what is the relationship between widowhood and occupational restructuring amongst older adult women?...

What is the Relationship between Widowhood What is the Relationship between Widowhood and Occupational Restructuring Amongst Older and Occupational Restructuring Amongst Older

Adult Women?Adult Women?

Group OneGroup OneNadia Abdel-Hafez, Vivien Chan, Paul Furtado, Melissa Lamasan,Nadia Abdel-Hafez, Vivien Chan, Paul Furtado, Melissa Lamasan,

Heather Moyse, Katherine Reece, Tatum WilsonHeather Moyse, Katherine Reece, Tatum Wilson

Seminar Presentation November 22nd, 2004

Presentation OutlinePresentation Outline

Working DefinitionsWorking Definitions Thought Evolution & Thought Evolution &

Research ProcessResearch Process Initial ModelInitial Model Critical AppraisalCritical Appraisal Additional FindingsAdditional Findings Final ModelFinal Model Gaps & Constructive Gaps & Constructive

Research ApproachesResearch Approaches ConclusionConclusion Facilitated DiscussionFacilitated Discussion

Working DefinitionsWorking Definitions

WidowhoodWidowhood “…“…bereavement followed by adjustment to a bereavement followed by adjustment to a

new role…” (Treas & Bengtson, 1987)new role…” (Treas & Bengtson, 1987) State, condition of having lost one’s spouse to State, condition of having lost one’s spouse to

death (webster-dictionary.org, 2004)death (webster-dictionary.org, 2004)

Occupational RestructuringOccupational Restructuring Change in occupational engagement and/or Change in occupational engagement and/or

meaning as a result of life events meaning as a result of life events

Process of Finding our Question

1. Brainstorming Ideas1. Brainstorming Ideas Discussion of different topicsDiscussion of different topics Empty nest syndrome and its impact on Empty nest syndrome and its impact on

occupation vs. widowhood and its impact on occupation vs. widowhood and its impact on occupationoccupation

Consensus: WidowhoodConsensus: Widowhood Widowhood involves a more traumatic experienceWidowhood involves a more traumatic experience

Thought Process Cont’d

2. Preliminary Questions2. Preliminary Questions

Discussion of focus: adults, gender, generation Discussion of focus: adults, gender, generation

11stst question: question:““What are the effects of widowhood on female What are the effects of widowhood on female occupation – A generational comparison”occupation – A generational comparison”

Problem:Problem:

- This question limited the study to - This question limited the study to only only quantitative research quantitative research

Thought Process cont’d

22ndnd Question: Question: ““How does widowhood amongst older adults lead to How does widowhood amongst older adults lead to

occupational restructuring?”occupational restructuring?” Problem:Problem:

- We realized it is difficult to - We realized it is difficult to answeranswer

3. Final Question:“What is the relationship between widowhood and occupational

restructuring amongst older women?”

Research Process

Databases usedDatabases used:: Medline, Eric, Psychinfo, Ageline, EmbaseMedline, Eric, Psychinfo, Ageline, Embase

Interfaces usedInterfaces used:: Ovid, Pubmed, Webspir, J-stor, Proquest, Cambridge Ovid, Pubmed, Webspir, J-stor, Proquest, Cambridge

scientificscientific Key wordsKey words::

Widow, widowhood, elderly, women, occupation, Widow, widowhood, elderly, women, occupation, activity, consequences, participation, bereavement, activity, consequences, participation, bereavement, coping, adaptationcoping, adaptation

Subject AreasSubject Areas:: Nursing, Gerontology, Sociology, Psychology, Death Nursing, Gerontology, Sociology, Psychology, Death

StudiesStudies

Initial Model: How Does Widowhood Amongst Older Adult Women Affect Occupational Restructuring?

Widowhood

External FactorsCulture/religionSocial economic statusPhysical environmentTimeSocial supportEssential activities previously performed by spouse (now unfulfilled)

Internal FactorsSpiritualityMental status

oCognitive, EmotionalIdentity

oMorals, Values

Occupational Restructuring

OccupationalPerformance

(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 Critical Appraisal of Research MethodologyMethodology

Adapting To Widowhood Through Adapting To Widowhood Through Meaningful Occupations: A Case StudyMeaningful Occupations: A Case Study

McIntrye & HowieMcIntrye & Howie

Paradigm: The qualitative approachParadigm: The qualitative approach

Criteria for Judging Trustworthiness in Criteria for Judging Trustworthiness in Qualitative ResearchQualitative Research

Lincoln and Guba, 1985Lincoln and Guba, 1985

CredibilityCredibility

Numerous Quotes embedded to support themes Numerous Quotes embedded to support themes generated.generated.

Member-checking suggested.Member-checking suggested. The length of engagement is unknown. The length of engagement is unknown. Triangulation attempted: literature used to confirm Triangulation attempted: literature used to confirm

themes. themes. Peer debriefing not indicatedPeer debriefing not indicated..


TransferabilityTransferability

Purposeful sampling.Purposeful sampling. Describing in detail the context. Describing in detail the context. Rich, thick description for themes Rich, thick description for themes

emerged.emerged.


Dependability Dependability

A Pilot interview was conductedA Pilot interview was conducted A detailed list of interview questions provided.A detailed list of interview questions provided. 3 interviews3 interviews Interviews tape recorded and transcribed.Interviews tape recorded and transcribed. Coding scheme described in detail.Coding scheme described in detail.

..


Confirmability Confirmability

TriangulationTriangulation Audit trail suggested. Audit trail suggested. Independent raters not Independent raters not

identifiedidentified..


Despite noted limitations, the study by McIntyre and Despite noted limitations, the study by McIntyre and Howie did demonstrate adequate trustworthiness in Howie did demonstrate adequate trustworthiness in the research methodology.the research methodology.

Therefore, results can transferable to our final model. Therefore, results can transferable to our final model.

Additional FindingsAdditional Findings

Majority of research quantitative in natureMajority of research quantitative in nature

Level 2, Depoy & GitlinLevel 2, Depoy & Gitlin

Most research from a psychology, sociology, Most research from a psychology, sociology, nursing and gerontology backgroundnursing and gerontology background

Numerous studies focused on religion and Numerous studies focused on religion and spiritualityspirituality

Most researchers eluded to engagement in Most researchers eluded to engagement in occupation as a means of adapting to widowhoodoccupation as a means of adapting to widowhood

Additional FindingsAdditional 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


OccupationalPerformance

New Meaning For Occupation

Yield Occupation

Take Over Occupationsof Deceased Spouse

Change in Meaning of Occupation

Development of New Occupations

OccupationalParticipation

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


WidowhoodInternal External

No Change

The Final Model

Gaps in Research and Constructive Gaps in Research and Constructive ApproachesApproaches

GapGap: Relevant research focusing on period of : Relevant research focusing on period of preparation for spouse’s deathpreparation for spouse’s death

e.g., long-term/sudden deathe.g., long-term/sudden death

Occupational Science ApproachOccupational Science ApproachExamine the differences between widows who Examine the differences between widows who

had time to prepare for the death of their had time to prepare for the death of their spouse versus widows who lost their spouse spouse versus widows who lost their spouse suddenly on occupational restructuring suddenly on occupational restructuring


Gap:Gap: Lacking literature examining gender Lacking literature examining gender roles and the experience of widowhoodroles and the experience of widowhood

Occupational Science Approach:Occupational Science Approach:

Examine gender roles and their effects on Examine gender roles and their effects on specific occupations following spousal lossspecific occupations following spousal loss

- Quantitative Approach (e.g., comparing genders)- Quantitative Approach (e.g., comparing genders)


Gap:Gap: Limited research on changes in role or Limited research on changes in role or circumstances and their impact on occupational circumstances and their impact on occupational restructuring in widowsrestructuring in widows

Occupational Science Approach:Occupational Science Approach:

Examine changes in daily roles and circumstances Examine changes in daily roles and circumstances and how this affects occupational restructuringand how this affects occupational restructuring

- Quantitative Approach (e.g., comparing pre/post)- Quantitative Approach (e.g., comparing pre/post)


Gap:Gap: Insufficient literature regarding the Insufficient literature regarding the meaning of occupations after the loss of a meaning of occupations after the loss of a spousespouse

Occupational Science Approach: Qualitative

Exploring the meaning of occupations

in widowhood

Constructive Approaches to OT & OS Constructive Approaches to OT & OS ResearchResearch

Areas for Future Research:Areas for Future Research:

Facilitating positive aging throughout widowhoodFacilitating positive aging throughout widowhood Does engaging in occupation in widowhood increase health and Does engaging in occupation in widowhood increase health and

well-being?well-being? What occupations facilitate positive aging?What occupations facilitate positive aging?

Cultural considerationsCultural considerations How does the mourning period as influenced by culture affect How does the mourning period as influenced by culture affect

occupations?occupations? What effect does moving in with children have on occupational What effect does moving in with children have on occupational

restructuring?restructuring?

Constructive Approaches to OT & Constructive Approaches to OT & OS Research Cont’dOS Research Cont’d

Areas for Future Research:Areas for Future Research:

Disability throughout widowhoodDisability throughout widowhood What is the relationship between disability and What is the relationship between disability and

occupational restructuring in widowhood? occupational restructuring in widowhood?

IdentityIdentity What is the relationship between widowhood and What is the relationship between widowhood and

occupational identity?occupational identity?

ConclusionConclusion

It is essential for further research to focus on It is essential for further research to focus on widowhood using an occupational lenswidowhood using an occupational lens Increasing geriatric population, particularly Increasing geriatric population, particularly

womenwomen Understanding of dynamic relationship between Understanding of dynamic relationship between

widowhood and other aspects of daily life is widowhood and other aspects of daily life is neededneeded

Facilitated DiscussionFacilitated Discussion

Our original question wasOur original question was: : “How does “How does widowhood amongst older female adults lead widowhood amongst older female adults lead to occupational restructuring?”to occupational restructuring?” Why is the question “how” problematic in this Why is the question “how” problematic in this

context of ‘widowhood’?context of ‘widowhood’?

what is the relationship between widowhood and occupational restructuring amongst older adult women?...

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