What is the Relationship between Widowhood and Occupational Restructuring Amongst Older Adult Women? Group One Nadia Abdel-Hafez, Vivien Chan, Paul Furtado, Melissa Lamasan, Heather Moyse, Katherine Reece, Tatum Wilson Seminar Presentation November 22 nd, 2004

Presentation Outline  Working Definitions  Thought Evolution & Research Process  Initial Model  Critical Appraisal  Additional Findings  Final Model  Gaps & Constructive Research Approaches  Conclusion  Facilitated Discussion

Working Definitions  Widowhood  “…bereavement followed by adjustment to a new role…” (Treas & Bengtson, 1987)  State, condition of having lost one’s spouse to death (webster-dictionary.org, 2004)  Occupational Restructuring  Change in occupational engagement and/or meaning as a result of life events

Process of Finding our Question 1. Brainstorming Ideas  Discussion of different topics  Empty nest syndrome and its impact on occupation vs. widowhood and its impact on occupation  Consensus: Widowhood  Widowhood involves a more traumatic experience

Thought Process Cont’d 2. Preliminary Questions Discussion of focus: adults, gender, generation  1 st question: “What are the effects of widowhood on female occupation – A generational comparison”  Problem: - This question limited the study to only quantitative research

Thought Process cont’d  2 nd Question:  “How does widowhood amongst older adults lead to occupational restructuring?”  Problem: - We realized it is difficult to answer 3. Final Question: “What is the relationship between widowhood and occupational restructuring amongst older women?”

Research Process  Databases used:  Medline, Eric, Psychinfo, Ageline, Embase  Interfaces used:  Ovid, Pubmed, Webspir, J-stor, Proquest, Cambridge scientific  Key words:  Widow, widowhood, elderly, women, occupation, activity, consequences, participation, bereavement, coping, adaptation  Subject Areas:  Nursing, Gerontology, Sociology, Psychology, Death Studies

Initial Model : How Does Widowhood Amongst Older Adult Women Affect Occupational Restructuring? Widowhood External Factors  Culture/religion  Social economic status  Physical environment  Time  Social support  Essential activities previously performed by spouse (now unfulfilled) Internal Factors  Spirituality  Mental status o Cognitive, Emotional  Identity o Morals, Values Occupational Restructuring Occupational Performance (increase, decrease) Yield Occupation Development of New Occupation No Change in Occupation

Adapting to Widowhood through Meaningful Occupations: A Case Study McIntyre & Howie Method: Purpose: Participant: Results:   Qualitative, case study   To explore one older woman’s adaptation to widowhood through meaningful occupations   One woman over 65 years old   Widowed twice   Three major themes emerged from the data  Doing, Social relationships, Occupational adaptation

Critical Analysis in Relation to our Topic McIntyre & Howie Strengths:   Link between internal and external factors affecting the person (eg. Social support and mental health)   Occupational restructuring in return affects the persons mental health   Occupational restructuring can take place by way of partaking in new occupations as well as maintaining pre-widowhood occupations

Critical Analysis in Relation to our Topic McIntyre & Howie Weaknesses:   Case study of only one woman’s experience, therefore hard to relate the results to our model   The researches chose a participant that had already adapted well to widowhood and did not have any negative side effects to explore   Woman had been widowed twice therefore may have a different view on widowhood than a first-time widow

Critical Appraisal of Research Methodology Adapting To Widowhood Through Meaningful Occupations: A Case Study McIntrye & Howie  Paradigm: The qualitative approach

Criteria for Judging Trustworthiness in Qualitative Research Lincoln and Guba, 1985 Credibility  Numerous Quotes embedded to support themes generated.  Member-checking suggested.  The length of engagement is unknown.  Triangulation attempted: literature used to confirm themes.  Peer debriefing not indicated.

Criteria for Judging Trustworthiness in Qualitative Research Transferability  Purposeful sampling.  Describing in detail the context.  Rich, thick description for themes emerged.

Criteria for Judging Trustworthiness in Qualitative Research Dependability  A Pilot interview was conducted  A detailed list of interview questions provided.  3 interviews  Interviews tape recorded and transcribed.  Coding scheme described in detail..

Criteria for Judging Trustworthiness in Qualitative Research Confirmability  Triangulation  Audit trail suggested.  Independent raters not identified.

Criteria for Judging Trustworthiness in Qualitative Research  Despite noted limitations, the study by McIntyre and Howie did demonstrate adequate trustworthiness in the research methodology.  Therefore, results can transferable to our final model.

Additional Findings  Majority of research quantitative in nature  Level 2, Depoy & Gitlin  Most research from a psychology, sociology, nursing and gerontology background  Numerous studies focused on religion and spirituality  Most researchers eluded to engagement in occupation as a means of adapting to widowhood

Additional Findings Limitations   Lack of research & limited researchers in the field   Prospective design and/or comparison groups only in 1/3 of quantitative studies   Not viewed from an Occupational therapy or Occupational science lens

Occupational Restructuring Occupational Performance New Meaning For Occupation Yield Occupation Take Over Occupations of Deceased Spouse Change in Meaning of Occupation Development of New Occupations Occupational Participation The Final Model

Widowhood Internal External Spirituality Mental Status Identity Culture/Religion Social Economic Status Physical Environment Time Social Support Essential activities of spouse unfulfilled Grieving Health Status Previous Exposure to Widowhood Gender Roles The Final Model

Death of Spouse Occupational Restructuring Widowhood Internal External No Change The Final Model

Gaps in Research and Constructive Approaches Gap: Relevant research focusing on period of preparation for spouse’s death  e.g., long-term/sudden death Occupational Science Approach Examine the differences between widows who had time to prepare for the death of their spouse versus widows who lost their spouse suddenly on occupational restructuring

Gaps in Research and Constructive Approaches Gap: Lacking literature examining gender roles and the experience of widowhood Occupational Science Approach: Examine gender roles and their effects on specific occupations following spousal loss - Quantitative Approach (e.g., comparing genders)

Gaps in Research and Constructive Approaches Gap: Limited research on changes in role or circumstances and their impact on occupational restructuring in widows Occupational Science Approach: Examine changes in daily roles and circumstances and how this affects occupational restructuring - Quantitative Approach (e.g., comparing pre/post)

Gaps in Research and Constructive Approaches Gap: Insufficient literature regarding the meaning of occupations after the loss of a spouse Occupational Science Approach:   Qualitative   Exploring the meaning of occupations in widowhood

Constructive Approaches to OT & OS Research  Areas for Future Research:  Facilitating positive aging throughout widowhood  Does engaging in occupation in widowhood increase health and well-being?  What occupations facilitate positive aging?  Cultural considerations  How does the mourning period as influenced by culture affect occupations?  What effect does moving in with children have on occupational restructuring?

Constructive Approaches to OT & OS Research Cont’d  Areas for Future Research:  Disability throughout widowhood  What is the relationship between disability and occupational restructuring in widowhood?  Identity  What is the relationship between widowhood and occupational identity?

Conclusion  It is essential for further research to focus on widowhood using an occupational lens  Increasing geriatric population, particularly women  Understanding of dynamic relationship between widowhood and other aspects of daily life is needed

Facilitated Discussion  Our original question was: “How does widowhood amongst older female adults lead to occupational restructuring?”  Why is the question “how” problematic in this context of ‘widowhood’?