumatic growth. Finally, this paper encourages psychologists across subdisciplines to share their unique skills and insights to help generate more robust psychological theories and methods.

Race/Ethnicity, Cumulative Midlife Loss, and Carotid Atherosclerosis in Middle-Aged Women

African-American women have elevated rates of cardiovascular disease compared with women of other races or ethnicities, and race/ethnicity-related stressors may play a role. We examined the association between a race/ethnicity-related stressor, midlife loss, and a marker of cardiovascular risk, carotid intima media thickness (IMT), in 1,410 African-American, White, Chinese, and Hispanic women from the Study of Women's Health Across the Nation. Participants were queried about losses annually over 12 years (1996-2013), with IMT assessed in year 12-13 via ultrasound. Linear regression models were used to examine associations between cumulative upsetting losses and IMT, adjusting for covariates. In minimally adjusted models in the full cohort, 3 or more upsetting losses (vs. none) were associated with IMT (β = 0.03, 95% confidence interval (CI): 0.01, 0.05; P = 0.0003). Results were more robust among African-American women (β = 0.042, 95% CI: 0.01, 0.07; P < 0.01) than White (β = 0.014, 95% CI: -0.01, 0.03; P = 0.21), Chinese (β = 0.036, 95% CI: -0.03, 0.10; P = 0.25), or Hispanic (β = 0.036, 95% CI: -0.07, 0.14; P = 0.51) women, although associations among women from racial/ethnic minorities overall were of similar magnitude. Results persisted in fully adjusted models (P for interaction with race/ethnicity = 0.04). Midlife loss may be a pathway through which race/ethnicity influences cardiovascular risk for African-American women and, potentially, Chinese and Hispanic women.

Risk of Psychological Distress Among Community-Dwelling Older Adults Experiencing Spousal Loss in Ghana

BACKGROUND

Spousal loss, common in older age, has been linked to negative mental health outcomes and well-being, yet the mechanisms linking spousal loss and mental health are still unclear.

OBJECTIVE

To investigate whether physical activity, social support, and gender modify the psychological distress effects of marital loss among community-dwelling older persons in Ghana.

METHODS

Data from a 2016/2017 Ageing, Health, Psychological Well-being, and Health-seeking Behavior Study (N = 1,200) were examined. OLS regression models examined associations between spousal loss and psychological distress outcomes and interaction terms.

RESULTS

Spousal loss (widowhood and divorce/separation) was associated with psychological distress (measured by the Kessler Psychological Distress Scale [KPDS-10]) for the full sample (β = .798, p < .001), women (β = .831, p < .001) and for men (β = .533, p < .05). After adjusting for potential confounders, the associations between spousal loss and psychological distress persisted for the full sample (β = .727, p < .001) and females only (β = .730, p < .001). In particular, when experiencing spousal loss, those with meaningful social support (β = -.856, p < .005) and engaged in physical activity (β = -.258, p < .001) were less likely to be psychologically distressed.

CONCLUSIONS

Spousal loss precipitates an independent risk of psychological distress in older age particularly among women, but social support and physical activity engagements moderate the relationship. These findings support the premise that providing opportunities to improve social support and regular physical activity may buffer the effects of psychological distress among older persons experiencing spousal loss. Providing support for older adults in times of divorce and widowhood, and working towards changes in social attitudes towards divorce are important considerations.

Bereavement is associated with reduced systemic inflammation: C-reactive protein before and after widowhood

BACKGROUND

Bereavement is associated with poorer health and early mortality. Increased systemic inflammation is one pathophysiological pathway thought to explain this health risk. However, few studies have examined systemic inflammation before and after widowhood.

PURPOSE

The current study examined the associations between inflammation and widowhood status before and after bereavement in a sample of married adults who became widowed between assessments in the English Longitudinal Study of Ageing.

METHODS

We examined levels and change over time in systemic inflammation, as assessed by C-reactive protein (CRP), among participants who became bereaved (n = 199). We then compared these results to a sample of participants whose spouse remained living, selected using a propensity score matching algorithm (n = 199).

RESULTS

Contrary to expectations, widowed participants' CRP decreased following bereavement, d = -0.29, p < 0.001. Change in CRP was not associated with pre-loss depression levels, caregiving status, marital quality, number of chronic diseases, prescribed medications, body mass index, age, or sex. Compared to continuously married participants, widowed participants' evidenced a significantly greater decrease in CRP after their spouse's death, β = -0.14, p < 0.001.

CONCLUSIONS

Widowed adults' systemic inflammation decreased significantly following bereavement, both as a group and compared to people who remained married. We discuss possible explanations for this counterintuitive finding, including the measure of inflammation used in the study and the timing of the study measurements.

Spousal Dementia Caregiving to Widowhood: Perceptions of Older Urban and Rural Widows

Older widows might experience poor health outcomes following their spousal dementia caregiving experience. Widows from rural areas with fewer resources may have worse health outcomes. Serial, qualitative interviews were conducted at baseline, 6-months and 12-months with 13 urban and nine rural older widows who cared for husbands with dementia. Perceptions of caregiving, widowhood, and resources were examined. Major themes were 24/7 Care, Watch the Man Go Down, Build a Network, Spiritual Support, No Regrets/Some Regrets, Time for Me Now, Loneliness, and Keep Reaching In. Compared to urban widows, rural widows had fewer emotional and tangible resources. All widows desired more support during spousal dementia caregiving and in their transition to widowhood. Nurses need to continue to support the transition from spousal dementia caregiving to widowhood and to test interventions unique to meeting the needs of urban and rural older women.

Bereavement outcomes among spousal hospice caregivers: Relief, rumination, and perceived patient suffering

Witnessing end-of-life suffering of loved ones is an underappreciated stressor that may affect caregiver bereavement. We interviewed 61 spousal caregivers of hospice patients who died within the past 6-18 months. Higher rumination about suffering and lower feelings of relief was related to poorer well-being. Rumination by caregivers about end-of-life suffering was an important predictor of depression and complicated grief. Most caregivers viewed the death as at least in part a relief. One important focus of grief support may be to help caregivers find productive ways to avoid rumination and use other forms of coping and to acknowledge feelings of relief.

Widowhood and mortality risk of older people in rural China: do gender and living arrangement make a difference?

Increased mortality after spousal bereavement has been observed in many populations. Few studies have investigated the widowhood effect in a traditional culture where the economy is underdeveloped. The reasons for the widowhood effect and its gender dynamic are not well understood. In this study, we assessed whether the widowhood-associated excess mortality exists and differs by gender and living arrangement in rural China. We used a six-wave panel of data derived from rural people over 60 years old in the Chaohu region of China. Cox regression analyses suggest that there was a positive effect of spousal loss on mortality for older rural Chinese and this effect was gender different. Our findings also suggest that living with adult children after spousal loss played a protective role in reducing the risk of older men's death, though it tended to increase older men's mortality risk in general.

Caregiving, Employment and Social Isolation: Challenges for Rural Carers in Australia

Australia has one of the world’s highest life expectancy rates, and there is a rapidly growing need for informal caregivers to support individuals who are ageing, have chronic illness or a lifelong disability. These informal carers themselves face numerous physical and psychological stressors in attempting to balance the provision of care with their personal life, their work commitments and family responsibilities. However, little is known about the specific challenges facing rural carers and the barriers that limit their capacity to provide ongoing support. A cross-sectional survey composed of open-ended responses and demographic/socioeconomic measures used routinely by the Australian Bureau of Statistics (ABS) and the Australian Institute of Health & Welfare (AIHW) was used with a cohort of 225 rurally-based carers within New South Wales, Australia. Demographic questions specified the respondents’ age, gender, employment, caregiving status, condition of and relationship to the care recipient, postcode, residency status, and distance and frequency travelled to provide care. Open-ended comments sections were provided to allow participants to describe any issues and problems associated with caregiving including employment, travel, residency, carer support groups and any other general information. The results show that most rural carers were middle-aged women supporting a spouse or a child. Unpredictability associated with providing care exacerbated demands on carers’ time, with many reporting significant employment consequences associated with inflexibility and limited job options in rural locations. Specific issues associated with travel requirements to assist with care were reported, as were the impacts of care provision on the respondents’ own personal health. The majority of carers were aware of the social supports available in their local rural community, but did not access them, leaving the carers vulnerable to marginalisation. Problems associated with employment were noted as resulting in financial pressures and associated personal stress and anxiety for the caregivers. While this issue is not necessarily limited to rural areas, it would appear that the lack of opportunity and flexibility evident in rural areas would exacerbate this problem for non-metropolitan residents. The participants also identified specific barriers to the provision of care in rural areas, including the significant impact of travel. Access to support services, such as carer groups, were rarely accessed due to a mix of factors including inaccessibility, poor timing and a lack of anonymity. Financially, there was considerable evidence of hardship, and there is an urgent need for a comprehensive review of government and community-based support to better meet the needs of rural carers.

Changes in depressive symptoms during widowhood among older Mexican Americans: the role of financial strain, social support, and church attendance

OBJECTIVES

This study examines how depressive symptoms change during the widowhood process among older adults of Mexican descent. This research also investigates whether financial strain, social support, and church attendance moderate changes in depressive symptoms in the context of widowhood.

METHOD

This study uses seven waves of data from the Hispanic Established Population for the Epidemiologic Study of the Elderly collected at approximately two-year intervals. This research applies multiphase growth models to examine changes in depressive symptomatology before, during, and after the transition to widowhood (the measurement wave at which spousal bereavement was first reported) among 385 older adults of Mexican descent who experienced the death of a spouse during the survey.

RESULTS

This study demonstrates that older adults of Mexican descent experienced a significant increase in depressive symptoms pre-widowhood and in particular, during the transition to widowhood. The levels and rates of changes in depressive symptoms post-widowhood did not differ from the pre-widowhood ones. Greater social support was related to more depressive symptoms during the transition to widowhood. More frequent church attendance was a protective factor against increases in depressive symptoms pre-widowhood.

CONCLUSION

This study highlights the multiphase pattern in the effects of the widowhood process on depressive symptomatology among older adults of Mexican descent. The findings also suggest that social support and church attendance can have implications for the interplay between widowhood and depressive symptoms.

Caregiver characteristics and bereavement needs: Findings from a population study

BACKGROUND

Globally, most care for people with life-limiting illnesses is provided by informal caregivers. Identifying characteristics of caregivers that may have unmet needs and negative outcomes can help provide better support to facilitate adjustment.

AIM

We compared characteristics, expressed unmet needs and outcomes for spousal caregivers, with other caregivers at the end of life, by gender and age.

DESIGN

The South Australian Health Omnibus is an annual, random, face-to-face, cross-sectional survey wherein respondents are asked about end-of-life care.

SETTING/PARTICIPANTS

Participants were aged over 15 years, resided in households in South Australia and had someone close to them die from a terminal illness in the last 5 years.

RESULTS

Of the 1540 respondents who provided hands-on care for someone close at the end of life, 155 were widows/widowers. Bereaved spousal caregivers were more likely to be older, female, better educated, have lower incomes, less full-time work, English as second language, sought help with grief and provided more day-to-day care for longer periods. Spousal caregivers were less likely to be willing to take on caregiving again, less able to 'move on' with life and needed greater emotional support and information about illness and services. The only difference between widows and widowers was older age of spouse in women. Younger spousal caregivers perceived greater unmet emotional needs and were significantly less likely to be able to 'move on'.

CONCLUSION

Spousal caregivers are different from other caregivers, with more intense needs that are not fully met. These have implications for bereavement, health and social services.

Trajectories of informal care and health

The evidence of the impact of informal care provision on the health of carers presents a complex and contested picture, depending on the characteristics of the care studied, including its duration, which has been relatively short in previous research (up to 4 years). Drawing on data from the Office for National Statistics Longitudinal Study, a 1% sample of linked Census records for respondents in England and Wales (N=270,054), this paper contributes original insights on the impact of care provision on the carer's health ten years later. The paper explores differentials in self-reported health in 2011 between individuals according to their caring status at 2001 and 2011, and controlling for a range of demographic and socio-economic characteristics. The results show that individuals providing informal care in 2011 (regardless of carer status in 2001) exhibit lower odds of poor health in 2011 than those who did not provide care in both 2001 and 2011. Taking the intensity of care into account, 'heavy' carers in 2001 (i.e. caring for more than 20 h per week) who were not caring in 2011 show a higher likelihood of reporting poor health than non-carers, while those who were 'heavy' carers in both 2001 and 2011 are around one-third less likely to report poor health at 2011 compared to non-carers (2001 and 2011). These findings provide new insights in relation to repeat caring and its association with the carer's health status, further contributing to our understanding of the complex relationship between informal care provision and the carer's health.

Identities in Transition: Women Caregivers in Bereavement

Population aging and longevity due to medical advances over the past few decades have meant that the approximately 44 million caregivers in the United States and eight million caregivers in Canada must provide more intensive levels of care and for longer periods of time. Consequently, caregivers are often profoundly affected by their caregiving role in emotional, psychological, physical, and financial ways. Thirty years of research on this population have helped to create a caregiver profile and identify the significant challenges for caregivers. One area explored to a much lesser extent is the postcaregiving period, when the caregiver transitions into a period of bereavement. This period can be particularly challenging for caregivers given the commitment inherent in the caregiving process. Research has shown that the emotional reactions of caregivers as well as practical challenges do not end with the death of the care recipient. In fact, complex realities, tensions, and responses continue well after the death into the postcaregiving period. This study of bereaved women caregivers explored their lived experiences in the postcaregiving phase. One central theme emerged and suggested that the experience of caregiving had an effect on the caregivers' identities, which then influenced their bereavement processes and experiences.

Beyond widowhood: Do prior discovered themes that describe the experiences of older Australian widowed women persist over time?

In previous cross-sectional studies researchers have explored the experiences of widowed women in the 1921-1926 cohort of the Australian Longitudinal Study on Women's Health and identified three major themes: health, social relationships and support, and financial and structural issues. In the current study the authors examine longitudinal data collected over 15 years to assess whether these themes persisted and/or evolved over time. The sample included 162 widowed women aged 70-90 years. Thematic analysis was used with a constant comparison method. Many women reported good health despite managing comorbidities. Social relationships frequently shifted from friends to family to more formal support. Most financial and structural issues related to managing increasing health costs as women aged. These results confirmed that the three major themes previously reported persisted over time, and underscore the importance of continuing to support women, and their changing needs, well beyond the initial period of bereavement.

Informal caring in England and Wales--Stability and transition between 2001 and 2011

Informal caring is of significant and increasing importance in the context of an ageing population, growing pressures on public finances, and increasing life expectancy at older ages. A growing body of research has examined the characteristics associated with informal care provision, as well as the impact of caring for the carer's physical and mental health, and their economic activity. However, only a relatively small body of literature has focused on the study of 'repeat' or continuous caring over time, and the factors associated with such trajectories. In 2001, for the first time, the United Kingdom census asked about provision of informal care, enabling identification of the prevalence of informal caregiving at a national level. This paper follows up informal carers from the 2001 Census in order to examine their characteristics and circumstances 10 years later using a nationally representative 1% sample of linked census data for England and Wales, the Office for National Statistics Longitudinal Study. The analysis classifies the range of possible combinations of caring and non-caring roles between 2001 and 2011, focusing on the characteristics of those who were providing care at one, or both, time points. Among other results, the analysis identified that, among those who were carers in 2001, caring again in, or continuing to care until, 2011 was associated with being female, aged between 45 and 54 years in 2011, looking after the home, and providing care for 50 hours or more per week in 2001. Such results contribute to our understanding of a particular group of informal carers and provide a more nuanced picture of informal care provision at different stages of the life course.

Widowhood and depression among older Europeans--the role of gender, caregiving, marital quality, and regional context

OBJECTIVES

This study investigates the role of gender, caregiving, and marital quality in the correlation between widowhood and depression among older people within a European context by applying the theory of Social Production Functions as a theoretical framework.

METHOD

Fixed-effects linear regression models are estimated using the first 2 waves (2004, 2006) of "The Survey of Health, Ageing and Retirement in Europe" (SHARE). A subsample of 7,844 respondents aged 50 and older in 11 countries, who were married at baseline and are either continuously married or widowed at follow-up, is analyzed.

RESULTS

Respondents who experienced widowhood between the 2 waves report significantly more depressive symptoms than those continuously married, with respondents living in Denmark and Sweden reporting a lower increase in depressive symptoms than those living in Greece, Spain, or Italy. There is no statistically significant interaction between gender and widowhood. Widowed persons who report higher marital quality at baseline show a larger increase in the number of symptoms of depression than those with low marital quality; widowed persons who report being a caregiver for their partner at baseline report smaller increase in the symptoms of depression compared with widowed noncaregivers.

DISCUSSION

The results support the results of previous studies using longitudinal data. Furthermore, the effect of widowhood varies among the 11 countries in the subsample although only a small amount of the variation in the increase of depressive symptoms after becoming widowed can be explained by such contextual factors.

Spousal loss and health in late life: moving beyond emotional trauma

OBJECTIVE

This study queries the linkage of older adults' spousal loss to multiple dimensions of their health.

METHODS

Data are from the 2005-2006 National Social Life, Health, and Aging Project, nationally representative of U.S. adults ages 57 to 85. Analyses examine associations of spousal loss and time since loss with multiple health dimensions.

RESULTS

Spousal loss is linked to a system of mental, social, behavioral, and biological issues, consistent with a stress-induced weathering process. Biological problems are more uniformly associated with women's than men's loss. While emotional sequelae may partially subside with time, a range of other outcomes remain worse even among individuals a decade or more past loss, than those with current partners.

DISCUSSION

Older adults' spousal loss influences multiple dimensions of their health. Gender differences in biological linkages suggest women's greater physiological vulnerability to this weathering event. Effects of loss are long term rather than transient, especially with biological conditions.

Informal care, health and mortality

Informal care provision is an activity in which individuals are increasingly likely to become involved across their life course, and particularly in later life, as a result of demographic changes such as increasing longevity and changes in co-residential living arrangements in later life. Academic research so far has highlighted the adverse impact of informal care provision on the financial position of the carer, however, the evidence on the impact of informal care provision on the carer's physical, mental and emotional health, and on their mortality, presents a more complex picture. This paper reviews research from the UK and beyond on the provision of informal care and its subsequent impact on health and mortality outcomes. Two key findings emerge from this review paper. Firstly, the cross-sectional analysis of data shows mixed associations between informal care provision and poor health outcomes for the carer. Such research highlights the importance of the demographic and socio-economic characteristics of the carer and the person cared for, and of the specific characteristics and nature of the care provided (e.g. duration, level). Secondly, longitudinal analysis, which typically benefits from a longer timeframe to follow up the impact of caring, shows that although informal care provision is not per se associated with adverse health and mortality outcomes, nevertheless particular types and durations of caring have shown negative outcomes.

Is use of formal community services by older women related to changes in their informal care arrangements?

This paper examines how the relationships between the factors (predisposing, enabling and illness) of the 1973 Andersen framework and service use are influenced by changes in the caring role in older women of the 1921–26 cohort of the Australian Longitudinal Study on Women's Health. Outcome variables were the use of three formal community support services: (a) nursing or community health services, (b) home-making services and (c) home maintenance services. Predictor variables were survey wave and the following carer characteristics: level of education, country of birth, age, area of residence, ability to manage on income, need for care, sleep difficulty and changes in caring role. Carer changes were a significant predictor of formal service use. Their inclusion did not attenuate the relationship between the Andersen framework factors and service use, but instead provided a more complete representation of carers' situations. Women were more likely to have used support services if they had changed into or out of co-resident caring or continued to provide co-resident care for a frail, ill or disabled person, needed care themselves, and reported sleep difficulties compared with women who did not provide care. These findings are important because they indicate that support services are particularly relevant to women who are changing their caring role and who are themselves in need of care.

Gender inequality from beyond the grave: intra-household distribution and wellbeing after spousal loss

The present article integrates research on spousal loss among older people and research on intra-household income distribution and relates pre-loss intra-household distribution of incomes to post-loss wellbeing. Data are drawn from the Swedish Panel Survey of Ageing and the Elderly (PSAE) and consist of couples that were married in the mid-1990s (N=1,503) and that were either still married (N=1,262) or who had experienced spousal loss (N=241) in 2002–03. The results showed that large intra-household pre-loss income differences increased the occurrence of psycho-social problems among both widows and widowers. Hence, unequal intra-household distribution of resources makes the coping process harder for both men and women. It was also shown that unequal pre-loss distribution of incomes affected a measure of global wellbeing among widowers. Widows suffered to a greater degree from economic difficulties, but these difficulties were not related to pre-loss distribution of incomes. Thus, the overall results showed that a gendered labour market that generates an unequal intra-household distribution of incomes has repercussions not only for gender equality among intact households, but also for the coping process of both widows and widowers.

Effects of marital closeness on the transition from caregiving to widowhood

OBJECTIVE

To examine the effects of marital closeness on indicators of well-being (depressive symptoms, grief, and relief) as spouses transition from the role of caregiver to that of widowed person.

METHODS

118 spouses of persons with end stage renal disease were interviewed prior to and after the death of the patient. Spouses reported on marital closeness, multiple indicators of pre-death strain as reflected by subjective health, depressive symptoms, caregiving burden, and caregiving satisfaction, as well as post-loss feelings of grief, depression, and relief.

RESULTS

Hierarchical regressions indicated that post-loss grief was predicted by gender (b = 0.32, p < 0.001), self-reported health (b = -0.28, p < 0.01), marital closeness (0.22, p < 0.05), and pre-loss depressive symptoms (b = 0.19, p < 0.10). Caregiver burden (b = 0.28, p < 0.05) and marital closeness (b = -0.41, p < 0.001) before the death, predicted relief from the caregiver role post-loss. Subjective health (b = -0.21, p < 0.05) and pre-loss depressive symptoms (b = 0.47, p < 0.001) predicted change in depressive symptoms over time.

CONCLUSION

These data highlight differences in the experiences of grief, relief, and depressive symptoms and suggest that marital closeness plays a central role. Results are interpreted in terms of theory regarding marital quality. Implications for interventions to improve the lives of caregivers and newly widowed spouses are discussed.