"Take good care of yourself" An integrative review of older widows' self-care for health and well-being.

Take good care of yourself is a regard often said to older bereaved women. However, what does it mean? Though self-care is a well-known phenomenon within health, it is not well understood in the context of late life spousal bereavement and widowhood. We undertook an integrative review to synthesize knowledge of older women's self-care challenges, resources and activities when bereaved and in a healthy transition to widowhood. Good care refers to health-promoting self-care and can be explained as the older widows' ability to access and mobilize resources and activities that are significant for a healthy transition to widowhood.

A controlled trial of two mind-body interventions for grief in widows and widowers.

Objective: Following bereavement, yearning and grief rumination are repetitive cognitive processes that can lead to disordered grief. Mindfulness training (MT) has been shown to reduce maladaptive repetitive thought. The current quasi-randomized controlled trial examined the feasibility, acceptability, and preliminary efficacy of MT for bereavement-related grief. Method: Ninety-five widow(er)s (Mage = 67.5, 79% women, 98% White) between 6 months to 4 years post-loss were assigned to a 6-week MT intervention or a progressive muscle relaxation (PMR) intervention, or a wait-list condition. Outcome measures were grief severity (Revised Inventory of Complicated Grief), yearning (Yearning in Situations of Loss), rumination (Utrecht Grief Rumination Scale), and decentering (Experiences Questionnaire-Decentering) assessed at baseline, Weeks 2 and 4 of intervention, post-intervention, and 1-month post-intervention. Growth curve analysis examined group differences in rates of improvement in outcomes through follow-up and associations with improvement in grief severity. Results: The MT and PMR groups showed significant rates of decline in grief severity and yearning, though only the PMR group showed a greater rate of decline in grief severity than wait-list. All groups showed significant rates of decline in grief rumination. The PMR and wait-list groups showed significant rates of increase in decentering compared to the MT group. Conclusions: Results support the feasibility and acceptability of MT and PMR for widow(er)s as well as the preliminary efficacy of PMR for improving grief severity in widow(er)s compared to a wait-list control condition. With replication, PMR could be a standalone intervention for non-disordered grief or a component of treatment for disordered grief. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Complicated grief, unusual perceptual experiences, and hope in widowhood / Luto complicado, experiências perceptivas incomuns e esperança na viuvez / Duelo complicado, experiencias perceptuales inusuales y esperanza en la viudez

The overall objective of this study is to assess grief in religious widows and hope, and the frequency of unusual perceptual experiences after the death of the spouse. It is hypothesized that (H1) religious widows will experience a less complicated grief, (H2) a greater hope, and (H3) a higher frequency of unusual perceptual experiences than non-religious widows. Three instruments, the Complicated Grief Inventory, the Hope Scale, and the Hallucinations Questionnaire were administered to a sample consisting of religious widows and a control group (non-religious widows). The results showed that religious widows experienced less complicated grief than non-religious widows, and fewer feelings of pessimism about the death of the loved one. Religious widows who showed higher feelings of hope, compared to non-religious ones, tended to have fewer indicators of complicated grief. Furthermore, those religious widows who displayed feelings associated with remembering the deceased tended, for example, to hear voices and smell perfumes. It is possible that these occurrences may even be functional and adaptive in order to cope with the negative feelings of grief and loss, rather than resulting in a resource deficit mechanism for dealing with pain and hopelessness.

O objetivo geral deste estudo é avaliar o luto e a esperança em viúvas religiosas, e a frequência de experiências perceptivas incomuns após a morte do cônjuge. A hipótese é que (H1) viúvas religiosas experimentarão um luto menos complicado, (H2) mais esperança e (H3) maior frequência de experiências perceptivas incomuns do que viúvas não religiosas. Três instrumentos, o Inventário do Luto Complicado, a Escala de Esperança e o Questionário de Alucinações, foram administrados a uma amostra composta por viúvas religiosas e um grupo de controle (viúvas não religiosas). Os resultados mostraram que as viúvas religiosas experimentaram um luto menos complicado do que as viúvas não religiosas e menos sentimentos de pessimismo em relação à morte de um ente querido. As viúvas religiosas que mostraram maior senso de esperança, em comparação com as viúvas não religiosas, tendem a ter menos indicadores de luto complicado. Além disso, aquelas viúvas religiosas que demonstravam sentimentos associados à memória do falecido tendiam, por exemplo, a ouvir vozes e cheirar perfumes. É possível que essas ocorrências possam até ser funcionais e adaptativas para lidar com os sentimentos negativos de luto e perda, em vez de ser um mecanismo de déficit de recursos para lidar com a dor e a desesperança.

El objetivo general de este estudio es evaluar el duelo en viudas religiosas y la esperanza, y la frecuencia de experiencias perceptuales inusuales después de la muerte del cónyuge. Se hipotetiza que (H1) las viudas religiosas experimentarán menor grado de duelo complicado, (H2) mayor esperanza y (H3) mayor frecuencia de experiencias perceptuales inusuales que las viudas no religiosas. Se administraron tres instrumentos, el Inventario de Duelo Complicado, la Escala de Esperanza, y el Cuestionario de Alucinaciones a una muestra integrada por viudas religiosas y un grupo control (viudas no religiosas). Los resultados mostraron que las viudas religiosas experimentaban menos duelo complicado que las viudas no religiosas, y menos sentimientos de pesimismo en torno a la muerte del ser querido. Las viudas religiosas que mostraron mayor sentimiento de esperanza, en comparación con las no religiosas, tendieron a menos indicadores de duelo complicado. Además, aquellas viudas religiosas que mostraban sentimientos asociados al recuerdo del difunto tendían, por ejemplo, a oír voces y oler perfumes. Es posible que estas ocurrencias puedan incluso ser funcionales y adaptativas para afrontar los sentimientos negativos del duelo y la pérdida, en lugar de resultar un mecanismo de déficit de recursos para lidiar contra el dolor y la desesperanza.

PERCEPTION OF TIME PERSPECTIVE IN WIDOWS OF LAW ENFORCEMENT OFFICERS DURING THE FIRST YEAR AFTER THE LOSS.

OBJECTIVE: The aim: The aim of this study is to examine the impact of the loss of a loved one on the perception of subjective time as well as analyse the changes occurring during the psychological care programme, in which special attention was given to finding a new meaning in life. PATIENTS AND METHODS: Materials and methods: The study was undertaken with 240 wives of deceased law enforcement officers. The age of the respondents ranged from 28 to 56 years. According to the results of the analysis of personal data and interviews obtained during the empirical study, experimental and control groups were formed - 32 women who had been widows for up to one year and expressed a desire to receive psychological assistance formed an experimental group (EG), while 34 others formed a control group (CG). They subsequently participated in the formative part of the experiment which provided 10 months of psychological support with preliminary and repeated psycho-diagnostic testing. RESULTS: Results: The article theoretically analyses studies by foreign and domestic experts on a person's perception of his psychological time under the influence of emotional trauma. It presents the results of a comparative experimental psychological examination of the widows of law enforcement officers to determine the tendency for changes in the perception of the time perspective while experiencing grief. CONCLUSION: Conclusions: A break caused by a loss, especially that of a loved one, disrupts a holistic view of life. Such breaks result in mental health problems, which in turn impact social relations and social realisation. Timely psychological assistance helps solve problems of legitimising behavioural change and accumulating resources for adapting to changing life scenarios.

Bereavement among widowed Latinos in the United States: A systematic review of methodology and findings.

This study systematically reviewed the methodology and findings of 19 peer-reviewed studies on the experience of bereavement among widowed Latinos, including risk and protective factors to the health of this vulnerable population. Of these studies, 10 included quantitative data, 3 were qualitative studies, and 6 were narrative reviews. Results emphasized the relevance of cultural beliefs about death, rituals, religion, and Latino values (i.e., familismo, respeto, simpatía, personalismo) as common themes in the included studies, along with expressions of grief (e.g., Ataque de nervios, somatization) that vary by gender and acculturation. Risk factors associated with diminished well-being in this population included being a male, financial strain, cultural stressors, having an undocumented legal status, experiencing widowhood at a younger age, and having poor physical health. Effective coping strategies identified included having adequate social support primarily from family, religion and religious practices, the use of folk medicine, volunteering, and the use of emotional release strategies. Moreover, the results highlight that researches informing the health needs of widowed Latinos in the US is limited, and studies with enhanced methodological rigor are needed to better understand the complex needs of this vulnerable population.

The Role of Private Religious Practices, Spiritual Mindfulness, and Years Since Loss on Perceived Growth in Widowed Adults.

Private religiosity can lead to perceived growth after bereavement, but little is known about the role of mindfulness and the time since loss in widowed adults. Using data from the second panel of the Midlife in the United States study (MIDUS), this study examined adults (n = 250) who were married one time and became widowed. Results showed that spiritual mindfulness moderated the effect of private religious practices on personal growth, and that the association between spiritual mindfulness and positive reinterpretation was moderated by time since loss. A high level of spiritual mindfulness seems to benefit widowed adults' personal growth and positive reinterpretation. Additionally, the greater time since loss the more positive is the association between mindfulness and positive reinterpretation. No difference was found in means between widowed adults and a matched control group of non-widowed adults (n = 250) on personal growth and positive reinterpretation.

Psychological Health Benefits of Companion Animals Following a Social Loss.

BACKGROUND AND OBJECTIVES: In later life, the loss of a spouse due to divorce or widowhood is common and can lead to elevated depressive symptoms and loneliness. Research suggests that companion animal (CA) may be beneficial for psychological health, but limited research has explored whether CA can buffer negative consequences of social losses. RESEARCH DESIGN AND METHODS: This study uses data drawn from the Health and Retirement Study (HRS) to examine changes in depressive symptoms and loneliness in relation to a social loss among those with/without a CA. We used inverse-probability weighted regression to adjust for selection factors and isolate effects of CA ownership on changes in psychological health. RESULTS: Regardless of CA ownership, spousal loss was associated with psychological health consequences. Facing a social loss without a CA was related to statistically greater increases in depressive symptoms relative to those with a pet (2.580 vs. 1.207 symptoms, respectively). Similarly, experiencing a loss was associated with significantly greater increases in loneliness, with statistically greater increases in loneliness among those without a CA (p < .01). However, those with a CA did not experience greater increases in loneliness than those who did not experience a loss. DISCUSSION AND IMPLICATIONS: In later life, CA ownership may buffer against the detrimental consequences of major social losses on psychological health. Future research on the therapeutic effects of CA ownership, as well as pet therapy, during other major life stage transitions is needed to help isolate potential mechanisms driving the benefits of human-animal interactions.

Grief, depressive symptoms, and inflammation in the spousally bereaved.

Grief is conceptualized by strong negative emotions, which include longing, sadness, and preoccupations with thoughts, recollections, and images of the spouse. In the initial months after the loss of a spouse, those who are widowed are at risk for cardiovascular problems and premature mortality. In the general population, depression is characterized by chronic low-grade inflammation, a key predictor of cardiovascular problems, morbidity, and mortality. Although depression and grief share similarities, they are distinct constructs. We aimed to identify if grief was related to inflammation among those who had a spouse recently die. We also sought to determine if those who are widowed and already experience elevated levels of depressive symptoms compared with the general population had higher levels of inflammation compared with those who are widowed who report fewer depressive symptoms. Ninety-nine recently bereaved individuals (M = 84.74 days since passing, SD = 18.17) completed a blood draw and psychological assessments. Proinflammatory T cell-derived cytokines were assessed, which included interferon gamma (IFN-γ), interleukin (IL)-6, tumor necrosis factor alpha (TNF-α), IL17-A, and IL-2. Bereaved individuals with a higher grief severity (using an established cut-score) had higher levels of the proinflammatory cytokines IFN-γ, IL-6, and TNF-α than those with less grief severity. Those who experienced higher levels of depression exhibited elevated levels of proinflammatory cytokines compared with those who had lower levels of depression (using a continuous measure of depressive symptoms, as well as an established cut score). This is the first study to demonstrate that inflammatory markers can distinguish those who are widowed based on grief severity such that those who are higher on grief severity have higher levels of inflammation compared with those who are lower on grief severity. These findings also add to the broader literature on depression and inflammation by showing that even in a population with high levels of depressive symptoms, there is a positive relationship between depression and inflammation.

Correlations Among Self-Rated Health, Chronic Disease, and Healthcare Utilization in Widowed Older Adults in Taiwan.

BACKGROUND: Taiwan has a rapidly aging population. It is well known that older adults usually have worse health than younger adults, with widowed older adults at a particularly high risk of poor health. Widowed older adults experience the effects of bereavement, which affects their health. Therefore, health topics related to widowed older adults deserve special attention. PURPOSE: The aim of this study was to discuss self-rated health for chronic diseases and healthcare utilization among widowed older adults. METHODS: A cross-section of data was used to analyze self-rated health-related issues. Data were adopted from the National Health Interview Survey in Taiwan, with the data on adults aged 65 years and over extracted and included in the assessment. Multinomial logistic regression models were used to investigate the relationships between healthcare utilization and self-rated health and chronic disease variables. RESULTS: The main empirical results show worse self-rated health status among widowed older adults in comparison with their nonwidowed peers and worse health status for widowers than widows. Next, age was negatively correlated with health rating, whereas a positive correlation with health was found for education. In addition, chronic diseases, particularly stroke, were found to be a significant predictive factor related to poor health status. Similar results were observed for healthcare utilization, apart from traditional Chinese medicine. Older adults who habitually purchased and used traditional Chinese medicine were shown to enjoy relatively better health statuses. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: These findings identified that chronic diseases and healthcare utilization correlated strongly with self-rated health for widowed older adults. Therefore, self-rated health may be used as a screening tool by the National Health Insurance System in Taiwan, and the results may be referenced by public health officials who are responsible for developing welfare strategies to promote healthy aging among the widowed in Taiwan.

Patient and Provider Perspectives on a Mind-Body Program for Grieving Older Adults.

BACKGROUND: Spousal bereavement in older age is a major stressor associated with an increase in both mental and physical problems. The Stress Management and Resiliency Training: Relaxation Response Resiliency Program (SMART-3RP) is an 8-week multimodal mind-body program that targets stress and has been found efficacious in decreasing the mental and physical manifestations of stress in varied populations. This qualitative study sought to investigate the relevance, credibility, and feasibility of the SMART-3RP in the community. METHODS: Focus groups were conducted among both older widowed adults and providers who support them in the community (eg, chaplains, hospice bereavement coordinators). Transcripts were coded independently by coders trained in qualitative research. Codebooks were created based on both general themes and detailed subthemes present in the transcripts. RESULTS: Findings from 4 focus groups revealed a general convergence between the needs of recently widowed older adults reported by widow(er)s and community providers alike and needs identified in the literature. Several components of the SMART-3RP target many of these needs (eg, social support, stress awareness, coping skills), making both community providers and widow(er)s report that the SMART-3RP is logical (89%) and would be helpful (100%) and successful in reducing symptoms (78%). Additionally, all widow(er)s reported a willingness to participate (100%). Feedback from the focus groups was used to adapt the SMART-3RP to improve its relevance to grief-related stress. CONCLUSIONS: Our findings suggest that the SMART-3RP may be helpful in decreasing somatic and psychological distress in older adults who have lost a spouse.

Exploring the association of sense of coherence, and spiritual and religious beliefs in a rural population group on the island of Crete, Greece.

OBJECTIVES/AIM: This article reports the results of an observation study, aimed at exploring an association between spirituality, religiousness, and sense of coherence in a population group residing in a rural area of Crete, Greece. STUDY DESIGN AND METHODS: The study was conducted during the period 2007-2009. Subjects aged 65 years and older (n = 118) living in two remote and rural villages in the Heraklion county (Crete) were eligible. Eighty-nine people (51 women and 38 men) participated. Demographic data were obtained, and all participants were asked to complete the Greek version of the self-reported Royal Free Interview for Spiritual and Religious Beliefs, and the Sense of Coherence Scale. RESULTS: Most participants reported strong religious beliefs and this was found to be related with increased age. Widowed participants expressed greater religiousness and spirituality (p = 0.029). The total score for Sense of Coherence was negatively correlated with gender (women have lower scores, p < 0.05), marital status (widows presented lower scores, p < 0.001), and increased age. A strong positive correlation of the Sense of Coherence score with the Spiritual Scale as measured by three questions of the Royal Free Interview was also identified (p = 0.039). CONCLUSIONS: The impact of gender and marital status seem to be emerging determinants in defining sense of coherence among inhabitants of rural Crete. The positive association between religious/spiritual beliefs and sense of coherence deserves further attention to promote a multidimensional approach in its study.

Remarriage of war and terror widows: a triadic relationship.

The article focuses on the intimate relationships of remarried Israeli national widows. An analysis of interviews with 15 widows and 12 of their husbands demonstrated the widows' continuing connection to the deceased husband and thus gives further corroboration to the theory of "'continuing bonds'"; husbands also express their relationship as triadic, with the fallen husband assigned a unique position in the family constellation, albeit not threatening to the new husband. The article concludes with specific guidelines for planning therapeutic programs, e.g., recommending clients to use some symbolic objects, either abstract or concrete, to help widows rebuild their self-identity.

Translating research findings into community based theatre: More than a dead man's wife.

Increasingly, qualitative scholars in health and social sciences are turning to innovative strategies as a way of translating research findings into informative, accessible and enjoyable forms for the community. The aim of this article is to describe how the research findings of a doctoral thesis - a narrative study about 58 older women's experiences of widowhood - were translated into a unique and professionally developed script to form the basis for a successful theatrical production that has travelled extensively within Australia. This article reports on the process of collaboration between a researcher, a highly regarded Australian actor/script writer and an ensemble of well-known and experienced professional actors. Together the collaborating partners translated the research data and findings about growing older and 'widowhood' into a high quality theatre production. In particular, we argue in this paper that research-based theatre is an appropriate medium for communicating research findings about important life issues of concern to older people in a safe, affirming and entertaining manner. By outlining the process of translating research findings into theatre we hope to show that there is a real value in this translation approach for both researcher and audience alike.

Reconciliarse con la vida tras la pérdida: estudio de un caso de duelo / No disponible

Se pretende reflejar dos procesos simultáneos de creatividad, crecimiento y cambio, ambos a través del psicodrama. Mediante la exposición del trabajo psicodramático con un caso de duelo, se describe la evolución de la “paciente” en su reconciliación con la vida y se muestra cómo la terapeuta en formación va desarrollando la seguridad y espontaneidad necesaria en su práctica professional (AU)

It aspires to reflect two simultaneous processes on creativity, personal growth and change, both through Psychodrama. By the showing of a psychodrama training on a mourning case, the “patient” evolution is detailed in her reconciliation with life, and it shows how the therapist in training goes developing the necessary self-confidence and spontaneity for her professional practice (AU)

Widowhood, illegitimacy, marital reproduction and female longevity in a rural Spanish population.

Using data from parish and civil registers in a rural community in northwest Spain (Los Nogales), family reconstitution provided 1502 complete reproductive histories, of which 584 corresponded to first marriages of women dying after their 50th birthday. A homogeneous sample consisting of women married in the period 1877-1899 (N=311) provided information concerning their reproductive performance, including ages at first and last maternity and number of children born alive and surviving, which was related to the mother's post-menopausal longevity, also considering premarital fertility and her marital status (widow/married). The results obtained indicate that mothers with a lower proportion of children dying before the first birthday and the age of 15 (mainly males) have a greater post-reproductive longevity. Moreover, women with a more protracted end to their reproductive period and greater fertility live for more years beyond their 50th birthday. These results do not prove a causality between maternal longevity and more successful reproduction; instead, they are indicative of a holistic condition of health. A wide spectrum of favorable biological and environmental factors will have positive consequences for a woman's life trajectory, affecting both her reproductive performance and her own likelihood of surviving.

Changes among male and female visitors to practitioners of complementary and alternative medicine in a large adult Norwegian population from 1997 to 2008 (The HUNT studies).

BACKGROUND: The aim was to investigate changes in the prevalence and characteristics of male and female visitors to practitioners of complementary and alternative medicine (CAM) in a large adult population from 1997 to 2008. METHODS: Two cross sectional adult total population health surveys from Central Norwegian (the Nord-Trøndelag Health Studies (HUNT)). In 1997 42,277 and in 2008 50,713 respondents were included. Variables included demographics (age, education, working status), lifestyle (daily smoker, did hard physical activities), health status (self-rated health status, recent complaints, chronic complaints, psychiatric complaints, a range of diseases) and health care use (visit general practitioner, chiropractor). A test of difference between the results of multivariable logistic regression models for each year, including all variables, was used to analyse changes from 1997 to 2008. RESULTS: In 1997 9.4% (95%CI 9.1-9.6) of the population had visited a CAM practitioner in the last 12 months and this increased to 12.6% (12.3-12.9) in 2008 (p < 0.001 for difference). Prevalence of CAM use in females was almost twice as high as that in males both years. For males, the significant changes from 1997 to 2008 (p < 0.05) were an increase in odds of visiting for those under 50 years, who had a recent complaint, were widower or did hard physical activities. There was a decrease for males who had a university degree, psychiatric complaint or hay fever. For females there was an increase in the odds for those under 50 years, who had a recent complaint or chronic complaint. It was a decrease for females with reported fair global health, psychiatric complaint, hay fever or if they had visited a chiropractor. CONCLUSION: The increase in visits was mainly among younger people of both genders with more limited complaints. A larger proportion of the more healthy part of the population is increasing their visits to CAM practitioners.

Evaluation of effectiveness and satisfaction outcomes of a mental health screening and referral clinical pathway for community nursing care.

The study aimed to explore the effectiveness of a mental health screening and referral clinical pathway for generalist community nursing care of war veterans and war widow(er)s in Australia on outcomes of client self-reported mental health, quality of life, and client and carer satisfaction. The pathway was developed by literature review and consultation, then trialled and evaluated. Validated screening tools were embedded within the pathway to support generalist nurses' mental health decision making. Pre- and post-measures were applied. Clients on whom the pathway was trialled were invited to complete an evaluation survey questionnaire, as were their informal carers. Most clients and carers who responded to these questionnaires were highly satisfied or satisfied with care provided through application of the pathway. This study adds understanding about one way that community nurses might identify people with mental health difficulties. The trialled pathway, which was modified and refined following the study, is now available on the Internet as an evidence-based resource for community nurses in Australia to guide practice and maximize holistic care for war veterans and war widow(er)s where that care is funded by Department of Veterans' Affairs.

Religiosity influences on bereavement adjustments of older widows in Taiwan.

AIMS: To describe difficulties encountered by older widows in Taiwan and the impact of intrinsic or extrinsic religiosity on their coping strategies during early widowhood. BACKGROUND: There is very limited information about how Taiwan's widows cope with their bereavement and no studies reporting the relationship between religious beliefs and healthy adjustment during this distressing period. DESIGN: Between-method qualitative and quantitative triangulation was used. Semi-structured interviews were conducted and transcribed data were analysed by critical thematic analysis. RESULTS: Twenty women in Taiwan, >65 years old, (mean = 72.95) were interviewed within three years of being widowed. There were two informant groups: those with intrinsic religious beliefs and those with extrinsic religious beliefs. They all reported intrapersonal and interpersonal problems. Several major coping strategies arose: 'practising positive or negative attitudes for adaptation'; 'using person-focused actions'; and 'taking the initiative or passively seeking help from others or helping others'. Informants with intrinsic religious beliefs reported fewer coping problems by holding positive attitudes and taking multiple actions for adaptation. The extrinsic religious group had more negative adaptation attitudes, such as withdrawal and low self-esteem and practised less faith religious activities in worshipping ancestors, experiencing fatalism and using divination. They reported more coping problems than the intrinsic religious group. CONCLUSION: Widows in Taiwan have different coping problems and strategies in postbereavement adjustment, affected by their different religious beliefs systems. More research is required to establish the generalisabilty of these findings. RELEVANCE TO CLINICAL PRACTICE: Widows in Taiwan need to be assessed for their religious belief systems and how this affects their ability to cope during bereavement. Clinicians should actively provide grief support and encourage new methods of social adaptation, especially with widows with extrinsic religious beliefs who may have less self-esteem and negative adaptation behaviours.