Psychological adjustment to sudden and anticipated spousal loss among older widowed persons.

OBJECTIVES: This study examined if older adults' psychological adjustment to widowhood varies based on whether the death was sudden or anticipated and if these effects are mediated by death context characteristics (e.g., predeath caregiving, nursing home use, spouse's age at death, and couple's communication about the death). METHODS: The effects of forewarning on multiple indicators of mental health and grief were examined in a sample of 210 widowed persons who participated in the Changing Lives of Older Couples (CLOC) study. The CLOC is a probability sample of 1,532 married individuals aged 65 and older for whom baseline information was collected in 1987-88, with widowed persons reinterviewed 6, 18, and 48 months after spousal loss. RESULTS: Forewarning did not affect depression, anger, shock, or overall grief 6 or 18 months after the loss. Prolonged forewarning was associated with elevated anxiety both 6 and 18 months after the death. Sudden spousal death elevated survivors' intrusive thoughts at the 6-month follow-up only. Sudden death was associated with slightly higher levels of yearning among women but significantly lower yearning among men both 6 and 18 months after the loss. DISCUSSION: The findings call into question the widespread belief that grief is more severe if death is sudden and suggest a more complex relationship between bereavement and circumstances of spousal death.     

The effect of widowhood on older adults' social participation: an evaluation of activity,disengagement, and continuity theories

PURPOSE: This study evaluated how levels of social participation change as a result of late-life widowhood. Social participation is a multidimensional construct incorporating both formal (e.g., meeting attendance, religious participation, and volunteer obligations) and informal (e.g., telephone contact and social interactions with friends) social roles. DESIGN AND METHODS: Using data from the Changing Lives of Older Couples study, analyses compared widowed persons to continuously married control participants to evaluate whether widowhood affects older adults' levels of social participation. RESULTS: Widowed persons had higher levels of informal social participation than nonwidowed persons, whereas formal social participation levels were comparable between the two groups. Social participation levels decrease before the death of a spouse, primarily because of poor spousal health, and increase following the loss, because of increased support from friends and relatives. IMPLICATIONS: Maintaining continuity in the realm of social participation is a strategy older adults use to cope with spousal loss; however, not all widowed persons have the same resources to alter their levels of social participation.     

Women bear a burden: gender differences in health of older migrants from Turkey

Studies show that older migrants have poorer health than native populations in Western Europe. To date, little systematic research has explored the differences between men and women within older populations with migration backgrounds. This article examines gender-specific aspects and mediating mechanisms of self-reported health among older migrants from Turkey. Using a mixed method approach, data and results from a quantitative survey and a qualitative study conducted in Berlin, Germany, are analysed and integrated at the interpretive level. Standardised face-to-face interviews were carried out with the help of a network approach with 194 older migrants from Turkey (93 women, 101 men, mean age: 68). Potential mediators showing significant gender differences are included in a parallel multiple mediation analysis. The documentary method is used to analyse 11 semi-structured narrative interviews with first-generation labour migrants from Turkey. Women reported significantly worse subjective health than men (c = 0.443, bCI [0.165–0.736]), conveyed through greater functional limitations (ab = 0.183, bCI [0.056–0.321]) and emotional loneliness (ab = 0.057, bCI [0.008–0.128]). Respondents to the qualitative study perceived that women age earlier and have poorer health due to the burden of performing a greater variety of social roles. Higher levels of emotional loneliness among women could be caused by their experiences of negatively assessed partnerships. Our results show that as a group, older female migrants have an elevated health vulnerability. A broader scientific foundation regarding gender differences in the health of older migrants and their causes is needed to promote gender-sensitive prevention and care for this group.     

Childlessness and the psychological well-being of older persons

OBJECTIVES: Rapid growth in the size of the childless elderly population has prompted concerns about the negative effects of childlessness on psychological well-being. This study adds to this line of inquiry by examining the effects of childlessness on two important dimensions of elderly persons' psychological well-being: loneliness and depression. METHODS: Using the 1993 Asset and Health Dynamics Among the Oldest Old data set, the authors estimated logistic and ordinary least squares regression models of psychological well-being for a nationally representative sample of people aged 70 and older (N = 6,517). RESULTS: Childlessness per se did not significantly increase the prevalence of loneliness and depression at advanced ages, net of other factors. There also was no statistical evidence for the hypothesis that childlessness increases loneliness and depression for divorced, widowed, and never married elderly persons. Sex, however, altered how childlessness and marital status influenced psychological well-being. Divorced, widowed, and never married men who were childless had significantly higher rates of loneliness compared with women in comparable circumstances; divorced and widowed men who were childless also had significantly higher rates of depression than divorced and widowed women. DISCUSSION: The findings suggest that it is important to understand the consequences of childlessness in the context of marital status and sex.     

Cosmic transcendence, loneliness, and exchange of emotional support with adult children: a study among older parents in The Netherlands

Gerotranscendence defines a shift in meta-perspective from earlier materialistic and pragmatic concerns, toward more cosmic and transcendent ones in later life. Population-based studies that have empirically examined this concept using Tornstam’s gerotranscendence scale, highlight cosmic transcendence as a core component, which includes a sense of belongingness with past and future generations. Such generative concerns may increase expectations regarding the quality of the bond with one’s children in later life. This study examined whether the association between emotional support exchanged with children and feelings of loneliness later in life varied by the degree of cosmic transcendence of the older parent. Data from 1,845 older parents participating in a population-based study living in The Netherlands were analyzed from the 1995/1996 cycle of the Longitudinal Aging Study Amsterdam. Interviews included self-report measures of cosmic transcendence, loneliness, emotional support exchanged with children, health indicators, and marital status. Results indicated that a negative association between loneliness and level of emotional support exchanged with children was more pronounced among older parents with higher cosmic transcendence scores, in particular among the married. It is argued that cosmic transcendence reflects a sense of generativity and an increased emotional dependency on children in later life. Under favorable social conditions (supportive relationships with children and being married) cosmic transcendent views had a positive impact on social well-being in later life. When children no longer met emotional needs of older parents, cosmic transcendence increased feelings of loneliness.     

Social networks among men and women: the effects of age and socioeconomic status

OBJECTIVES: This study examines the main and interactive effects of age and socioeconomic status (SES) on social networks. METHODS: Respondents are drawn from a regional stratified probability sample aged 40 to 93 years. Hierarchical regression analysis estimates the influence of age and SES on dimensions of social networks, controlling for marital status and health among men and women. RESULTS: Among men, older age was associated with older networks. Professional men report networks that are less geographically proximal, however, occupational effects are most obvious in late life. Among women, age is associated with smaller networks that are older, less geographically proximal, and less frequently contacted. Whereas less education is associated with younger network members in midlife, among women in later life, lower levels of education are not associated with a younger network. Professional women report older networks composed of a higher proportion of friends than do homemakers. Higher levels of education are linked to larger personal networks among men and women, but not to the number of individuals considered closest. Among women, higher levels of education are also associated with less proximal networks. DISCUSSION: An examination of within-group variability reveals influences of age and SES on personal networks among men and women.     

Socio-demographic determinants of smoking among low-income women in Aleppo, Syria.

OBJECTIVES: To determine the spread and sociodemographic correlates of smoking among low-income women in Aleppo, Syria. METHODS: A sample of 412 women was recruited from eight randomly selected primary care centres (total number 22) in Aleppo. The response rate was 97.2%, the mean age of participants was 28 (+/- 8.4) years, and married women constituted 88.3% of those studied. A special questionnaire was prepared for study purposes, and interviews were conducted in an anonymous, one-to-one fashion. RESULTS: Current smoking and daily smoking were found among respectively 16.5% and 7.5% of those investigated. Smokers were older, economically better off and came from smaller households (P < 0.05 for all) than non-smokers. They also were more likely to be non-Arabs, Christians, and city residents than nonsmokers (P < 0.05 for all). Mental morbidity and physical abuse were both associated with smoking among those investigated (P < or = 0.05). Smokers among married women were more likely to marry later, to marry a nonrelative, to be older at the birth of their first child, and were less likely to live with members of their husband's family (P < 0.05 for all). Multivariate predictors of smoking status among married women were race, residence, household, consanguinity, working, mental morbidity and physical abuse. CONCLUSIONS: Our data show that the level of smoking among poor women in this society is still low compared to that of men, but it is higher than that of women in other social strata studied. Women's smoking is found to be associated with a less tradition-oriented social profile.     

Social and emotional loneliness among non-demented and demented elderly people

There is a lack of studies about loneliness and cognitive functioning among elderly people and, above all, among those with cognitive impairment. The aim of this study is to investigate loneliness, both social and emotional, in non-demented and demented elderly people. The study is based on 589 persons, who answered the question about social loneliness (often being lonely) in the Kungsholmen longitudinal project. All subjects were examined extensively to reach a diagnosis and to determine the dementia level. Data were collected through structured interviews on subjective social loneliness as well as emotional loneliness (feelings of loneliness, from often to never) and background variables (age, sex, housing and housing conditions). Non-demented elderly subjects reported themselves to be lonely significantly less often compared to demented subjects, but there were no differences in the emotional experience of loneliness. Social loneliness was more common in the different levels of dementia and increased with reduced cognitive functioning, while emotional loneliness decreased. Living together with someone and living in one's own apartment showed a positive influence on feelings of loneliness.     

Onset of loneliness in older adults: results of a 28?year prospective study

The goal of this research is to test whether often observed correlates of loneliness in older age are related to onset of loneliness longitudinally. Despite the increasing number of longitudinal studies, the investigation of factors that are related to onset of loneliness is still limited. Analyses are based on data of the TamELSA study, which is a population-based prospective study in Tampere, Finland and started in 1979. For the present study 469 older adults aged between 60 and 86 years at baseline, who were not lonely at baseline, were selected and followed-up in 1989, 1999 and 2006. During the 28 years of follow-up approximately one third (N = 178) of the study population developed feelings of loneliness. Logistic regression analyses indicated that losing a partner, reduced social activities, increased physical disabilities, increased feelings of low mood, uselessness and nervousness, rather than baseline characteristics, are related to enhanced feelings of loneliness at follow-up. The higher incidence of loneliness among women can be fully explained by the unequal distribution of risk factors among men and women (e.g., women more often become widowed). Our results are in line with the cognitive approach that conceptualizes loneliness as an unpleasant feeling due to a perceived discrepancy between the desired and the achieved level of social and personal resources.     

Social contacts and their relationship to loneliness among aged people - a population-based study

BACKGROUND: Emotional loneliness and social isolation are major problems in old age. These concepts are interrelated and often used interchangeably, but few studies have investigated them simultaneously thus trying to clarify their relationship. OBJECTIVES: To describe the prevalence of loneliness among aged Finns and to study the relationship of loneliness with the frequency of social contacts, with older people's expectations and satisfaction of their human relationships. Especially, we wanted to clarify whether emotional loneliness is a separate concept from social isolation. METHODS: The data were collected with a postal questionnaire. Background information, feelings of loneliness, number of friends, frequency of contacts with children, grandchildren and friends, the expectations of frequency of contacts as well as satisfaction of the contacts were inquired. The questionnaire was sent to a random sample of 6,786 aged people (>74 years) in various urban and rural areas in Finland. We report here the results of community-dwelling respondents (n = 4,113). MAIN RESULTS: More than one third of the respondents (39.4%) suffered from loneliness. Feeling of loneliness was not associated with the frequency of contacts with children and friends but rather with expectations and satisfaction of these contacts. The most powerful predictors of loneliness were living alone, depression, experienced poor understanding by the nearest, and unfulfilled expectations of contacts with friends. CONCLUSION: Our findings support the view that emotional loneliness is a separate concept from social isolation. This has implications for practice. Interventions aiming at relieving loneliness should be focused on enabling an individual to reflect her own expectations and inner feelings of loneliness.     

Influence of psychological characteristics and social relations on receiving preventive home visits in older men and women

The purpose was to analyze whether psychological characteristics and social relations in older men and women were related to accepting and receiving preventive home visits during 3 years, when offered as part of a national scheme. The study was based on secondary data from the Danish Intervention Study on Preventive Home Visits in 34 municipalities. The study population included 3,377 men and women who answered questions about psychological characteristics and social relations at baseline, survived and took part in the three year follow-up study. Number of preventive home visits was registered during 3 years in a specially designed software installed in the municipalities. Psychological characteristics were measured by questions on sadness, aggressiveness, life satisfaction, mood, loneliness and sense of coherence. Social relations were measured by questions on cohabitation status, diversity in social relations and social participation. Covariates included age and disability. Older men with poor psychological rating on most of the variables had larger odds ratios of accepting and receiving preventive home visits compared to older men with higher ratings. Older women with poor rating on the psychological characteristics and high social participation had larger odds of accepting and receiving preventive home visits, and women with a strong sense of coherence had larger odds of receiving many visits. It is concluded that psychological characteristics and social relations in older persons seem to influence whether they accept and receive preventive home visits, but patterns of associations are complex and vary for men and women.     

Social support and its correlation with loneliness: a cross-cultural study of Nepalese older adults

The aim of this study was to analyze the situation of social support exchange among elderly men and women and to study the cross-cultural validity of predictors of loneliness in two Nepalese castes/ethnicities of older adults. Data for this study were taken from a cross-sectional study of the elderly at least 60 years old living in one ward of Kathmandu City, conducted in 2005. Loneliness was measured using a three-item loneliness scale based on the University of California at Los Angeles (UCLA) Loneliness Scale. Sources of social support were classified as spouse, children living with their elders, children living apart, and friends/neighbors. Study findings indicate that the main social support exchange for the elderly was with adult children living together, spouse, and friends/neighbors. Results also show gender difference in social support. Significant variables of loneliness were social support received from spouse, social support provided to spouse, and children living together with both elderly parents. This finding shows there is a high degree of cross-cultural invariance in the predictor sources of social support on loneliness among two Nepalese castes/ethnicities older adults.     

Onset of mobility disability among community-dwelling old men and women. The role of tiredness in daily activities

BACKGROUND: in the primary prevention of disability among older adults it might be useful to identify individuals at high risk for functional decline before it occurs. OBJECTIVE: to examine whether tiredness in daily activities is an independent determinant of onset of mobility disability at 1 1/2-year follow-up among non-disabled older men and women. DESIGN: a prospective study with 1 1/2-year follow-up. SETTING: 34 communities in four counties in Denmark. SUBJECTS: 1396 older non-disabled adults (74-75 and 80 years old) living in 17 of the participating communities. METHODS: questionnaire surveys at baseline and at 1 1/2-year follow-up. Tiredness in daily activities was measured by questions about tiredness in six mobility activities. Onset of mobility disability was measured as onset of need for help in one to six mobility activities. RESULTS: men and women who felt tired in their daily activities at baseline had a higher risk of onset of mobility disability at 1 1/2-year follow-up, when adjusted by the covariates. In addition, low social participation, poor psychological function, and physical inactivity were independent risk factors of onset of mobility disability among men, and home help, low sense of coherence and physical inactivity were independent risk factors of onset of mobility disability among women. CONCLUSION: older people who complain about tiredness are at higher risk of becoming disabled than others. This highlights the need for alertness and management of this early sign of functional decline in a preventive perspective.     

Social interactions and depressive symptoms among community dwelling older adults in Nepal: A synergic effect model

In Asian families, where patriarchal family systems are common, living arrangements of older adults are characterized by residing with a married son. This study examines the synergic effects of intergenerational solidarity (emotional and instrumental support exchange and anticipated support) on depression of older adults from a developing country, Nepal. Gender differences are also explored in the study. This was a cross-sectional face-to-face interview study of 489 community dwelling older adults living in an urban area of Nepal. The data were analyzed using multiple regression models with each dimension of intergenerational solidarity and conflict variables entered one-by-one with the confounding variables. The results illustrate that older women receiving lower emotional and instrumental support were significantly more likely to be depressed compared to older men receiving less support from their son. Also, women reporting lower anticipated support and higher conflict with their son were more likely to be depressed than men. Regarding synergic effects, emotional support exchange buffered against the deleterious effects of conflict with depression in older adults. The results highlight a need for further research on late life intergenerational relationships (IR) and mental health of older adults in developing countries so that it can be useful for health care practitioners.     

A meta-analysis of change in marital and employment status as predictors of alcohol consumption on a typical occasion*

Meta-analysis is used to combine results of primary data from 12 longitudinal studies to examine the consistency of results with respect to the role of changes on the individual level in marital status and employment status on changes in consumption of alcohol per typical occasion. The analyses control for the effects of Time 1 consumption per occasion and education. Not getting married and becoming unmarried are associated with increased consumption at follow-up and both variables are positively related to increased consumption among older men, but only becoming unmarried was related to increased consumption among older women. Becoming married is homogeneously and negatively associated with consumption at follow-up for younger and older persons of both sexes. Chronic unemployment is negatively related to consumption at follow-up among older mates and younger females. Becoming unemployed between measurements is homogeneously and negatively related to consumption among older mates and females, but positively related among younger mates. Becoming employed is homogeneously and positively related to later consumption among all groups except young females.     

Spousal characteristics as predictors of well-being in older couples.

This study examined the relations between spousal variables and the psychological well-being of husbands and wives in older couples to determine if spousal characteristics were more important determinants of well-being for wives than for husbands. One hundred-twenty older married men and women completed standardized self-report measures and a short interview. The variables investigated included education, verbal intelligence, personality, physical health, marital adjustment, psychological well-being, as well as response bias to marital defensiveness. Spousal variables significantly predicted wives' well-being (R2 = 29%) with the three most influential predictor variables being the husbands' perception of the marriage, positive dimension of well-being and physical health. In contrast, spousal variables did not significantly predict husbands' well-being. The study supported the hypothesis of differential responsiveness of men and women to spousal variables and highlighted the importance of marital adjustment for the psychological well-being of older wives.     

Women's Sexual Health and Aging

Older women are often sexually active, but physicians caring for older women rarely address sexual concerns. Although women's desire for sex declines with age, a majority of older women rate sex as having importance in their lives. Women identify emotional intimacy as an important reason for engaging in sexual relationships. Women are less likely than men to have an available spousal or intimate partner and more likely to have a partner with sexual difficulties of their own. Up to half of sexually active older women report a distressing sexual problem, with low desire and problems related to genitourinary syndrome (vulvovaginal atrophy) being most common. Difficulty with orgasm in older women is often associated with a partner's erectile dysfunction. Sexually transmitted infections (STIs) are increasingly prevalent in older women. A minority of older women report discussing sexual issues with a physician. Most commonly, the patient initiates discussions. Physicians should ask regularly and proactively about sexual activity and function. Important interventions include offering practical advice to common chronic medical conditions and sexual problems that confront older women; treating vulvovaginal atrophy; and providing STI screening, prevention strategies, and treatment when appropriate.     

Older adults’ mentioned practices for coping with loneliness

In recent years, loneliness has been receiving increasing attention, yet there remains a lot to learn about how older adults cope with loneliness. In this study, the practices older adults consider for coping with loneliness and the relationship between various types of coping practices, loneliness, and personal resources are examined. Several hypotheses about the relationship between social and emotional loneliness, personal resources, and mentioning coping practices are formulated. Data was collected in Gipuzkoa (Basque Country, Spain) through structured interviews using a telephone survey among a representative sample of older adults aged 55 and over (N = 894). Results show that lonely and non-lonely respondents alike consider a few coping practices and prefer active and individual coping practices over social and passive ones for coping with loneliness. Experiencing emotional loneliness is related to mentioning more individual and active coping practices. Social coping practices were considered less often by respondents who experienced better self-rated health and more often by respondents with vision loss, a higher educational level and higher quality of life. In conclusion, while older adults differ in coping efforts they mention, these differences are only explained to a small extent by their experience of loneliness and available resources. For future research and practice development, a deeper understanding of the process of coping with loneliness is needed.

     

Gender Differences in Depressive Symptoms Among Older People Living in the Community

Objective: To study gender differences in depressive symptoms among older people. Method: Data obtained from a study of 533 women and 467 men aged 65 and over living independently in Melbourne were analysed to explore any gender differences in depressive symptoms. Results: There is a low prevalence of depressive symptoms among both older men and women living in the community, with a slightly higher prevalence among women. However, women were twice as likely as men to report sufficient symptoms to be classified as depressed. This gender difference was not explained by age, but was fully accounted for by either IADL dependency or marital status. In turn, widows were more likely to be classified as depressed because they were more often lonely. Conclusions: Women are more likely than men to be classified as depressed in community surveys of older people because they are more likely to experience an IADL dependency and because they are more likely as widows to experience loneliness.     

Social network, social support, and loneliness in older persons with different chronic diseases

OBJECTIVES. This study examines whether patterns of social network size, functional social support, and loneliness are different for older persons with different types of chronic diseases. METHODS. In a community-based sample of 2,788 men and women age 55 to 85 years participating in the Longitudinal Aging Study Amsterdam, chronic diseases status, social network size, support exchanges, and loneliness were assessed. RESULTS. Social network size and emotional support exchanges were not associated with disease status. The only differences between healthy and chronically ill people were found for receipt of instrumental support and loneliness. Disease characteristics played a differential role: greater feelings of loneliness were mainly found for persons with lung disease or arthritis, and receiving more instrumental support was mainly found for persons with arthritis or stroke. DISCUSSION. The specifics of a disease appear to play a (small) role in the receipt of instrumental support and feelings of loneliness of chronically ill older persons.