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Challenges and Facilitators for Psychosocial Support when Aging and Dying in Place: A Rapid Review of the Literature. Can J Aging 2023; 42:135-153. [PMID: 35762308 DOI: 10.1017/s071498082200023x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Most seniors in Canada live at home and consistently indicate that they prefer to stay there for as long as possible. Consequently, this desire places increasing pressure on supports such as informal caregivers and community services. The current rapid review set out to examine the psychosocial aspects of aging and dying in place that point to gaps in programs and services to support this preference. We searched PubMed, PsycInfo, and Google Scholar for peer-reviewed entries, and identified 42 articles for analysis, which we charted on a form we created and tested. Lack of attention to the whole person, lack of preparation for the journey ahead, and difficulties establishing collaborative and trusting relationships were, broadly, the challenges identified. A blend of initiatives in the community combined with an integrated palliative approach to care may mitigate some of the challenges that limit options for aging and dying in place.
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Hsiao YH, Lee MC, Yeh CJ, Tai CJ, Lee SS. Social Participation and Survival in Widowed Persons: Results of the Taiwan Longitudinal Study on Aging. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182010974. [PMID: 34682721 PMCID: PMC8535271 DOI: 10.3390/ijerph182010974] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 10/15/2021] [Accepted: 10/16/2021] [Indexed: 12/24/2022]
Abstract
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.
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Affiliation(s)
- Yu-Han Hsiao
- Department of Public Health, Chung Shan Medical University, Taichung 40201, Taiwan; (Y.-H.H.); (C.-J.Y.)
- Department of Family Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung 40343, Taiwan;
| | - Meng-Chih Lee
- Department of Family Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung 40343, Taiwan;
- Institute of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli 35053, Taiwan
- College of Management, Chaoyang University of Technology, Taichung 41331, Taiwan
| | - Chih-Jung Yeh
- Department of Public Health, Chung Shan Medical University, Taichung 40201, Taiwan; (Y.-H.H.); (C.-J.Y.)
| | - Chi-Jung Tai
- Department of Family Medicine, Pingtung Hospital, Ministry of Health and Welfare, Pingtung 90054, Taiwan
- Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Correspondence: (C.-J.T.); (S.-S.L.)
| | - Shiuan-Shinn Lee
- Department of Public Health, Chung Shan Medical University, Taichung 40201, Taiwan; (Y.-H.H.); (C.-J.Y.)
- Correspondence: (C.-J.T.); (S.-S.L.)
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Predictors and Importance of Social Aspects in Ikigai among Older Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168718. [PMID: 34444474 PMCID: PMC8391354 DOI: 10.3390/ijerph18168718] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 08/12/2021] [Accepted: 08/15/2021] [Indexed: 12/15/2022]
Abstract
Ikigai is a unique Japanese concept that encompasses not only joy and happiness, but also the purpose and meaning of life. The purpose of this study was to explore the factors that contribute to Ikigai, an important concept in the health of older women, and to clarify the relationship between Ikigai and the enhancement of the social aspects of their health. The participants in this longitudinal study, conducted between October 2017 and February 2020, were physically healthy older women aged 65 years and above (N = 132). Physical function and social activity were used as predictors of Ikigai. In addition, willingness for new interactions was used to examine the social aspects of health. A causal model was created from these factors, and path analysis was performed. The results demonstrated that participating in numerous interpersonal activities was predictive of increased Ikigai, but physical function was not. In addition, Ikigai was found to affect the willingness for new interactions. Further, Ikigai could be related to the willingness for new interactions. To enhance the social aspects of older women’s health, it is necessary to focus on Ikigai.
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The double burden of poverty and marital loss on the mental health of older Australian women; a longitudinal regression analysis using 17 annual waves of the HILDA cohort. Soc Psychiatry Psychiatr Epidemiol 2021; 56:1059-1068. [PMID: 33415407 DOI: 10.1007/s00127-020-02019-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 12/22/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE Compared to men, older women have poorer mental health and are more vulnerable to poverty, especially when living alone. However, few studies have examined how gender, marital status and poverty are inter-related and are associated with mental health. This study examines the gendered associations between relative poverty, marital status and mental health in older Australians. METHODS Drawing on 17 waves of the HILDA Survey, fixed-effects longitudinal regression analysis was utilised to examine the association between: (1) relative poverty (< 50% median household income) and mental health (MHI-5); (2) marital status and poverty, in a cohort of Australians aged 65 + years. We then examined effect modification of the association between relative poverty and mental health by marital status. RESULTS Within-person associations, stratified by gender, showed that women in relative poverty reported poorer mental health than when not in relative poverty, however no association was observed for men. Being divorced/separated was associated with increased odds of relative poverty for women, but not men. Widowhood was strongly associated with relative poverty in women, and also among men, albeit a smaller estimate was observed for men. There was no evidence of effect modification of the relationship between relative poverty and mental health by marital status for either men or women. CONCLUSION This study provides evidence that relative poverty is a major determinant of mental health in older Australian women. Addressing gender inequities in lifetime savings, as well as in division of acquired wealth post marital loss, may help reduce these disparities.
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Oe H, Yamaoka Y. Investigating into the critical factors supporting healthy independent longevity: A proposition of a conceptual model with measurements during and beyond COVID-19 pandemic. Health Mark Q 2021; 38:130-149. [PMID: 34693891 DOI: 10.1080/07359683.2021.1986961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
This study investigated the factors that support the elderly citizens' perceived healthy independent longevity during and beyond the COVID-19 pandemic. The Structural Equation Modeling was conducted with the 1607 dataset collected from Japan to validate a proposed model with six antecedent factors. It has been found that "Town vibrancy" and "Mobility and transportations" have the most significant impact, whereas "Health and welfare policies" and "Community bonding" have a relatively lower impact on their perceived healthy longevity. The study has provided a conceptual model with measurements for further discussions in the field of study.
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Affiliation(s)
- Hiroko Oe
- The Business School, Bournemouth University, Bournemouth, UK
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Stemen SE, de Medeiros K, Radina ME. Exploring cause of death as a factor in social convoy membership: the case of Pauline. J Women Aging 2020; 33:170-183. [PMID: 33170100 DOI: 10.1080/08952841.2020.1825033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Research integrating social convoy and continuing bonds frameworks suggests that deceased individuals can be included in convoys as connections may carry on after death. Building on this, we present a qualitative case study that explores whether such relationships are influenced by the way people die. Pauline, 67, compares the "natural" deaths of relatives to her husband's suicide. Analysis of Pauline's interview revealed that the unexplained death of her husband impacted her identity and contributed to his continued existence within her convoy. Consequently, the cause of death may be an important consideration for researchers integrating the social convoy and continuing bonds frameworks.
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Affiliation(s)
- Sara E Stemen
- Department of Sociology and Gerontology , Miami University, Oxford, Ohio, USA
| | - Kate de Medeiros
- Department of Sociology and Gerontology , Miami University, Oxford, Ohio, USA
| | - M Elise Radina
- Department of Sociology and Gerontology , Miami University, Oxford, Ohio, USA
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Sekgobela G, Peu M, van der Wath A. "They brought my smile back": A phenomenological description of widows' experiences of psychosocial support. DEATH STUDIES 2019; 45:603-612. [PMID: 31584347 DOI: 10.1080/07481187.2019.1671542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The consequences of widowhood can be overwhelming. Widows sometimes experience difficulties to obtain psychosocial support to overcome the challenges they face. In this phenomenological study, purposively selected widows were asked about their experiences of widowhood in terms of different sources of support. The analysis illuminated the meaning widows attach to different sources of psychosocial support. Participants experienced both positive and negative encounters with their sources of support. During negative encounters, widows experienced feelings of disappointment; and when their psychosocial support needs were met, they experienced a sense of happiness and a positive level of satisfaction.
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Affiliation(s)
- Gopolang Sekgobela
- Department of Nursing Science, University of Pretoria, Pretoria, South Africa
| | - Mmapheko Peu
- Department of Nursing Science, University of Pretoria, Pretoria, South Africa
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Sekgobela GL, Peu DM, van der Wath AE. Health-Support Needs of Widows in South Africa: A Phenomenological Inquiry. OMEGA-JOURNAL OF DEATH AND DYING 2018; 81:507-522. [PMID: 29979112 DOI: 10.1177/0030222818786416] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Community health care should facilitate effective adaptation to widowhood. In South Africa, the primary health-care nurses, who are the first-line health-care services, seem to miss opportunities for identifying and effectively managing widows experiencing health risks. This study explored the health-support needs of widows. We purposively selected 12 participants, who were widows between 25 and 65 years old residing in an urban area of South Africa. Data were gathered during unstructured individual phenomenological interviews and analyzed using a descriptive phenomenological method. Widowhood is an embodied and intense emotional experience with a cognitive impact. Related to these experiences are widows' health-support needs. Widows have a need to be listened to and to be understood and cared for; attitudes and skills which require time and availability from primary health-care nurses. Widows expressed a need to engage in support groups, receive home visits, and receive health education from primary health-care nurses.
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Affiliation(s)
- Gopolang L Sekgobela
- Department of Nursing Science, Faculty of Health Sciences, University of Pretoria, South Africa
| | - Doriccah M Peu
- Department of Nursing Science, Faculty of Health Sciences, University of Pretoria, South Africa
| | - Anna E van der Wath
- Department of Nursing Science, Faculty of Health Sciences, University of Pretoria, South Africa
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Escolar-Pujolar A, Córdoba Doña JA, Goicolea Julían I, Rodríguez GJ, Santos Sánchez V, Mayoral Sánchez E, Aguilar Diosdado M. The effect of marital status on social and gender inequalities in diabetes mortality in Andalusia. ACTA ACUST UNITED AC 2017; 65:21-29. [PMID: 29233513 DOI: 10.1016/j.endinu.2017.10.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Revised: 09/21/2017] [Accepted: 10/01/2017] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To assess the modifying effect of marital status on social and gender inequalities in mortality from diabetes mellitus (DM) in Andalusia. MATERIAL AND METHODS A cross-sectional study was conducted using the Andalusian Longitudinal Population Database. DM deaths between 2002 and 2013 were analyzed by educational level and marital status. Age-adjusted rates (AARs) and mortality rate ratios (MRRs) were calculated using Poisson regression models, controlling for several social and demographic variables. The modifying effect of marital status on the association between educational level and DM mortality was evaluated by introducing an interaction term into the models. All analyses were performed separately for men and women. RESULTS There were 18,158 DM deaths (10,635 women and 7,523 men) among the 4,229,791 people included in the study. The risk of death increased as the educational level decreased. Marital status modified social inequality in DM mortality in a different way in each sex. Widowed and separated/divorced women with the lowest educational level had the highest MRRs, 5,1 (95%CI: 3,6-7,3) and 5,6 (95% CI:3,6-8,5) respectively, while single men had the highest MRR, 3,1 (95%CI: 2,7-3,6). CONCLUSIONS Educational level is a key determinant of DM mortality in both sexes, and is more relevant in women, while marital status also plays an outstanding role in men. Our results suggest that in order to address inequalities in DM mortality, the current focus on individual factors and self-care should be extended to interventions on the family, the community, and the social contexts closest to patients.
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Affiliation(s)
- Antonio Escolar-Pujolar
- Consejería de Salud de la Junta de Andalucía, Delegación Territorial en Cádiz, Cádiz, España.
| | | | | | | | - Vanesa Santos Sánchez
- Dipartamenti di Scienze Economiche e Aziendali, Università degli Studi di Sassari, Sassari, Cerdeña, Italia
| | | | - Manuel Aguilar Diosdado
- Servicio de Endocrinología y Nutrición, Hospital Universitario Puerta del Mar, Servicio Andaluz de Salud, Cádiz, España
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Hin S, Ogórek B, Hedefalk F. An Old Mom Keeps You Young: Mother's Age at Last Birth and Offspring Longevity in Nineteenth-Century Utah. BIODEMOGRAPHY AND SOCIAL BIOLOGY 2016; 62:164-181. [PMID: 27337552 DOI: 10.1080/19485565.2015.1124325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
This study analyzes the intergenerational effects of late childbearing on offspring's adult longevity in a population in Utah (United States) that does not display evidence of parity-specific birth control-a so-called natural fertility population. Studies have found that for women who experience late menopause and prolonged reproduction, aging is postponed and longevity is increased. This is believed to indicate female "robustness" and the impact of biological or genetic factors. If indeed there is a genetic component involved, one would expect to also find evidence for the intergenerational transmission of longevity benefits. Our study investigates the relationship between prolonged natural fertility of mothers and their offspring's survival rates in adulthood. Gompertz regression models (N = 7,716) revealed that the offspring of mothers who were naturally fertile until a relatively advanced age lived significantly longer. This observed positive effect of late reproduction was not independent of but conditional upon survival of the mother to the end of her fecundity (defined as age 50). Offspring's relative risks at death beyond age 50 were 6-12 percent lower than those of their counterparts born to mothers who had an average age at last birth. Our results, which account for various early, adult, and later-life conditions, as well as shared frailty, suggest that there is a positive relationship between mother's age at last birth and offspring longevity, and strengthen the notion that age at menopause is a good predictor of this relationship.
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Affiliation(s)
- Saskia Hin
- a Centre for Sociological Research , University of Leuven , Leuven , Belgium
| | - Bartosz Ogórek
- b Faculty of Humanities , Pedagogical University , Krakow , Poland
| | - Finn Hedefalk
- c Department of Physical Geography and Ecosystem Science , Lund University , Lund , Sweden
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Kennaugh R, Byles J, Tavener M. Beyond widowhood: Do prior discovered themes that describe the experiences of older Australian widowed women persist over time? Women Health 2015; 56:827-42. [PMID: 26624986 DOI: 10.1080/03630242.2015.1118731] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
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.
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Affiliation(s)
- Robyn Kennaugh
- a Priority Centre for Generational Health and Ageing, School of Medicine and Public Health, Hunter Medical Research Institute , University of Newcastle , Newcastle , New South Wales , Australia
| | - Julie Byles
- a Priority Centre for Generational Health and Ageing, School of Medicine and Public Health, Hunter Medical Research Institute , University of Newcastle , Newcastle , New South Wales , Australia
| | - Meredith Tavener
- a Priority Centre for Generational Health and Ageing, School of Medicine and Public Health, Hunter Medical Research Institute , University of Newcastle , Newcastle , New South Wales , Australia
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DiGiacomo M, Lewis J, Phillips J, Nolan M, Davidson PM. The business of death: a qualitative study of financial concerns of widowed older women. BMC WOMENS HEALTH 2015; 15:36. [PMID: 25906773 PMCID: PMC4407784 DOI: 10.1186/s12905-015-0194-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 04/13/2015] [Indexed: 11/29/2022]
Abstract
Background The feminisation of ageing and increasing number of widowed women in contemporary society has significant implications. Older women are at risk of poor health, social, and economic outcomes upon widowhood. The aim of the study was to describe women’s experiences in the period soon after their husbands’ death, including their financial issues and concerns, and the ways in which these experiences impacted on the transition to widowhood late in life. Methods This was a longitudinal study using serial in-depth semi-structured interviews with 21 community-dwelling women over the age of 65 in Australia. Verbatim transcripts underwent Interpretive Phenomenological Analysis. Results Thematic analysis revealed: 1) administrative burden increases vulnerability; 2) gender roles impact on transitions; and 3) financial adjustments render housing insecurity and health risk. High administrative burden within the context of significant grief and mourning was a defining feature of the early bereavement period. Complicated protracted administrative processes, insensitive interactions, and reminders of loss contributed to distress, anxiety and feelings of demoralisation. Several women identified assumption of household financial management as the most difficult aspect of coping with their husband’s death. Conclusions Older women may have unmet needs for assistance with administrative, financial, and legal issues immediately following spousal death and potentially for years afterward. Lack of familiarity and absence of instrumental support with financial and legal issues signal the need for policy reform, resources to improve financial literacy in women throughout the life course, increased advocacy, and consideration of different support and service models.
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Affiliation(s)
- Michelle DiGiacomo
- University of Technology Sydney, Faculty of Health, PO Box 123, Broadway, New South Wales, 2008, Australia.
| | - Joanne Lewis
- University of Technology Sydney, Faculty of Health, PO Box 123, Broadway, New South Wales, 2008, Australia.
| | - Jane Phillips
- University of Technology Sydney, Faculty of Health, PO Box 123, Broadway, New South Wales, 2008, Australia.
| | - Marie Nolan
- Johns Hopkins University, School of Nursing, North Wolfe Street, Baltimore, MD, 21205, USA.
| | - Patricia M Davidson
- University of Technology Sydney, Faculty of Health, PO Box 123, Broadway, New South Wales, 2008, Australia. .,Johns Hopkins University, School of Nursing, North Wolfe Street, Baltimore, MD, 21205, USA.
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DiGiacomo M, Lewis J, Nolan MT, Phillips J, Davidson PM. Health transitions in recently widowed older women: a mixed methods study. BMC Health Serv Res 2013; 13:143. [PMID: 23597163 PMCID: PMC3648377 DOI: 10.1186/1472-6963-13-143] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Accepted: 04/16/2013] [Indexed: 11/19/2022] Open
Abstract
Background Older recently widowed women are faced with increased health risks and chronic conditions associated not only with bereavement, but also, older age. Loss and grief, adjusting to living alone, decreased income, and managing multiple chronic conditions can impact on older women’s ability to transition following recent spousal bereavement. Providing appropriate, timely, and effective services to foster this life transition is of critical importance, yet few services directed towards these women exist in Australia, and there is little data describing the experiences of women and their support needs at this time. Methods We conducted a longitudinal mixed method study using in-depth semi-structured interviews and questionnaires that were administered three times over a twelve month period to understand the experiences and needs of older women in the period following their husbands’ deaths. Descriptive statistics and Interpretive Phenomenological Analysis were used to analyse quantitative and qualitative data, respectively, prior to data integration. Results Participants were twenty-one community-dwelling recently widowed older women who were an average age of 71 (SD 6.13) years. The majority of participants scored within normal ranges of depression, anxiety, and stress, yet a subset of participants had elevated levels of each of these constructs (37%, 27%, and 19%, respectively) throughout the study period. Positive self-reports of general health predominated, yet 86% of participants were living with one or more chronic condition and taking an average of 4 medications per day. The majority (76%) experienced exacerbations of existing conditions or were diagnosed with a new illness in the early bereavement period, leading to planned and unplanned hospitalisations and other health service use. Qualitative data provided insight into these experiences, the meanings women ascribed to them, and their reasons for enacting certain health risk behaviours. Conclusions The combination of co-morbidities, polypharmacy, and risk behaviors impacted on medication management and appeared associated with health events. The feminization of ageing and an increasing number of older women living alone with multiple chronic conditions represent significant challenges to health services and societal support systems. Older women’s transition to widowhood signals concomitant health transitions and multidimensional support needs.
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Affiliation(s)
- Michelle DiGiacomo
- Centre for Cardiovascular and Chronic Care, Faculty of Health, University of Technology Sydney, PO Box 123, Broadway, NSW 2007, Australia.
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