Comportamientos de riesgo para la salud en hombres mayores brasileños viudos / Health risk behaviors in elderly Brazilian widowers

RESUMEN Se buscó comparar la prevalencia de comportamientos de riesgo para la salud en hombres mayores viudos con las de hombres mayores con pareja, solteros y divorciados/separados, así como la prevalencia de comportamientos de riesgo en hombres mayores viudos según rango de edad, escolaridad y raza/color. Se realizó un estudio transversal con hombres mayores (≥ 60 años) entrevistados por el Sistema de Vigilancia de Factores de Riesgo y Protección para Enfermedades Crónicas por Encuesta Telefónica (Vigitel) en 2016 (n=5.384) y 2017 (n=5.801) que incluye muestras representativas de adultos de las capitales de los estados brasileños y del Distrito Federal. De ellos, 886 eran viudos. Los comportamientos de riesgo fueron: inactividad física en el tiempo libre, consumo irregular de frutas, verduras y legumbres, tabaquismo y consumo abusivo de alcohol. La prevalencia de tabaquismo fue menor entre los hombres mayores con pareja [RP = 0,68; IC95% (0,52-0,90)] que entre los viudos. En los demás comportamientos de riesgo no se observaron diferencias en la prevalencia de los viudos en relación a los demás grupos. Cuando se analizaron solamente los viudos, se observaron importantes asociaciones de los comportamientos de riesgo con las variables grupo de edad y escolaridad, pero no con raza/color.

ABSTRACT The objective of this study was to compare the prevalence of health risk behaviors among elderly widowers with that of elderly partnered males, as well as single or divorced/separated men. Additionally, we set out to examine the prevalence of risk behaviors in elderly widowered men according to age, education level, and race/skin color. A cross-sectional study was conducted with elderly men (≥ 60 years) who were interviewed through the Surveillance System of Risk and Protective Factors for Chronic Diseases by Telephone Survey (Vigitel) in 2016 (n=5,384) and 2017 (n=5,801). The Vigitel survey includes representative samples of adults residing in the capitals of Brazilian states and the Federal District, and of those surveyed, 886 were widowers. Identified risk behaviors included physical inactivity during leisure time, irregular consumption of fruits, vegetables and legumes, smoking and alcohol abuse. The prevalence of smoking was lower among partnered elderly men [PR=0.68, CI95% (0.52-0.90)] than among widowers. There were no differences in the prevalence of other risk behaviors between widowers and other groups. When only widowers were taken into account, there was significant association of risk behaviors with age and educational level, but not with race/skin color.

Health situation in the perception of elderly widows assisted by primary health care / Situación de salud en la percepción de viudas ancianas asistidas por la atención primaria de salud / Situação de saúde na percepção de idosas viúvas assistidas pela atenção primária à saúde

ABSTRACT Objective: Analyze the perception of elderly widow women about their health situation. Method: Descriptive and exploratory research, based on qualitative approach performed with 34 widowed women aged 60 years and over, enrolled in primary health care. It was used content analysis in its thematic analysis modality. Results: Three thematic nuclei were obtained: "positive self-perception of health in old age", "negative understanding of health related to the diseases" and "negative repercussions of the absence of the husband in the health situation of the widows". Presence of the family, chronic diseases under control, physical limitations and absence of the partner directly influenced the responses of the elderly widows. Final considerations: The elderly widows perceive their health situation as relatively good and some factors are challenges to a better health situation. For the participants, widowhood means more than just the physical loss of the husband, interfering negatively in the perception of their health situation.

RESUMEN Objetivo: Analizar la percepción de la mujer viuda anciana acerca de su propia situación de salud. Método: Investigación descriptiva y exploratoria, basada en el enfoque cualitativo realizado con 34 mujeres viudas de al menos 60 años, inscritas en la atención primaria de salud. Se utilizó análisis de contenido en su modalidad de análisis temático. Resultados: Se obtuvieron tres núcleos temáticos: "autopercepción positiva de la salud en la vejez", "comprensión negativa de la salud relacionada con las enfermedades" y "repercusiones negativas de la ausencia de la pareja en la situación de salud de las viudas". La presencia de la familia, las enfermedades crónicas bajo control, las limitaciones físicas y la ausencia de la pareja influyeron directamente en las respuestas de las viudas ancianas. Consideraciones finales: Las viudas ancianas perciben que su situación de salud es relativamente buena y algunos factores son desafíos para mejorar la situación de la salud. Para las participantes, la viudez significa más que solo la pérdida física del esposo, lo que interfiere negativamente en la percepción de su situación de salud.

RESUMO Objetivo: Analisar a percepção de mulheres idosas viúvas sobre sua situação de saúde. Método: Pesquisa descritiva e exploratória, baseada na abordagem qualitativa realizada com 34 mulheres viúvas com idade igual ou superior a 60 anos, cadastradas na atenção primária à saúde. Utilizou-se da análise de conteúdo em sua modalidade análise temática. Resultados: Foram obtidos três núcleos temáticos: "a autopercepção positiva da saúde na velhice", "compreensão negativa da saúde relacionada aos agravos" e "repercussões negativas da ausência do companheiro na situação de saúde das viúvas". Presença da família, doenças crônicas sob controle, limitações físicas e ausência do companheiro influenciaram diretamente as respostas das idosas viúvas. Considerações finais: As idosas viúvas percebem sua situação de saúde como relativamente boa e alguns fatores são desafios a uma melhor situação de saúde. Para as participantes, a viuvez significa mais que apenas a perda física do cônjuge, interferindo negativamente na percepção de sua situação de saúde.

Involuntary freedom in elderly widows: narrative insights / Liberdade involuntária em idosas viúvas: olhares narrativos

Due to the existing age gap between the average life expectancy of males and females, the widowhood process in old age is mainly experienced by women. In light of this, this study aims to understand the state of widowhood from a female perspective, analysing its impact at the level of lifestyle choices, in addition to identifying the changes that took place in the lives of elderly women and to what extent widowhood influences the choice of daily life as well as leisure activities. This is an exploratory-descriptive study that resorts to a qualitative methodology, using a study group comprising 30 elderly widowed women, aged 65 or above. Data were collected during semi-structured individual interviews and its content was analysed with the WebQda Software (Web Qualitative Data Analysis). Results show that becoming a widow gave the elderly a greater sense of independence and freedom. Simultaneously, it also showed that in the early years of widowhood, widows experience more feelings of grief and nostalgia for their loved ones (feeling of missing someone immensely).

O processo de viuvez na terceira idade é predominantemente vivido pelas mulheres, devido ao diferencial etário entre a esperança média de vida do sexo feminino face ao masculino. Nesse contexto, através deste estudo, pretende-se compreender como o estado de viuvez feminino influenciou as opções de estilo de vida, identificando as alterações originadas em mulheres idosas e influencia as diferentes atividades do dia a dia e de lazer. Com uma metodologia qualitativa, assume-se como um estudo exploratório-descritivo, realizado junto de um grupo constituído por 30 idosas na situação de viúvas e com idade igual ou superior a 65 anos. Para a recolha de dados optou-se pela realização de entrevistas semiestruturadas, sendo posteriormente os dados analisados em termos de conteúdo e tratados com o suporte do Software WebQda (Web Qualitative Data Analysis). Os principais resultados evidenciam que o facto de as idosas terem ficado viúvas lhes deu maior independência e sensação de liberdade, apesar de o estudo inferir, igualmente, que a viuvez possui um impacto marcante, porquanto se observa uma tendência exponencial para a descrição de emoções associadas ao processo de luto.

La depresión y el duelo en las parejas / Depression and grief in couples

Un motivo de consulta psiquiátrica y psicológica constituyen las parejas en que uno de los miembros presenta una depresión. También la ocurrencia de una pérdida importante que lleve a la pareja a un proceso de duelo. Revisaremos en este artículo los datos de la experiencia clínica y de la investigación que nos pueden ayudar como terapeutas a encarar mejor estos complejos temas.

A reason for psychiatric or psychological consultation are couples with one member affected by a major depression. Or couples affected by bereavement and grief. Data from clinical experience and from the literature are revised in order to help us as therapists in these complex situations.

O luto em adultos idosos: natureza do desafio individual e das variáveis contextuais em diferentes modelos / Bereavement in older adults: individual challenge and contextual variables in different models

A perda por viuvez em idade avançada é, porventura, de entre vários acontecimentos do ciclo de vida, um dos mais normativos e, simultaneamente, dos menos investigados. Com o aumento da esperança de vida, a viuvez nos adultos idosos ocorre cada vez mais tarde no ciclo de vida, é um acontecimento expectável e parece haver vantagens em conceptualizá-lo como uma importante transição psico-social que implica a reconfiguração do significado da vida e dos seus propósitos. Neste artigo abordaremos alguns dos principais modelos do processo de luto e algumas variáveis individuais e contextuais que determinam reacções associadas à perda. Faremos uma particular focalização no modelo proposto por Stroebe e Schut bem como nas suas implicações teóricas e práticas.

The loss of a spouse in old age is one of the most significant, but least investigated events in the life cycle. With increasing life expectancy, widowhood in older adults occurs increasingly later in the life cycle. It is an expectable event and may be advantageously conceptualized as a major psychosocial transition that involves the reconfiguration of the meaning of life and its purpose. The present article discusses some of the main models of the grieving process and the effect of some individual and contextual variables on reactions regarding the loss of a spouse. It focuses mainly on Stroebe and Schut dual process model as well as on its theoretical and practical implications.

Perfil psicosocial del viudo y huérfano afectados por la muerte materna familiar / Psychosocial profile of the widower and orphans affected by maternal death family

Objetivo: Describir el perfil psicosocial del viudo y huérfanos afectados por la muerte materna familiar en el departamento de Alta Verapaz durante el año 2009. Metodología: Estudio descriptivo en el cual se entrevistó a miembros, viudos y huérfanos, de 64 de 72 (89%) familias afectadas por muerte materna que ocurrieron en 2009. Resultados: Las familias estudiadas estaban conformadas por 62 viudos (en dos casos la fallecida no tenía pareja) y 286 huérfanos...

A relação entre variáveis de saúde mental e cognição em idosos viúvos / The relation among variables of mental health and cognition in widowed elders

O objetivo do estudo foi avaliar as habilidades cognitivas de idosos viúvos. O grupo total de 34 viúvos (com perda do companheiro nos últimos 12 meses) foi identificado entre os idosos de Veranópolis (RS), sendo que 30 aceitaram participar do estudo. Outros 30 participantes casados, pareados conforme sexo, idade e escolaridade, compuseram o grupo controle. Os instrumentos utilizados foram: Questionário de Medida de Queixas Subjetivas de Memória (Mac-Q); Fluência verbal, categoria animal; Mini-exame do estado mental (MEEM); Teste de evocação seletiva livre e com pistas de Buschke; subteste de Dígitos da escala WAIS; Escala de depressão geriátrica (GDS) e Questionário fenomenológico do luto (BPQ). Verificou-se que os viúvos tinham significativamente mais sintomas depressivos e mais pontos na escala de luto. Entretanto, não foi evidenciada diferença significativa entre as médias no desempenho cognitivo de idosos viúvos ou idosos casados. Discute-se que a escolha da viuvez censitária (ter o estado civil viúvo) e não do luto emocional (auto-referido) como critério de seleção pode ter influído na ausência de associação entre viuvez e disfunção cognitiva, entre outros.

To assess the cognitive abilities of widowed elders, a total sample of 34 elders (who have lost their spouses in the last 12 months) was identified among elders in Veranópolis-RS and 30 of them accepted to participate in the study. The control group was composed by 30 married subjects paired according to gender, age and level of education. The instruments used were: Measure Questionnaire of Memory Loss Complaints; Verbal Fluency - animal category; Mini-Mental State Examination (MMSE); Free and Cued Selective Reminding Test; Digit subtest; Geriatric Depression Scales and Bereavement Phenomenology Questionnaire. Widowed elders had significantly more depressive symptoms and more points on the bereavement scale. However, there was no significant difference between the means of cognitive performance of widowed or married elders. In the census, the choice of widowhood as a selection criterion instead of bereavement (self reported) might have influenced the lack of association between widowhood and cognitive dysfunction, among other aspects.

The Life of Elderly Women Living Alone

PURPOSE: This study aimed to uncover the fundamental nature of living alone in female elderly. METHODS: The phenomenological research approach developed by van Manen was adopted. RESULTS: The theme was 'taking a firm stand alone on the edges of life'. The composition elements of living alone experienced by elderly women were as follows: 1) Corporeality: participants perceived their bodies by their health status. Unhealthy participants were suffering with diseases and dependant on other persons, while healthy participants were free from family responsibility and kept on moving. 2) Spatiality: participants felt both freedom and loneliness while they stayed home. 3) Relationality: participants felt pity and yearning for their bereaved husband and sometimes talked to his picture. According to their children's filial piety, participants were pleased or displeased. However, they incessantly devoted themselves to their children. 4) Temporality: participants considered the rest of their life as extra-time which was proceeding to death, and tried to keep themselves busy before they died. CONCLUSION: A nurse should understand the multifarious aspects of elderly women's life, and then intervene to consolidate their strengths for self-supporting the final years of life.

A Study on the Life Adjustment of Widowed Elderly Women in Korea: A Q-Methodological Approach / 간호학회지

PURPOSE: The purpose of this study was to analyze the types of life adjustment of widowed elderly women in Korea. METHODS: The research design was a Q-Methodological Approach. Thirty selected Q-statements from 32 subjects were classified into a shape of normal distribution using a 7 point scale. The collected data was analyzed using a QUANL PC program. RESULTS: Three types of life adjustment were identified. Type I is the independent type: overcome the reality. Type II is the abandonment type: deny the reality. Type III is the accommodation type: accept the reality. CONCLUSION: The results of the study indicate that different approaches to the quality of life for widowed elderly women in Korea are recommended based on the three types of life adjustment.

Concept Development of Grief-Focusing on the Process of Spousal Bereavement / 간호학회지

PURPOSE: This study was done to develop the concept of grief focusing on the process of spousal bereavement in Korea. METHODS: The Hybrid model was used for analysis according to the 3 phases. An extensive literature review was done for the Theoretical phase. In-depth interviews were conducted with 15 participants whose spouses died within the past 3 years in the Field phase. In the Final analytic phase, the results in the Theoretical and the Field phases were compared, analyzed, and integrated according to the process of grief. RESULTS: The antecedent of the concept of spousal grief was spousal death. The dimensions of grief were classified to inner dimensions related to oneself, relational dimensions related to family and others, and existential dimensions related to the meaning of being. The attributes of grief were physical suffering, decline of cognitive ability, heartbreaking sorrow, expectations and conflicts of a new life, social stigma, dependence on or resentment towards God, etc. The empirical referent of grief was physical, psychological, social, and spiritual health status. The grieving progressed through 3 phasesshock-emancipation, suffering, and integration. CONCLUSION: Nurses should recognize the importance of their unique position as supporters for grievers, and try to assess individual characteristics and to provide tailored nursing interventions.

Effects of a Bereavement Intervention Program on Depression and Life Satisfaction in Middle Aged Widows in Korea / 간호학회지

PURPOSE: This study was designed to examine the effects of a bereavement intervention program on levels of depression and life satisfaction in middle aged widows in Korea. METHODS: A quasi-experimental design with non-equivalent control-group pretest-posttest was used. The subjects (control group, n = 10; intervention group, n = 17) were bereaved less than 6 months in G City and J Province, Korea. The bereavement intervention program consisted of Dan-jeon breathing, self-help group activities and a health examination. The experimental group attended 10 sessions of a bereavement intervention program. The control group had a health examination without the intervention program. For both groups, the level of depression and life satisfaction levels were measured before and after the experiment. RESULTS: The decrement of depression level in the experimental group was significantly greater than in the control group (p<.001). The increment in life satisfaction in the experimental group was significantly greater than in the control group (p<.001). CONCLUSION: The results suggested that the bereavement intervention program was effective in decreasing level of depression and in increasing the life satisfaction of widows. Accordingly, a bereavement intervention program can be applied as an intervention to help widows.

Dependency, Abuse, and Depression by Gender in Widowed Elderly / 간호학회지

PURPOSE: The purpose of this study was to investigate the effects of dependency and abuse on depression according to gender in widowed elderly. METHOD: A convenient sample consisted of 246 widowed elderly who were more than 65 years old in four cities. Data was collected using a structured questionnaire from August to September, 2002. A dependency Scale developed by Ahn (1999) was used to measure the level of dependency. Emotional abuse and physical abuse were measured by 10 items for emotional abuse and 7 items for physical abuse selected out of the Conditions Scale of Elder Abuse. The level of depression was measured by the Geriatric Depression Scale (GDS).The SPSS WIN 11.0 version program was used for data analysis. RESULT: In male widowed elderly, dependency affected depression indirectly through emotional abuse. While in female widowed elderly, dependency affected depression directly and affected emotional abuse indirectly. CONCLUSION: The study showed that dependency was the most explainable variable on depression in widowed female elderly. Therefore, it dependency should be assessed first in nursing intervention to relieve depression of widowed elderly.

Sentimiento de soledad, estilos de afrontamiento y sentimiento de satisfacción con la red social en dos crisis vitales: divorcio y viudez en mujeres / Loneliness, coping styles and satisfaction feelings with the social network in two life crisis: divorce and widowhood in women

Se explora la relación entre el sentimiento de soledad, los estilos de afrontamiento y el sentimiento de satisfacción obtenido en las relaciones con la red social en 123 mujeres de mediana edad – entre 45 y 65 años- frente a crisis dos vitales, divorcio y viudez. Con tal fin, se administró a los sujetos bajo estudio un Cuestionario de datos personales y de situación de crisis, el Cuestionario de Estilos de Afrontamiento (WCCL) de Folkman y Lazarus y el Inventario de Soledad Emocional y Social (ESLI) de Vincenzi y Grabosky. Se concluye que, en la crisis se evalúa el futuro, por el cual la vida tendrá que seguir un rumbo imprevisible frente al que las culturas proporcionan diferentes definiciones y rituales que facilitan el pasaje en los diferentes momentos del ciclo vital La educación proporciona un despliegue más creativo de recursos frente a las crisis, un enriquecimiento y sentimiento de seguridad de la persona y habilidades que generan una mayor resiliencia y mejoran la calidad de vida.

Bienestar psicológico y estrategias de afrontamiento frente al divorcio y la viudez en mujeres de mediana edad / Psychological well being and coping strategies in middle aged women facing divorce and widowhood

Este trabajo explora 1) el divorcio y la viudez, como crisis vitales y 2) el sentimiento de soledad, aislamiento social y autoestima, manifestación del bienestar psicológico y las estrategias de afrontamiento utlizadas frente al divorcio y la viudez por mujeres de mediana edad, 61 divorciadas y 62 viudas, con los instrumentos Cuestionario de Estilos de Afrontamiento -WCCL- de Folkman y Lazarus (1980), Inventario de Soledad Emocional y Social -ESLI- de Vincenzi y Grabosky (1989) y un cuestionario con información sociodemográfica. Las crisis vitales: divorcio o viudez, influyen sobre las estrategias de afrontamiento: Autoatribución de la Culpa, Confrontación, Distanciamiento y Reevaluación Positiva, más empleadas por las divorciadas que por las viudas. En las respuestas frente a la crisis según los niveles de soledad y aislamiento, emocional y social, y el grado de autoestima, manifestación del bienestar psicológico, el afrontamiento de las divorciadas es más activo que el de las viudas, por su mayor grado de bienestar psicológico.