Characteristics of the bereavement experience of older persons after spousal loss: An integrative review

“Data abstraction and synthesis Data synthesis followed the framework by Whittemore and Knafl (2005) and Whittemore (2008) (Table 1).”

“It is suggested that use of various coping styles, which shift between confronting the loss or attending to restorative aspects of living with the loss (oscillation) enables successful adjustment (Stroebe and Schut, 1999).”

“Traditional views of grief as a linear and normative process that ends with its resolution, expressed in breaking bonds and moving on with life have been widely questioned (Attig, 1996; Florczak, 2008; Moules, 1998; Neimeyer, 2001; Pilkington, 2006).”

“Thus, grieving is inherently about reconstructing life’s meaning (Neimeyer, 2001, 2005), relearning to live everyday life following the loss (Attig, 1996, 2001), attending to the loss and its everyday consequences through a complex and dynamic coping process (Stroebe and Schut, 1999, 2010), and remembering the decease…”

“…life’s narrative (Neimeyer, 2001, 2006), shatters persons’ familiar and taken-for-granted world (Attig, 1991), and requires a complex coping process that shifts between focusing on the loss experience itself and attending to the everyday consequences of the loss (Stroebe and Schut, 1999, 2010).”

“Research shows that individual and group therapybased interventions are often unnecessary and may only be beneficial for persons with a debilitating experience of grief (Jordan and Neimeyer, 2003; Schut et al., 2001).”

“…experience more depression, despair and distress (Bennett, 1997a,b, 1998; Onrust and Cuijpers, 2006), higher rates of institutionalization and an increased mortality risk compared to non-bereaved peers (Elwert and Christakis, 2008; Martikainen and Valkonen, 1996; Nihitilä and Martikainen, 2008).”

“Research shows that individual and group therapybased interventions are often unnecessary and may only be beneficial for persons with a debilitating experience of grief (Jordan and Neimeyer, 2003; Schut et al., 2001).”

“…Richardson et al., 2003), and which suggest that grief affects psychosocial health, depression and wellbeing (Bennett, 1997a,b; Byrne and Raphael, 1997, 1999; Fry, 2001; Mendes de Leon et al., 1994; Onrust and Cuijpers, 2006; Ott and Lueger, 2002; Turvey et al., 1999; van Grootheest et al., 1999).”

“Other dings, such as the reformulation of identity or changes independence are less established, albeit other existing search shows that a reorganization of social connections curs in bereavement (Balaswamy et al., 2004; Ha, 2008, 10; Ha et al., 2006; Lund et al., 1990; Stelle and Uchida, 04) .”

“Traditional views of grief as a linear and normative process that ends with its resolution, expressed in breaking bonds and moving on with life have been widely questioned (Attig, 1996; Florczak, 2008; Moules, 1998; Neimeyer, 2001; Pilkington, 2006).”

“…Richardson et al., 2003), and which suggest that grief affects psychosocial health, depression and wellbeing (Bennett, 1997a,b; Byrne and Raphael, 1997, 1999; Fry, 2001; Mendes de Leon et al., 1994; Onrust and Cuijpers, 2006; Ott and Lueger, 2002; Turvey et al., 1999; van Grootheest et al., 1999).”

“…Richardson et al., 2003), and which suggest that grief affects psychosocial health, depression and wellbeing (Bennett, 1997a,b; Byrne and Raphael, 1997, 1999; Fry, 2001; Mendes de Leon et al., 1994; Onrust and Cuijpers, 2006; Ott and Lueger, 2002; Turvey et al., 1999; van Grootheest et al., 1999).”

“A statistically ignificant decline in grief over time was found in three tudies that followed a cohort of widow/ers up to 30 onths (p < .01 to p < .001) (Carlsson and Nilsson, 2007; tt et al., 2007; Thompson et al., 1991).”

“…Richardson et al., 2003), and which suggest that grief affects psychosocial health, depression and wellbeing (Bennett, 1997a,b; Byrne and Raphael, 1997, 1999; Fry, 2001; Mendes de Leon et al., 1994; Onrust and Cuijpers, 2006; Ott and Lueger, 2002; Turvey et al., 1999; van Grootheest et al., 1999).”

“A clearer picture emerges when coping is examined in elation to grief resolution (Herth, 1990; Robinson, 1995), ealth dysfunction (Gass, 1987, 1988), or social support obinson, 1995).”

“Multiple losses pose many motional and practical challenges, such as facing failing ealth and symptoms, struggling with one’s limitations during everyday activities, living with an increased need for support, maintaining social connections and a sense of belonging, and reviewing one’s life and having hopes for the fut…”

“Introduction The loss of a close other through death is a pervasive xperience in old age (Lalive d’Epinay et al., 2009), with pousal loss being one of the most life-changing losses yrne and Raphael, 1994; Carr et al., 2001).”

“…before death of spouse and thereafter up to 29 months (16 per participant) Hermeneutic phenomenological analysis after Cohen, Kahn and Steeves X X X Thompson et al., 1991 and USA Gerontology Longitudinal, case– control study Effect of spousal bereavement on psychological distress Bereaved older…”

“, 2001), determine the amount of hours spent doing housework (Utz et al., 2004), and the extent of widows’ self-perceived independence (Bennett et al.”

“…propose that the experience of loss disrupts life’s narrative (Neimeyer, 2001, 2006), shatters persons’ familiar and taken-for-granted world (Attig, 1991), and requires a complex coping process that shifts between focusing on the loss experience itself and attending to the everyday…”

“According to Attig (2004), reavement threatens taken-for-granted life-worlds and srupts life’s narrative, leading to ‘‘an unravelling of the ily life and disruption of the flow of our life stories that e have accomplished through primary pre-reflective, n-deliberative, active, caring engagement…”

“…personal strength, finding meaning, religiosity, social support, caregiver stain Latent growth modelling based on structural equation modelling analytic framework X Kowalski and Bondmass, 2008 and USA Nursing Cross-sectional descriptivecorrelational study Physical and psychosocial symptoms of…”

“The findings of eight studies indicate that older, reaved persons have to reorient themselves in their cial world (Anderson and Dimond, 1995; Chan and Chan, 11; Harrison et al., 2004; Hegge, 1991; Holtslander et , 2011; Holtslander and Duggleby, 2010; Rodgers, 2004; ilson and Supiano, 2011).”

“Introduction The loss of a close other through death is a pervasive xperience in old age (Lalive d’Epinay et al., 2009), with pousal loss being one of the most life-changing losses yrne and Raphael, 1994; Carr et al., 2001).”

“A clearer picture emerges when coping is examined in elation to grief resolution (Herth, 1990; Robinson, 1995), ealth dysfunction (Gass, 1987, 1988), or social support obinson, 1995).”

“Included studies show that older, idowed persons use various activities and strategies to ve with their loss, in particular ‘‘keeping busy’’ and ‘‘being volved in routines and activities’’ (Anderson and imond, 1995; Brabant et al., 1992; Harrison et al., 004; Hegge, 1991; Hegge and Fischer, 2000; Hockey et al., 001; H…”

“Other dings, such as the reformulation of identity or changes independence are less established, albeit other existing search shows that a reorganization of social connections curs in bereavement (Balaswamy et al., 2004; Ha, 2008, 10; Ha et al., 2006; Lund et al., 1990; Stelle and Uchida, 04) .”

“For women, age and grief correlated ositively (Sable, 1991).”

“Moreover, it has been found that newly widowed, older persons experience more depression, despair and distress (Bennett, 1997a,b, 1998; Onrust and Cuijpers, 2006), higher rates of institutionalization and an increased mortality risk compared to non-bereaved peers (Elwert and Christakis, 2008;…”

“Thus, grieving is inherently about reconstructing life’s meaning (Neimeyer, 2001, 2005), relearning to live everyday life following the loss (Attig, 1996, 2001), attending to the loss and its everyday consequences through a complex and dynamic coping process (Stroebe and Schut, 1999, 2010), and remembering the decease…”

“…a continued engagement with their lost partner as a source of comfort (Anderson and Dimond, 1995; Carlsson and Nilsson, 2007; Carnelley et al., 2006; Costello and Kendrick, 2000; Harrison et al., 2004; Hegge and Fischer, 2000; Hockey et al., 2001; Vale-Taylor, 2009; Wilson and Supiano, 2011).”

“…a continued engagement with their lost partner as a source of comfort (Anderson and Dimond, 1995; Carlsson and Nilsson, 2007; Carnelley et al., 2006; Costello and Kendrick, 2000; Harrison et al., 2004; Hegge and Fischer, 2000; Hockey et al., 2001; Vale-Taylor, 2009; Wilson and Supiano, 2011).”

“Two studies found that the most frequent leisure activities were talking or getting together with family or friends, gardening, religion, walking or sports, and reading or watching TV (Janke et al., 2008; Patterson, 1996).”

“…62 Questionnaire Herth Hope Scale Jalowiec Coping Scale Grief Resolution Index Pearson correlation ANOVA with Turkey HSD post hoc test Multiple regression X Hockey et al., 2001 and UK Qualitativeexploratory study Practical and emotional challenges of sustaining meaningful life Widow/ers aged…”

“However, nurses and other health professionals regularly encounter and work with conjugally bereaved older persons in their clinical practice (Moules et al., 2007; White and Ferszt, 2009).”

“Included studies show that older, idowed persons use various activities and strategies to ve with their loss, in particular ‘‘keeping busy’’ and ‘‘being volved in routines and activities’’ (Anderson and imond, 1995; Brabant et al., 1992; Harrison et al., 004; Hegge, 1991; Hegge and Fischer, 2000; Hockey et al., 001; H…”

“Data abstraction and synthesis Data synthesis followed the framework by Whittemore and Knafl (2005) and Whittemore (2008) (Table 1).”

“oreover, studies report that older widow/ers experienced ense of discontinuation of time, or a disruption between e past, present, and the future, and a new perception of e future as limited and fraught with uncertainty (Chan d Chan, 2011; Holtslander et al., 2011; Holtslander and ggleby, 2010).”

“…of functional health CES-D Life satisfaction Coping and adaptation Classification of change in leisure activity ANOVA to determine association btw change or stability X Kim et al., 2011 and USA Nursing Longitudinal cohort study Data from Changing Lives of Older Couples (CLOC) study Trajectory of…”

“Both, qualitative and quantitative reearch approaches are useful to study the family bereaveent experience, and allow for the collection of interactive nd systemic family data and the use of the family as the nit of analysis (Feetham, 1991; Ganong, 2011; Gilliss, 983; Gilliss and Davis, 1992).”

“Even though spousal loss happens frequently at an dvanced age, bereavement is considered particularly hallenging for older persons because of concurrent losses utside a bereavement context (Jeffreys, 2011; Moss et al., 001; Pilkington, 2005).”

“…al., 2008; Richardson et al., 2003), and which suggest that grief affects psychosocial health, depression and wellbeing (Bennett, 1997a,b; Byrne and Raphael, 1997, 1999; Fry, 2001; Mendes de Leon et al., 1994; Onrust and Cuijpers, 2006; Ott and Lueger, 2002; Turvey et al., 1999; van Grootheest et…”

“, 2001; Stroebe, 2008), and their continued lationships with the deceased spouse (Boerner and hulz, 2009; Field and Filanosky, 2010; Field and iedrichs, 2004; Field et al., 2003; Sanger, 2009).”

“Concerns about finances and house ownership are also reported (Holtslander and Duggleby, 2010; Steeves and Kahn, 2005).”

“Studies show that relationships with family, friends, neighbours and other widow/er are a resource in bereavement (Bent and Magilvy, 2006; Carlsson and Nilsson, 2007; Harrison et al., 2004; Hockey et al., 2001; Holtslander and Duggleby, 2010; Jacob, 1996b; Robinson, 1995; Rodgers, 2004; Wilson and Supiano, 2011).”

“…Sickness Impact Profile t-Test or Chi-square test for differences Pearson and biserial correlation for associations ANOVA with Scheffè post hoc test X Harrison et al., 2004 and USA Nursing Hermeneutic phenomenological study Widowhood experience African American widows 11 70 100 Interviews and…”

“…persons experience times in a day or a year that are particularly difficult, such as mealtimes, bedtime, anniversaries and specific seasons, and that they face challenges in dealing with spare time (Anderson and Dimond, 1995; Brabant et al., 1992; Holtslander and Duggleby, 2010; Steeves, 2002).”

“Such a gender focus may be a result of the fact that some consider widowhood a women’s health issue due to the feminization of old age (Williams et al., 2006).”

“Multiple losses pose many motional and practical challenges, such as facing failing ealth and symptoms, struggling with one’s limitations during everyday activities, living with an increased need for support, maintaining social connections and a sense of belonging, and reviewing one’s life and having hopes for the fut…”

“Both, qualitative and quantitative reearch approaches are useful to study the family bereaveent experience, and allow for the collection of interactive nd systemic family data and the use of the family as the nit of analysis (Feetham, 1991; Ganong, 2011; Gilliss, 983; Gilliss and Davis, 1992).”

“Other dings, such as the reformulation of identity or changes independence are less established, albeit other existing search shows that a reorganization of social connections curs in bereavement (Balaswamy et al., 2004; Ha, 2008, 10; Ha et al., 2006; Lund et al., 1990; Stelle and Uchida, 04) .”

“Journal of Advanced Nursing 23 (2), 287–294. wles, K.V., Rodgers, B.L., 1991.”

“The combination of the use of many coping styles and high effectiveness was associated with good social integration (p .05) (Robinson, 1995).”

“The findings of eight studies indicate that older, reaved persons have to reorient themselves in their cial world (Anderson and Dimond, 1995; Chan and Chan, 11; Harrison et al., 2004; Hegge, 1991; Holtslander et , 2011; Holtslander and Duggleby, 2010; Rodgers, 2004; ilson and Supiano, 2011).”

“…loss, in particular ‘‘keeping busy’’ and ‘‘being volved in routines and activities’’ (Anderson and imond, 1995; Brabant et al., 1992; Harrison et al., 004; Hegge, 1991; Hegge and Fischer, 2000; Hockey et al., 001; Holtslander et al., 2011; Jacob, 1996b; McIntyre and Howie, 2002; Rodgers, 2004;…”

“…from the reviewed studies whether dependence on family is increased by widowhood or other factors, such as old age and health status, but some studies report that the availability of family seems to influence the amount of support older persons receive (Bennett et al., 2010; Utz et al., 2004).”

“…persons experience times in a day or a year that are particularly difficult, such as mealtimes, bedtime, anniversaries and specific seasons, and that they face challenges in dealing with spare time (Anderson and Dimond, 1995; Brabant et al., 1992; Holtslander and Duggleby, 2010; Steeves, 2002).”

“…relationships with family, friends, neighbours and other widow/er are a resource in bereavement (Bent and Magilvy, 2006; Carlsson and Nilsson, 2007; Harrison et al., 2004; Hockey et al., 2001; Holtslander and Duggleby, 2010; Jacob, 1996b; Robinson, 1995; Rodgers, 2004; Wilson and Supiano, 2011).”

“Other dings, such as the reformulation of identity or changes independence are less established, albeit other existing search shows that a reorganization of social connections curs in bereavement (Balaswamy et al., 2004; Ha, 2008, 10; Ha et al., 2006; Lund et al., 1990; Stelle and Uchida, 04) .”

“Concerns about finances and house ownership are also reported (Holtslander and Duggleby, 2010; Steeves and Kahn, 2005).”

“Traditional views of grief as a linear and normative process that ends with its resolution, expressed in breaking bonds and moving on with life have been widely questioned (Attig, 1996; Florczak, 2008; Moules, 1998; Neimeyer, 2001; Pilkington, 2006).”

“However, nurses and other health professionals regularly encounter and work with conjugally bereaved older persons in their clinical practice (Moules et al., 2007; White and Ferszt, 2009).”

“…the reviewed studies are flected in other studies, such as widow/ers’ sense of neliness (Byrne and Raphael, 1997; Costello, 2002; ewart et al., 2001; Stroebe, 2008), and their continued lationships with the deceased spouse (Boerner and hulz, 2009; Field and Filanosky, 2010; Field and iedrichs,…”

“Even though spousal loss happens frequently at an dvanced age, bereavement is considered particularly hallenging for older persons because of concurrent losses utside a bereavement context (Jeffreys, 2011; Moss et al., 001; Pilkington, 2005).”

“Three of the clients were on their first holidays since spousal bereavement and it is clear that the holiday afforded these people time to negotiate their new identities as widow/ers in a social context and to evaluate their often pervasive sense of post-bereavement loneliness (Naef et al., 2013).”

“Furthermore, the longer people live the higher chance they have to experience the deaths of people close and beloved to them, which may trigger deterioration of elderly people’s physical function [40].”

“Bereavement of a spouse or a close person is related to periods of grief, loneliness, and other psychological reactions (Naef et al., 2013).”

“, withdrawal of life-sustaining treatments);(10) and distress at acclimating to a new lifestyle and daily routine.(11) Emerging evidence suggests that specialty palliative and hospice care positively impacts family caregivers after their care recipients die.”

“These differ‐ ent reviews identified important factors that influence aspects of physical health (Stahl & Schulz, 2014); identity, mental health (Holm & Severinsson, 2012; Lobb et al., 2010; Naef et al., 2013; Nseir & Larkey, 2013); and family relationships (Merz & De Jong Gierveld, 2016).”

“The importance of support throughout the entire process is crucial, including continued support after the loss of a loved one, as times of grief and sadness require a reconstruction of life without the loved one [45,48,59].”

“Naef et al. (2013) demonstrated that the need for social support appears to be related to a sense of loneliness, as well as difficult times of the day and year.”

“29 The present study aimed to (1) investigate LGBT+ specific experiences of partner bereavement; (2) to examine decision-making processes in relation to disclosure of relationships and identities; and (3) appraise the Acceptance-Disclosure Model of LGBT+ bereavement using primary qualitative data.”

“The pain, sorrow, and anguish of losing a loved one are ubiquitous in the grief literature (Naef et al., 2013).”

“Not surprisingly, grief counsellors help their clients express their emotions in positive ways, including tears (Naef et al., 2013).”

“Scholarship on older adult ( > 65) bereaved spouses is robust (see Naef et al., 2013), and as such, several researchers (e.g., Jones et al., 2019) have called for an examination of spousal loss in those under the age of 75.”

“The social activities of widowed people tend to be limited, as they are averse to social interaction and may lack the confidence to appear in public alone (Naef et al ., 2013).”

“Second, whereas the impact of spousal and child loss is relatively well understood (for reviews, see Kristiansen et al., 2019; Naef et al., 2013), less is known about the effects of losing less close but still important types of relationships including other family members and friends, which is the…”

“This differs from that of older widow(er)s who may be retired, facing health concerns, and no longer still have children at home (Naef et al., 2013).”

“Adopting a qualitative approach, our study reaf fi rmed the existing understanding of bereavement in old age, as a disruptive experience in which individuals can express resilience (e.g. Holm et al., 2019; Naef et al., 2013; Neimeyer & Holland, 2015; Newson et al., 2011).”

“Losing one ’ s spouse is often highly painful and has been associated with decreased well-being and health problems (Naef et al., 2013; Shor et al., 2012).”

“It is well established that social networks are an important source of support (Brazil et al. 2003, Naef et al. 2013, Powers et al. 2014).”

“This may result due to the loss of a spouse leading to disruptions in carrying out daily activities or routines [40].”

“Older adults have to face changes in their lives, such as widowhood, physiological changes, and health deterioration (Diekmann et al., 2020; Naef et al., 2013), and thus they will form their own unique preferences in the selection of tourist destinations and product types.”

“In the literature, the daily-life impact of spousal loss appeared to be less if the remaining spouse conducted an active coping strategy during informal care provision and after the loss (Miller et al., 2020; Naef et al., 2013).”

“In addition, selfcare is a key factor for resilience in older adults dealing with conjugal loss (Naef et al., 2013).”

“Nevertheless, as emphasized by Naef et al. (2013), widowhood induces the need to find and adjust to a new rhythm of life and to other routines.”

“Similar findings have been observed, with older persons expressing a quest for a new identity in the midst of life changes (Moore et al., 2006; Naef et al., 2013) .”

“…transition also entails the ability to pro-actively shape their lives, experiencing self-growth, learning new skills and assuming new roles (Naef et al., 2013), as leisure has been shown to offer opportunities for social support and a sense of belonging (Joseph & Southcott, 2019; Liechty…”

“외로움 은 배우자를 사별한 남성노인들에게 공통으로 나타난 정서 문 제이며[1,7,10,14,16], 사별 전부터 사별 후까지 지속한다는 결 과와 유사하였다[1,14].”

“Loss of a spouse is regarded as one of the most traumatic experiences an individual can endure (Boelen & Prigerson, 2007), and it typically affects women in later life (Naef et al., 2013).”

“Many older adults report being regularly bothered by these challenges (Naef et al., 2013).”

“Previous studies have reported an association between social activities and depression, as well as between social support and depressive symptoms in older widowed people (Holm et al., 2019; Naef et al., 2013).”

“For some be-reaved people, losing a family member may disrupt their daily lives because they have to deal with different daily living tasks on their own after the loss (Naef et al., 2013).”

“For instance, the integrative review based study of Naef et al. (2013) found that late life spousal bereavement was characterized by disruption of daily routine, loneliness, and increased health problems, and Holm et al. (2019) found that late life spousal bereavement was associated with emotional…”

“Apart from common bereavement outcomes such as the risk of prolonged grief, depression, and post-traumatic stress, be-reaved older adults may also face high mortality risk, poor physical health issues, identity challenges, and high-level loneliness (Naef et al., 2013; Neimeyer & Holland, 2015).”

“Finally, while not the focus of this paper, this study provides a rare, idiographic perspective on male widowhood, an area that remains underrepresented in grief and resilience research (Ang, 2023; Bennett et al., 2003; Naef et al., 2013; Rodger et al., 2006; Yu et al., 2021).”

“These experiences are further compounded by age-related changes, such as diminished physical and cognitive capacities, concurrent and cumulative losses, social isolation, and increasing dependence on others (Gerber et al., 2024; Naef et al., 2013).”

“As previously noted, the literature has typically reflected a female perspective on spousal bereavement (Naef et al., 2013).”

“, 2004)는 보고와 일치하며, 배 우자 사별 후 부정적 정서를 경험(Naef et al., 2013)하 게 됨으로써 더 가중되어 나타난 결과라 할 수 있다.”

“The decreased quality of sleep can be linked to changes in familiar routines or psychosocial responses and has been found to improve with time (Kowalski & Bondmass, 2008; Naef et al., 2013).”

“This experience is closely linked to increased mortality rates and can exacerbate the risk of various diseases in the months following the spouse ’ s death (Beischel, 2019; Kashani Khatib et al., 2019; Naef et al., 2013).”

“In a study, it was found that daily activities and routines of the elderly in grief were disrupted (Naef et al., 2013).”