Journal of Qualitative Research in Health Sciences

Document Type : Original Article

Authors

1 Student Research Committee, Zeynab (P.B.U.H) School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran

2 Department of Nursing, Zeynab (P.B.U.H) School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran

10.34172/jqr.2024.13

Abstract

Background: Aging is a critical period of human life during which the elderly experience many losses. Difficult problems facing the elderly such as the loss of a loved one can be very stressful. Identifying the resilience factors of the elderly in this regard provides a clear path to achieving the concept of “successful elderly”. Accordingly, the present study aimed to explain the experiences of the elderly who have lost their spouse.
Methods: This study was conducted qualitatively using a content analysis approach. To collect data, semi-structured interviews were conducted with 24 elderly people who were selected through purposive sampling. Data analysis was performed according to the model proposed by Graneheim and Lundman. The accuracy and robustness of the data were also assessed based on Lincoln and Guba’s criteria.
Results: Three main categories including the purgatory of separation, manifestation of interests, and on the way to resilience were extracted from the findings that can explain the experiences of the elderly who lost their spouse in the specific sociocultural context of Iran.
Conclusion: The findings of the study reflected both positive and negative experiences affecting the elderly and emphasized the need for effective strategies to improve the situation according to the sociocultural conditions of Iran. Therefore, it is necessary for the elderly, their family members, and society as social capital to change attitudes and provide appropriate facilities while meeting the emotional, psychological, social, and economic needs of the elderly and considering their right to independence and empowerment.

Keywords

  1. Zhou J, Hearst N. Health-related quality of life of among elders in rural China: the effect of widowhood. Qual Life Res. 2016;25(12):3087-95. doi: 10.1007/s11136-016-1338-y.
  2. Khosravan S, Salehi S, Ahmadi F, Mansoorian MR. The experience of widowed head of the family during role transition: a qualitative study. J Qual Res Health Sci. 2013;2(1):62-75. [Persian].
  3. Zhang Z, Lin IF. Intergenerational support among widowed older adults in China. Int J Popul Stud. 2017;3(1):94-109. doi: 10.18063/ijps.2017.01.003.
  4. Bennett KM, Soulsby LK. Wellbeing in bereavement and widowhood. Illn Crises Loss. 2012;20(4):321-37. doi: 10.2190/IL.20.4.b.
  5. Zarghami H, Farimaneh M. Analysis of demographic and socio-economic characteristics of old adults in Iran. Iranian Journal of Official Statistics Studies. 2016;26(2):139-60. [Persian].
  6. Siflinger B. The effect of widowhood on mental health - an analysis of anticipation patterns surrounding the death of a spouse. Health Econ. 2017;26(12):1505-23. doi: 10.1002/ hec.3443.
  7. Stafford M, McMunn A, Zaninotto P, Nazroo J. Positive and negative exchanges in social relationships as predictors of depression: evidence from the English Longitudinal Study of Aging. J Aging Health. 2011;23(4):607-28. doi: 10.1177/0898264310392992.
  8. Van de Velde S, Bracke P, Levecque K. Gender differences in depression in 23 European countries. Cross-national variation in the gender gap in depression. Soc Sci Med. 2010;71(2):305- 13. doi: 10.1016/j.socscimed.2010.03.035.
  9. Jadhav A, Weir D. Widowhood and depression in a cross-national perspective: evidence from the United States, Europe, Korea, and China. J Gerontol B Psychol Sci Soc Sci. 2018;73(8):e143-53. doi: 10.1093/geronb/gbx021.
  10. Zheng Y, Lamoureux EL, Chiang PP, Rahman Anuar A, Wong TY. Marital status and its relationship with the risk and pattern of visual impairment in a multi-ethnic Asian population. J Public Health (Oxf). 2014;36(1):104-10. doi: 10.1093/ pubmed/fdt044.
  11. Perkins JM, Lee HY, James KS, Oh J, Krishna A, Heo J, et al. Marital status, widowhood duration, gender and health outcomes: a cross-sectional study among older adults in India. BMC Public Health. 2016;16(1):1032. doi: 10.1186/ s12889-016-3682-9.
  12. Holm AL, Berland AK, Severinsson E. Factors that influence the health of older widows and widowers-a systematic review of quantitative research. Nurs Open. 2019;6(2):591-611. doi: 10.1002/nop2.243.
  13. Das A. Spousal loss and health in late life: moving beyond emotional trauma. J Aging Health. 2013;25(2):221-42. doi: 10.1177/0898264312464498.
  14. Perkins JM, Lee HY, Lee JK, Heo J, Krishna A, Choi S, et al. Widowhood and alcohol, tobacco, and other drug use among older adults in India. J Gerontol B Psychol Sci Soc Sci. 2018;73(4):666-74. doi: 10.1093/geronb/gbw134.
  15. Heuberger R, Wong H. The association between depression and widowhood and nutritional status in older adults. Geriatr Nurs. 2014;35(6):428-33. doi: 10.1016/j. gerinurse.2014.06.011.
  16. Rendall MS, Weden MM, Favreault MM, Waldron H. The protective effect of marriage for survival: a review and update. Demography. 2011;48(2):481-506. doi: 10.1007/s13524- 011-0032-5.
  17. Ytterstad E, Brenn T. Mortality after the death of a spouse in Norway. Epidemiology. 2015;26(3):289-94. doi: 10.1097/ ede.0000000000000266.
  18. Brenn T, Ytterstad E. Increased risk of death immediately after losing a spouse: cause-specific mortality following widowhood in Norway. Prev Med. 2016;89:251-6. doi: 10.1016/j.ypmed.2016.06.019.
  19. Osorio-Parraguez P. Health and widowhood: meanings and experience of elderly women in Chile. Health. 2013;5(8):1272-6. doi: 10.4236/health.2013.58173.
  20. Nath B. Mental Health and Perceived Loneliness Among Widowed Older Adults: Exploring the Effects of Gender and Social Support [thesis]. Simon Fraser University; 2019.
  21. Do YK, Malhotra C. The effect of coresidence with an adult child on depressive symptoms among older widowed women in South Korea: an instrumental variables estimation. J Gerontol B Psychol Sci Soc Sci. 2012;67(3):384-91. doi: 10.1093/geronb/gbs033.
  22. Powers SM, Bisconti TL, Bergeman CS. Trajectories of social support and well-being across the first two years of widowhood. Death Stud. 2014;38(6-10):499-509. doi: 10.1080/07481187.2013.846436.
  23. Burns N, Grove SK. Understanding Nursing Research E-Book: Building an Evidence-Based Practice. Elsevier Health Sciences; 2010.
  24. Elaldi S, Yerliyurt NS. The efficacy of drama in field experience: a qualitative study using MAXQDA. J Educ Learn. 2017;6(1):10-26. doi: 10.5539/jel.v6n1p10.
  25. Bengtsson M. How to plan and perform a qualitative study using content analysis. NursingPlus Open. 2016;2:8-14. doi: 10.1016/j.npls.2016.01.001.
  26. Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005;15(9):1277-88. doi: 10.1177/1049732305276687.
  27. Graneheim UH, Lundman B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today. 2004;24(2):105- 12. doi: 10.1016/j.nedt.2003.10.001.
  28. Izadi-Avanji FS, Hasani P, Rakhshan M, Alavi-Majd H. Structure of resilience in older adults with chronic conditions. J Qual Res Health Sci. 2017;5(4):314-25. [Persian ].
  29. Rostami M, Younesi SJ, Foroughan M, Mohammadi Shahboulaghi F, Malakouti SK. Structural factors contributing to suicidal ideation in Iranian older adults: a grounded theory approach. J Qual Res Health Sci. 2022;11(2):130-8. doi: 10.22062/jqr.2021.193746.0.
  30. Holloway I, Galvin K. Qualitative Research in Nursing and Healthcare. John Wiley & Sons; 2016.
  31. Khalili Z, Gilani M, Ilali EA. A review of human dignity in the elderly and its related. Clin Exc. 2019;8(3):11-21. [Persian].
  32. Adib M, Esmaeili M, Zakerimoghadam M, Dehghan-Nayeri N. Consequences of elder abuse: a qualitative study. Iran J Nurs Res. 2020;15(1):29-37. [Persian].
  33. Heravi-Karimooi M, Rejeh N, Montazeri A. Health-related quality of life among abused and non-abused elderly people: a comparative study. Payesh. 2013;12(5):479-88. [Persian].
  34. Vaezi A, Lotfi MH, Shaker M. The effect of implementation of elderly respect training program in families on elder abuse in Yazd. J Community Health Res. 2018;7(2):74-84. [Persian].
  35. Tabari F, Khaghanizade M, Dehghan-Nayeri N, Najafi-Mehri S. Explain the concept of autonomy in the maintain dignity elderly: a qualitative study. Iran J Nurs Res. 2016;11(3):17- 27. [Persian].
  36. Bagheri-Nesami M. Exploration of elderly women lived experiences about psychological-emotional changes: a qualitative study. J Mazandaran Univ Med Sci. 2011;20(1):203-16. [Persian].
  37. Pandey MK, Jha AK. Widowhood and health of elderly in India: examining the role of economic factors using structural equation modeling. Int Rev Appl Econ. 2012;26(1):111-24. doi: 10.1080/02692171.2011.587109.
  38. Wells M. Resilience in older adults living in rural, suburban, and urban areas. Online J Rural Nurs Health Care. 2010;10(2):45-54. doi: 10.14574/ojrnhc.v10i2.55.
  39. Cacioppo JT, Patrick W. Loneliness: Human Nature and the Need for Social Connection. WW Norton & Company; 2008.
  40. Fadila DE, Ebeid IA, El-Gilany AH. Death attitude and its associated factors in institutionalized elderly: a cross-section study in North Eastern Delta, Egypt. IOSR J Nurs Health Sci. 2018;7(6):12-9. doi: 10.9790/1959-0706031219.
  41. Ghufran M, Ansari S. Impact of widowhood on religiosity and death anxiety among senior citizens. J Indian Acad Appl Psychol. 2008;34(1):175-80.
  42. Hofer J, Busch H, Šolcová IP, Tavel P. Relationship between subjectively evaluated health and fear of death among elderly in three cultural contexts. Int J Aging Hum Dev. 2017;84(4):343-65. doi: 10.1177/0091415016685331.
  43. Bitarafan L, Kazemi M, Yousefi Afrashte M. Relationship between styles of attachment to God and death anxiety resilience in the elderly. Iran J Ageing. 2018;12(4):446-57. doi: 10.21859/sija.12.4.446. [Persian].
  44. Berman A, Snyder S, Frandsen G. Kozier & Erb’s Fundamentals of Nursing: Concepts, Practice, and Process. New Jersey: Pearson; 2016.
  45. Spahni S, Morselli D, Perrig-Chiello P, Bennett KM. Patterns of psychological adaptation to spousal bereavement in old age. Gerontology. 2015;61(5):456-68. doi: 10.1159/000371444.
  46. Ironson G, Stuetzle R, Fletcher MA. An increase in religiousness/spirituality occurs after HIV diagnosis and predicts slower disease progression over 4 years in people with HIV. J Gen Intern Med. 2006;21(Suppl 5):S62-8. doi: 10.1111/j.1525-1497.2006.00648.x.
  47. Azami Y, Motamedi A, Doostian U, Jalalvand M, Farzanegan M. The role of resiliency, spirituality, and religiosity in predicting satisfaction with life in the elderly. Counseling Culture and Psycotherapy. 2012;3(12):1-20. doi: 10.22054/ qccpc.2011.5906. [Persian].
  48. Haight BK, Michel Y, Hendrix S. The extended effects of the life review in nursing home residents. Int J Aging Hum Dev. 2000;50(2):151-68. doi: 10.2190/qu66-e8uv-nymr-y99e.