The impact of social network change due to spousal loss: A qualitative study on experiences of older adults who are aging in place

Abstract

Spousal loss due to nursing home admission or death is challenging for the well-being of the remaining partner and for aging in place. We explored: “How does social network change due to spousal loss impact older adults who are aging in place?.” In-depth interviews were held with six older women who were aging in place and who lost their spouses in the past two years. Narrative analysis was conducted. Results indicate that the impact varies in three dimensions and that variations within dimensions follow three themes. The results emphasize the complexity of impact and the urgent need for a person-centred approach toward older adults after spousal loss.

Introduction

Aging in place refers to being able to remain in one’s current non-institutionalized residence even when faced with increasing need for support because of life changes, such as declining health, widowhood, or loss of income (Pastalan, 2013). Older adults want choices about where and how they age in place (Wiles et al., 2012). Mobility, social relations, and the environment as enabler of mobility and social relations are important elements that contribute to the maintenance of aging in place (Gardner, 2011; Menec et al., 2011; Ottoni et al., 2016). Moreover, governments of Western welfare states promote aging in place to deflect rising health expenses due to aging societies (Pacolet et al., 2018). Social networks are important for continuing aging in place as a direct source of support (Burt, 1997; Kahn & Antonucci, 1980; Suanet & Antonucci, 2015) and, indirectly, as a stress-buffering factor and a precondition for health and well-being (Berkman et al., 2000; Cohen & Wills, 1985; Cornwell & Laumann, 2015; Freund & Baltes, 1998; Huber et al., 2016; Jowkar et al., 2010; Kawachi, 2001; Seeman et al., 2001; Uchino et al., 1996).

The spouse is an important member of the social network during the adult life span, for reasons of love and intimacy, but also for support and providing care (Calasanti & Kiecolt, 2007; Dykstra & de Jong Gierveld, 1999; Eriksson et al., 2019; McIntosh et al., 2011; Roelofs et al., 2021). Experiences of loss of the spouse due to nursing home admission are similar to experiences of loss of the spouse to death to a certain extent. Nursing home admission of the spouse in case of dementia is accompanied by a loss of social identity and by a change of the social connectedness between partners (Králová, 2015); this has been referred to in the literature as a social death (Borgstrom, 2017). The loss of a spouse due to nursing home admission or death is a change in the social network and a determinant of other changes in the social network, such as an increased contact with the children (Vos et al., 2020). The loss affects older adults majorly with negative consequences for the health and well-being of the remaining partner and as such challenges aging in place (Allen et al., 2021; Fry, 2001; Lundorff, Thomsen, Damkier, & O’Connor, 2019; Wilson et al., 2020).

Older adults report satisfaction with their social networks and tend to experience relatively high levels of well-being compared to younger adults (Charles & Carstensen, 2010; Tomini et al., 2016), despite generally changing or declining social networks (Fuller-Iglesias et al., 2015; Huxhold et al., 2013; Klein Ikkink & Tilburg, 1999; Reinhardt et al., 2003) and the prevalence and experiences of loneliness and social isolation (Graneheim & Lundman, 2010; Hoogendijk et al., 2020; Wolfers et al., 2022). Older adults report positive emotions with family members (Charles & Piazza, 2007), predominant positive interactions with members of the social network (Birditt & Fingerman, 2003; Newsom et al., 2005), and compared to younger adults smaller increases in distress when interpersonal tensions appear (Birditt et al., 2005). This is also referred to as successful aging (Martin et al., 2015). However, these age-related advantages on the socio-emotional level seem to disappear when older adults are confronted with persistent high levels of distress (Charles & Carstensen, 2010). The loss of a spouse due to nursing home admission or death is a potential source of persistent distress that affects older adults’ well-being and quality of life (Ask et al., 2014; Gaugler et al., 2009; Noël-Miller, 2010; van Boekel et al., 2021).

In this study, the loss of a spouse due to nursing home admission or death is perceived as a change in the social network with a high impact and as a potential source of persistent distress that challenges both well-being and aging in place. To gain a more comprehensive understanding of this quite common but life-altering event during old age and to unravel the meaning of “impact,” we consider older adults who are aged >65 years and aging in place and who recently lost their spouse to be experts on the subject. Therefore, we build on older adults’ experiences to answer the following research question: “How does social network change due to spousal loss impact older adults who are aging in place”?

Method

Study design and setting

An exploratory, qualitative research design was used to examine the experiences of spousal loss and social network change of older adults who are aging in place. A short interview protocol was followed to facilitate an open conversation on the subject and give participants the opportunity to narrate their own matters or major concerns (Kallio et al., 2016). The study was conducted in the southern region of the Netherlands, in the homes of the participants. Only the respondent and the interviewer were present at the time of the interview to ensure confidentiality (Allmark et al., 2009). A report on the Standards for Reporting Qualitative Research is available as Supplementary File 1 appended to account for the quality criteria that are followed (O’Brien et al., 2014).

Participants and recruitment

Participants were recruited among people who were aged 65 or older and aging in place. For this study, aging in place was defined as the current non-institutionalized environment in which the participants were living with support from home care nurses. Participants were recruited through four home care organizations from the network of the research department (Luijkx et al., 2020) by seven home care nurses who volunteered to participate in the selection procedure. Initially, the inclusion criteria were “the older adult is experiencing health decline” and “the home care nurse notices social network change within the life of the older adult.” The nurses became involved with the participants and their spouses in a period of (spousal) health decline and eventually, spousal loss due to nursing home admission or death. The nurses asked if their client was interested in participating and, if so, handed over an information set. The information set contained information on the research topic and on how to participate. An informed consent form was enclosed as well as a form for the registration of social contacts. After returning the forms, a researcher (WV or MJ) contacted the respondent and made an appointment for the interview, preferably without others being present. After a year, the enrollment of older adults lingered and eventually stopped, despite several reminders to the home care nurses. The researchers then chose to stop the recruitment procedure and examine the sample so far. Within the sample, which fitted the inclusion criteria, we found one subgroup of seven older adults who had recently been admitted to the hospital and who returned home with home care afterward. Results on this subgroup were published elsewhere (Ouden et al., 2021). Another subgroup of the sample contained six older adults who had lost their spouses after a shorter or longer period of health decline, either because of their death or because of them moving into a nursing home. The present study includes the participants of the latter subgroup, which is a sample of older adults who are aged 65 years and older and aging in place with experiences of spousal loss. Examining this subgroup provides the opportunity to explore in detail the similarities and differences between the six participants (Smith & Larkin, 2009).

Ethical approval and consent to participate

Ethical approval was given by the Ethics Review Board of the School of Social and Behavioral Science of Tilburg University (EC-2018 75t). An informed consent form was signed by all participants before participating in the research.

Data collection

The six in-depth interviews in this study were conducted by the first author (WV), who is a PhD student and is experienced in interview techniques as a researcher, team coach and healthcare consultant. The interviews were guided by a protocol that was informed by the book of Holloway and Freshwater (2009) on narrative research in nursing and that consisted of (a) an introduction of the interviewer, a freshen-up of the research goals and a check whether the informed consent had been signed, and (b) after the audiotape had been started and the respondent had confirmed his or her permission, two questions were asked: “From [name nurse] I heard you were separated from/lost your husband recently. Can you tell me more about this period?” and “How do you perceive your life has changed since you have been separated from/lost your husband?” Additionally, a set of supporting questions was asked, on the one hand to come toward participants’ experiences (“How did you feel about that?,” “How did you deal with that?”) and on the other hand to guide the narrative toward social network changes (“Do you still do the same things as before the separation/loss?,” “With whom?”). The interviews lasted between 60 and 120 minutes and ended when information saturation was reached. The participants received a small present after the interview when they were thanked by the researcher. The interviews were audio-taped and transcribed verbatim. Original files were stored in accordance with the university’s data management protocols. Transcripts were anonymized by the first author before data analysis. Data were collected between December 2018 and November 2019.

Data analysis

Initially, grounded theory building was conducted (Corbin & Strauss, 2014) because of its usefulness for understanding specific phenomena within processes, such as experiences of spousal loss and social network change while aging in place (Langley, 1999). Additionally, the in-depth interviews were considered as narratives to maximize understanding of the experiences of participants, because it is through narratives that we make sense of our social worlds (Smith & Larkin, 2009). Analyzing the interviews as narratives helped us to understand the collected data more profoundly and examine how participants make sense of their experiences themselves, in order to reach a deeper understanding of the expected complexity of personal experiences (Doucet & Mauthner, 2008; Forrest et al., 2016; Smith & Larkin, 2009).

First, the interviews were coded thematically by one researcher (WV), using Atlas.ti 8. The coded interviews were read by two other researchers (three by MJ and three by LB) to enhance reliability. Both researchers, one of whom had a PhD and experience in qualitative research (MJ), while the other had a PhD and had published on spousal loss (LB), worked as senior researchers at the ACC. When new codes were added to the codebook by one of the researchers or when existing codes were slightly adapted, these changes were discussed until consensus was reached. The codebook is available as Supplementary File 2. Second, the interviews were read again, and a listening guide (Table 1) was used to guide the reading, analysis, and discussion of the narratives to enhance reliability. The researchers answered the questions in the listening guide for themselves and discussed their answers pairwise until they reached consensus (WV/MJ discussed interviews 2, 4, and 6, while WV/LB discussed interviews 1, 3, and 5). Third, in order to construct meaning from the words of the participants, comments were added to the text fragments within each interview in Atlas, ti (WV). The comments were meant to differentiate between what the respondent said, how she said this and why at that moment in the interview, and how the researchers interpreted this fragment in relation to answering the research question. For example, respondent 3 states in one sentence that she misses her husband during breakfast and that she regrets the moments when she wasn’t very friendly to him when he was on his sickbed, but that now she can visit the Dutch coast again, where she loves to go (what) when she explains that the loss of her husband affects her more (in a negative way) than she expected (why). She expresses feelings of regret, as well as feelings of relief (how), and she imagines that she would have burdened herself a little more, by taking better care of her husband, if she had known that his sickbed period would only last such a short time. Now she feels guilty despite her dominant feelings of relief (interpret). The comments were discussed within the same pairs (WV/MJ discussed interviews 2, 4, and 6 and WV/LB discussed interviews 1, 3, and 5) until consensus was reached on the meaning of the words of the participants. Finally, a summary was made of all six interviews, with the codes used, the comments made and an interpretation of the narrative. The summaries and the preliminary versions of this paper were discussed with the three researchers (WV, LB, and MJ) and the supervisors (KL and RL) to answer the research question. The summaries were in Dutch and enabled the researchers to interpret the data in their native language. All preliminary versions of the paper were written in English, which made the contents of the paper a subject of the discussions as well as the translation of the contents. All authors are experienced researchers and agreed upon the translation. The final version of the paper was revised by a native speaker of a professional proof-reading service.

Table 1. Listening guide with questions that were used to discuss and analyze respondents’ narratives.

1. Discussing the narrative	a.  What is going on in the life of this respondent?
	b.  What appear to be important words, themes, events, contradictions and persons in their lives or chronologies?
	c.  What would you code differently?
2. Discussing people in the narrative	d.  How does the respondent speak about herself/himself?
	e.  How does the respondent speak about other people? What identity does she/he give them?
3. Discussing relations in the narrative	f.   What relations are part of the narrative?
	g.  How does the respondent speak about these relations?
4. Discussing structures and processes in the narrative	What is indicated about:
	h. … different life stages and events that happened in these life stages?
	i.  …health decline?
	j.  …social network change?

Questions are based on the four required “readings,” which are needed to operationalize a narrated subject, also referred to as “The Listening Guide” (Doucet & Mauthner, 2008).

Results

All six participants were women. They talked about the lives they had lived with their spouses, which had come to an end because the spouse had passed away (5, 6) or because the situation at home was no longer tenable for the participants (1, 2, 3, 4). When the situation became untenable, the husband moved to a hospice and died within a few weeks (1, 3), or he moved to a nursing home where he still lived at the time of the interview (2, 4). The nursing home admissions were induced by the worsening of the psycho-geriatric conditions of the spouses. The losses hit the lives of the participants between two and 24 months ago but were a large part of the narratives of all the participants. Table 2 shows the status of the participants and the changes in respect of their spouses. The age of the participants is not specified, because all of the participants fit the inclusion criterium of >65 and we contend that the participants’ specific chronological age is not of importance when examining the experiences of older women on spousal loss. Asking for their age, we perceive, would infringe their privacy unnecessarily and was therefore not asked during the interviews. During the interviews, no doubts were raised on cognitive and/or communicative impairment of the participants.

Table 2. Status and change of the respondents.

No	Fictitious name	Gender	Civil status	Domestic status	Social network status	Spousal health decline	Spousal loss
1	Mrs van Someren	f	Married	Social housing	A daughter and her family – Emotional and instrumental support, visits	Chronic illness;	6 months ago;
			40–60 years	in a city	Sisters – Visits	sickbed of 27 months at home	death
					Friends – Going out
2	Mrs Jansen	f	Married	Social housing	One son and his family – Instrumental support, visits	Aging with unknown decline;	4 months ago;
			> 60 years	in a city	Her four other children – No contact at all	husband collapsed unexpectedly	nursing home admission
					No neighbors, friends or acquaintances
3	Mrs Doorwerth	f	Married	Service apartment	Two daughters and a son – Instrumental support, visits	Regular aging with a handicap (deaf);	3 months ago;
			> 60 years	in a city	A niece – Visits	sickbed for 10 months at home; 3 weeks in a hospice	death
					Friends (recently deceased) – Emotional support, visits
					A neighbor – Reciprocal instrumental support
4	Mrs de Vries	f	Married	Rental apartment	Son – Instrumental support, visits	Alzheimer’s disease for 3 years	2 months ago;
			> 60 years	in a small town	Friends – Emotional and instrumental support, visits		nursing home admission
					Digital friends – Emotional support
5	Mrs Lansink	f	Married	Country house	Daughter – Instrumental support, visits	Regular aging with unknown decline	24 months ago;
			> 60 years	in the woods	Son – Visits		death
					Brother – Instrumental support, visits
					A neighbor – Reciprocal instrumental support
					A few acquaintances – Little contact
6	Mrs de Wit	f	Married	Rental apartment	Foster son and foster daughter and their families – Instrumental support, visits	Chronic illness;	7 months ago;
			> 60 years	in a city	A brother – Contact unclear	sickbed for several days at home	death
					Two neighbors from her building – Drinking coffee in the common room
					No friends or acquaintances

All the participants described the loss of their husbands and the changes in the social network that were instigated by the loss. Their stories on their loss spanned periods of time varying from several days (2, 6) to several years (1, 4). The changes in the social networks of the participants mainly concerned changes in the social support they received. Occasionally, the stories evoked strong emotions during the interview (1, 4, 6). In the forthcoming sections, first, the narratives of the participants about their spousal loss are presented; second, the changes experienced within the social networks of the participants are reported; and last, three dimensions of impact are derived from participants’ narratives. The names that are used for the participants are fictitious.

Experiences of spousal loss

Mrs van Someren lost her second husband six months ago, after 27 months of informal care provision. She had felt heavily burdened by the need to be available 24/7 for her husband. It had made her feel very alone. No one seemed to understand the struggle she was going through. “And well, the last months I took care of him, day and night. That’s why I lost 19 kilograms of weight. (…) Because it was heavy. (…) Yes, then I was lying in my bed and it went wrong again [WV: with her husband lying in a bed in the living room]. He rang his bell and then I had to get up and hurry down the stairs, check his saturation and call the hospital. (…) Many nights I sat with him, that he turned all blue and he had no breath and all that. And you can do nothing. You can do nothing, than taking care of him.” Mrs van Someren got agitated during the interview when talking about her younger years. Repeatedly, she was forced to fight for a safe life for herself and her only daughter due to a violent first marriage. Eventually, she managed to create a safe home with her second husband, whom she recently lost. She respectfully indicated that she missed her husband in daily life, but she felt fortunate to have such a strong bond with her only daughter. Moreover, later in the interview Mrs van Someren shared her cheerful perspective. She started talking about her plans for the next three weekends, for the forthcoming holidays and for Christmas, mostly with her daughter. Also, she recounted some cheerful anecdotes about the possibility of finding a new husband. “I don’t need another man. Why? I’m telling you: I’m perfectly able to spend the money I have left myself! (laughing).” The loss of her second husband filled her with gratefulness and appreciation for him. Nevertheless, it marked the end of an era of worries and unmistakably heralded a new beginning.

Mrs Jansen lost her husband four months ago. Her husband was admitted to a nursing home. It left her home alone and overrun. “What happend or what he got, no one knows. Suddenly, we were eating, “I’m gonna be sick,” he said. “Come on over here to the chair, because I’m falling on the ground and I’m dying.” (…) And they brought him to the hospital. Yes, for three weeks he laid there and then straight to the nursing home, not allowed to come home again.” Later in the interview, she said that she had not expected to take him home again. Actually, she was relieved that her husband could move out quickly, because taking care of him had become too burdensome for her. She had always taken good care of her husband. Mrs Jansen also mentioned that, in the past, she had had a hard time making friends. She never really managed to make a good friend, although she had tried a few times. Therefore, and because of her belief that marital partners should form a close union, she always joined her husband. “He was on the board of an association for retired people, he was treasurer of the disabled people’s association. (…) We were in it together. If there were activities, we went together.” Mrs Jansen was proud of the close relationship with her husband. She visited him every other day and sometimes she stayed for dinner. She did his laundry to make sure he looked handsome. She felt fortunate to be still able to continue their relationship, despite his nursing home admission.

Mrs Doorwerth lost her husband three months ago, after a sickbed period of ten months. Within that period, she felt that her privacy was negatively affected by the care provision scheme that constantly brought nurses into her home. The constant concern for her husband burdened her. Therefore, at some point, she organized a short holiday. “And he (WV: her husband) went to a care hotel by the sea, when I had made reservations for a holiday in a coastal village, well yes, but yes, I really needed a short time without worries. And then he went to that care hotel and I, with my son, to a hotel in that coastal village. Well, for me, it was a great week, oh and I really enjoyed the carelessness.” After the holiday she felt guilty because her husband made it clear that he had had a terrible week. Furthermore, she expressed her appreciation for her husband and she told him that she had missed him during the daily routines. However, when the interviewer asked her for an example of a moment when she had had a hard time, after her husband died, she said: “Well, now don’t you laugh, I cleaned up the place. My husband preserved everything, magazines, paperwork, well, you name it. And that’s what I cleaned up. And sometimes, I just have to laugh, well, well, well, and then I run into some notes with his handwriting and then my tears come up again. They do. But actually, I have been very busy since his decease. I took up a lot of things and perhaps that’s all right, because that provides a change of mind.” Moreover, she indicated that she had no problem with being alone, because now she could do whatever she wanted.

Mrs de Vries described how she was losing her husband in stages: three years ago she lost him to Alzheimer’s disease, two months ago she lost him due to nursing home admission and eventually she will lose him to death. She felt a duty to take care of her husband until the end, out of thankfulness for him and because she felt that she was a strong person and thus fit for the job. However, increasing care demands and a more complicated care coordination made the situation untenable at home. Eventually, she felt unable to accomplish “her duty.” It felt as if she was giving up on her husband. She talked extensively about the days surrounding her husband’s nursing home admission. “But then, well, then you come home at night. I could easily have smashed everyting into smithereens, I was that angry! (…) Yes, simply angry, with myself, because I had the feeling that I had given up on him. Yes. It’s not like that, now I know, but I would have preferred to have finished it at home.” At least the loss of her husband to a nursing home brought an end to an intensive period of survival for her, but she felt sad, redundant as an informal carer and a little lost in life.

Mrs Lansink lost her husband approximately two years ago. She told the interviewer that she missed talking to her husband, and discussing and solving things together. In that respect, she mentioned that she hated it when people did not take her opinion seriously nowadays. As an illustration, she quoted a dialogue with her gardener: “And every time the gardener says: no, that’s not how I do it. No?! But I want you to do it like that! Yes, well, but I could do it like that? No! Thát’s how I want it! Well, if you are 80, then most people don’t take you seriously anymore. That’s a problem.” Her story was filled with recent occasions when she had resolved issues herself, such as arranging a stay in a care hotel after being admitted to hospital, regaining her physical fitness despite an unhelpful doctor and the renovation of her house. Moreover, she felt free to go wherever and do whatever she wanted due to the resources she had; that is, enough money, two houses, a car, and a caring daughter.

Mrs de Wit became emotional when she talked about the loss of her husband seven months ago. She missed him very much, especially during the morning routine. She mentioned that her foster children had told her that she had handled the loss of her husband well, “but inside, I’m crying,” she said. Mrs de Wit indicated that she had known her husband since 1939 and that they had been through so much together. “And the children were adopted. So that’s what we did together, we all had to do that, well, how do I? It’s not been very easy. With everything, it was all very, very far-reaching, but we survived and we were able to manage all that. Now I have to manage this myself.” Mrs de Wit felt very alone. She felt that she had to be strong for her (grand)children and that she should move on, but she still had not figured out how.

Table 3 presents the personal experiences with spousal loss of the participants. The personal experiences can be divided into, on the one hand, feelings that are concerned with the loss of the significant other and, on the other, feelings that are evoked in oneself as a result of the loss.

Table 3. Personal experiences with spousal loss.

Respondent	Feelings concerned with the loss of the significant other	Feelings that are evoked in oneself as a result of the loss
1. Mrs van Someren	Gratefulness and appreciation	A new beginning
2. Mrs Jansen	Affection and pride	Fortunate because of continuing relationship
3. Mrs Doorwerth	Appreciation and emptiness	Free and careless
4. Mrs de Vries	Emptiness and affection	Redundant as an informal carer; no meaning of life
5. Mrs Lansink	Appreciation and emptiness	Free to make one’s own decisions
6. Mrs de Wit	Affection and emptiness	Lonely and not able to live life on her own

Changes experienced within the social network due to spousal loss

Mrs van Someren lost a “good man” and she indicated that she experiences empty days since his decease. Fortunately, she felt very much supported by her daughter while her husband was on his sickbed and during the days when they had to say goodbye. Moreover, her daughter provides great support nowadays. Together, they discuss how she could continue her life and her daughter helped her freshen up her home and took her on a holiday. Mrs van Someren also used to have a good relationship with her sisters. They visited her every now and then when her husband was on his sickbed, but they made her feel very alone. Her sisters obviously did not understand her situation. “Once, it was raining cats and dogs, and I had to do some grocery shopping and he lay there [WV: her husband was lying in his bed in the living room], and then my sister came to visit us, and they have two cars and a huge house in the city, no kids, and they still didn’t ask me ‘Anny, do you perhaps need anything?’” Soon, her diluted relationships with her sisters were left behind. During her husband’s sickbed period, her group of friends was her lifeline to the world outside her home. Once a week, someone from the municipality came to stay with her husband to enable Mrs van Someren to go out with her friends. She greatly appreciated the carefree moments of laughing with her mates back then, and she still does (“they always kept a seat for me!”). Finally, a caring neighbor held a key to her house and kept a watchful eye on her. This made Mrs van Someren feel as if she was being taken care of.

Mrs Jansen did not mention experiences of change within her social network, neither did she express feelings of loneliness or emptiness concerning her husband’s nursing home admission. She was proud that she could still take care of her husband and thus continue the close relationship they had always had. She felt grateful that they were still together, although they always had hoped to stay at home together until the end. Furthermore, she talked in an animated way about her son and his family and she felt supported by them. Her son always helped her with her grocery shopping and with buying a new dress when she needed one. During the interview, however, it became clear that contact with her other four children and their families had been lost. Mrs Jansen appeared reluctant to talk about them. Moreover, acquaintances from her husband’s hobbies had already been lost in the past decade, neighbors were always kept at a distance, and she never had any friends. The home care nurses who still visited her after her husband’s nursing home admission regularly asked her how she felt and how her day was going, which she very much appreciated.

Mrs Doorwerth talked about the loved ones she had lost recently. She had lost her sister. “Oh, oh, and still, when I think about it, then I think: so sad, she is not here anymore, shame, shame, shame. Yes, well, that’s how things go. But I feel supported by my children.” And she had lost two of her closest friends. “Well, that’s what I regret most, losing friends. The contacts with my two friends were a lot more intense than with my husband. (…) But he was a loving and caring husband, I must say. Sometimes you hear stories about men being real bastards (laughing), no, he was absolutely not like that.” Mrs Doorwerth was grateful for her children and the support they gave to her since her husband died. Her daughters came to her so they could cook together, and her son and a niece visited her regularly. Also, she mentioned all kinds of trips she could hypothetically undertake and activities she could take up again, now her husband had deceased. She and her husband appeared to have had diverging interests. But meanwhile, she kept herself busy in and around her house, not going anywhere anymore.

Mrs de Vries had a hard time getting used to being alone. A while ago, when she first lost her husband to Alzheimer’s disease, she initiated a Facebook group for peers, i.e. people who had also lost their spouses to Alzheimer’s disease. The peer group became a major source of support for her. “Well, I felt very lonely at New Year’s Eve, terrible, terrible. Yes, when I think about that moment. Phew, I still get emotional. (…) He [WV: her husband] went to bed at 8:30 p.m. and I think: well, here I am on my own all night long. (…) Then I went outside on the balcony in the rain, crying: next year I will be alone. And then my phone bleeped and it was a message from someone from the group [WV: the Facebook group]. Also alone. Had not crossed my mind! She texted: is the bar not open? (…) [WV: And Mrs de Vries opened and entered the chatroom.] At certain times it was so much fun. I did not go to bed until 1:30 a.m.” While losing her husband, first to Alzheimer’s disease and later to nursing home admission, she had her son to support her and to help her move her husband to the nursing home. She had friends from the village she used to live in, she had her Facebook friends, and she even got her hairdresser help her out when she needed a ride to the city center. Nevertheless, during the interview, Mrs de Vries expressed a sense of emptiness around her.

Mrs Lansink emphasized that she was perfectly able to manage on her own. However, she talked extensively and with humor about her and her husband’s joint achievements, presenting them together as a genuine team. Mrs Lansink appeared proud of, and satisfied with, the life she had lived with her husband. Nowadays, her daughter helped her order the heaviest groceries online and occasionally they went out together. Her brother, who lived in a village nearby, sometimes helped her with her mail. During the interview she mentioned how she considered moving back from her house in the woods into the city again, because of the presence of more facilities and her old acquaintances. However, this period of considering her next steps had already lasted two years since her husband died. Meanwhile, her days were increasingly filled with watching television and the interview showed no signs of her taking any action regarding moving to the city.

Mrs de Wit recalled the times that she and her husband went cycling together and had a picnic on the way and about the time they spent on their mutual hobby. Nowadays, she tended to spread her activities, such as doing the laundry and receiving her cleaning lady at home, over the entire week to keep herself busy. She was grateful for her two foster children. One of them helped her with her “medical stuff” and the other one invited her to his home regularly. “And on Sundays, he [WV: her foster son] usually calls around 5 p.m, ‘I’m coming to pick you up to eat something warm’, or…, but actually I would rather end this. Well, it feels like infringement … He invites me with love, and they all do this with love, because when I’m not around then they say ‘where’s granny?’, ‘Is granny not here?’” The contact with her brother was reduced to a phone call sometimes, because he lived in another part of the country and he had his own life. Sometimes, Mrs de Wit pushes herself to have coffee in the community room of the building she lives in. Over there she talks with two friendly, older ladies, although she felt it is hard to blend within this community. She did not talk the local dialect and her hearing impairment limits a good conversation. All in all, she sighed that the pleasantness in life had gone.

Table 4 presents the changes in the social networks of the participants, which were mainly concerned with experiences of change (or not) in the social support that was received.

Table 4. Changes in the social networks of the respondents.

Respondent	Loss of spousal support	Change in support from children and grandchildren	Support from brothers and sisters	Support from friends and acquaintances	Support from neighbors
1. Mrs Van Someren	Loss of a good man	Increased emotional support	Cooled-off contacts due to missing support in period of informal care provision	Increased frequency of going out	Increased instrumental support
		Increased instrumental support
2. Mrs Jansen	No experiences of loss mentioned; now living apart	No experiences of change mentioned	No experiences of change mentioned	No experiences of change mentioned; contacts were already lost	No experiences of change mentioned
3. Mrs Doorwerth	Loss of a good man, despite personality differences	Increased instrumental support	Loss of emotional support, due to recently lost sister	Loss of emotional support, due to recently lost friends	Increased instrumental support
4. Mrs de Vries	Loss of a good man	Increased instrumental support	No experiences of change mentioned	Increased emotional support from Facebook group	No experiences of change mentioned
				Increased instrumental support
5. Mrs Lansink	Loss of talking, discussing and solving things together	Increased instrumental support	Increased instrumental support	No experiences of change mentioned	Increased instrumental support
6. Mrs de Wit	Loss of spouse as her social network	Increased instrumental support	No experiences of change mentioned	Going out occasionally	No experiences of change mentioned

Three dimensions of impact of social network change due to spousal loss

The impact of spousal loss and the experiences of social network change due to spousal loss appear to be multidimensional. We derive three dimensions of impact from the narratives: impact due to the disruption of daily life, impact due to the loss of a close relationship and social support as a counterbalance to impact.

Impact due to a disruption of daily life

Participants miss their husband who filled a large part of their daily lives. They indicate that they miss their husbands in their joint morning routine (6), eating together (3) and doing activities together (1, 4, 6), or that the days and weeks were empty without their spouse (1, 4, 6). In some cases, the 24/7 informal care burden that filled their daily lives was relieved or dissolved by the loss of their spouse (1, 2, 3, 4). Therefore, it was concluded that losing a spouse impacts daily life negatively, especially if daily life together used to be a source of well-being (5, 6). Alternatively, in cases where daily life together does not add much to one’s well-being, the negative impact of the loss is much lower (1, 3, 4).

Impact due to the loss of a close relationship

Participants mentioned their long-lasting marriages in every interview. All participants expressed norms about marriage being “until death do us part” and about “the wife takes care of the husband and the children.” Participants esteemed their husbands highly and talked with words of appreciation (1, 3, 5) and affection (2, 4, 6) about their spouses. Moreover, the narratives reveal how these close relationships were loaded. Participants told the interviewers about shared hobbies and interests, such as visiting a market together (1), joining an association together (2), a joint love for baking (4) and discovering the family past through genealogy (6). The close relationships differed in the balance between spouses, though. A husband-dominated relationship is evident in the cases of Mrs Jansen (2) and Mrs de Wit (6), where their husbands were mainly responsible for joint and personal decisions, such as decisions about the inheritance for the children or a decision on developing neighborhood relations. Both Mrs Jansen and Mrs de Wit participated in the social networks of their spouses and did not mention having any friends, acquaintances, or neighbors of their own. A wife-dominated relationship is evident in the cases of Mrs van Someren (1) and Mrs de Vries (4). Both ladies say little about the relationships with their husbands but present themselves explicitly as tough ladies who handled the informal caring for their husbands with fierceness. A relationship between autonomous partners is apparent in the case of Mrs Lansink (5), who refers to her marital relationship as a strong unity. She talks proudly about their joint accomplishments, despite having differing interests and personalities. The marital relationship of Mrs Doorwerth (3) could also be qualified as a relationship between autonomous partners, although she mentions preferring discussing important things with her friends rather than with her husband. Her husband was a good man, she says, but they were completely different personalities.

Therefore, we conclude that participants experienced an impact due to the loss of a close relationship. However, the impact depends on the kind of relationship that was lost. A negative impact is evoked when the remaining partner relied on the deceased partner for every aspect of social interaction (2 and 6), while a smaller impact is evoked when the remaining partner was responsible for the aspects of social interaction, either for both spouses (1 and 4) or for themselves only (3 and 5).

Social support as a counterbalance

After losing their spouses, all participants mentioned that they felt supported by their social networks. The social support appeared to serve as a counterbalance to the impact of the spousal loss; that is, the disruption of daily life due to spousal los and to the impact of the loss of a close relationship. First, and above all, they felt supported by their children, who scaled up instrumental support if needed, and who paid regular visits back and forth (all). In contrast, the absence of support from brothers, sisters and friends was sometimes felt as a shortcoming that raised feelings of disappointment—for example, when expectations of support were not met because brothers, sisters and friends did not seem to understand what was going on in the life of the participants (1, 4), or when support appeared not to be available anymore due to deceased friends (3) or was absent due to an almost non-existent social network (2, 6). However, the absence of support from brothers, sisters, and friends did not appear to be a problem (1, 2, 3, 4, 5). For example, Mrs de Vries (4) worked out what her daily life would, could and should be like after the recent nursing home admission of her husband and kept her friends at a distance for the time being.

Therefore, it was indicated that social support could serve as a counterbalance to spousal loss and social network change. However, which aspects of social interaction should be counterbalanced and by whom appeared to depend highly on the personal needs and expectations of the remaining spouse.

Discussion

In exploring how social network change due to spousal loss impacts older adults, we interviewed six women who lost their husbands. The women were all dealing with the everyday consequences of this loss and the changes that the loss instigated in their social network, despite variations in the time that had gone by since the date of the loss. Although the women experienced quite a similar situation at first glance, the impact appeared to vary in three dimensions: (1) a disruption of daily life; (2) the loss of a close relationship; and (3) social support as a counterbalance to the impact of the loss. The depth and kind of impact (negative, less negative, and sometimes even slightly positive) appeared to depend on: (1) the well-being or satisfaction with daily life before the loss; (2) the balance in the marital relationship before the loss; and (3) the alignment between the needs and expectations of the remaining spouse and the available social resources.

The results regarding the impact of spousal loss in the present study resonate with earlier findings from the literature. 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). Our study corroborates this; for example, the narratives that contain active coping in daily life after spousal loss, such as cleaning up (1, 3), doing the laundry (2) and taking directions (5), indicate a moderate impact, whereas less active coping (4, 6) appears to indicate a higher impact. Furthermore, the results of several quantitative studies reveal the complex relation between bereavement, the preceding relationship of the partners and the circumstances of loss. For example, a sudden versus an anticipated death of a spouse did not clearly explain psychological adjustment afterward (Carr et al., 2001) or -another example- between a quarter and a fifth of older adults experience social and emotional loneliness within their marriage, especially when informal care provision is part of the relationship (de Jong Gierveld et al., 2009). The narratives in our study confirm this complexity. Moreover, the narratives reveal and illustrate that the content and quality of, and satisfaction with, the marital relationship account for the depth of the impact of spousal loss. Finally, in regard to social support as a counterbalance, the literature indicates that spousal loss mainly causes emotional loneliness and to a lesser extent social loneliness or depression (Szabó et al., 2020), and that older adults appreciate their weak ties, such as the friends they go out with (Ten Bruggencate et al., 2017), and might benefit from these weak ties to compensate for the loss of close ties (Huxhold et al., 2020). Based on our participants’ narratives, we can confirm a loss of emotional support in some cases and no replacement of this emotional support by other members of the social network. We can also confirm that instrumental support and social distraction (i.e., going out with friends) were scaled up and served as a counterbalance.

Placing the results from our study in a broader perspective, we recognize the rather Western and twentieth-century frame of reference with norms of monogamy, “marriage until death parts us,” “the husband takes care of the wife” and a reluctance to burden the children with one’s own sorrows. For example, the narrative of respondent 3 reveals a strong compliance with the Christian-based norm of the family as the cornerstone of “the good life” (Vogt, 2006), which seems counter-intuitive for a lady with a high sense of autonomy and whose marital relationship appeared not to contribute largely to her socio-emotional wellbeing. Our results do indicate a diversity of impact within this frame of reference, though, but it is important to further examine diversity within and between cultures in bereavement after spousal loss and the individual preferences in support-seeking behaviors (Fiori et al., 2006; You et al., 2020). With respect to the diversity of impact within a culture, it is worth noting that the participants 1 and 3 had a marital relationship that did not particularly contribute to their personal socio-emotional well-being, although their relationships met purposes of the family as a safe place (1) or served as a manifestation of “the good life” (3). For them, the loss of their spouse could be interpreted as an opportunity to shape their life ahead according to their own conditions. This heartfelt “relief” (that was obvious to the researchers) does not match the previously mentioned cultural norm and might be worth investigating in future research. Future research is also recommended from the perspective of the informal care provider. Female spouses experience a great burden in providing informal care to their partner (Swinkels et al., 2019) and informal care provision should not be seen as a given (Aaltonen et al., 2020). However, societal developments (in terms of aging populations and reducing governmental health expenditure) enhance informal care provision (Broese van Groenou & De Boer, 2016) and future research could examine how the impact of spousal loss preceded by informal care provision could be reduced. Additionally, if we place our results in a perspective of spousal loss as a risk factor for aging in place, then we indicate that the risk arises in the domain of the socio-emotional wellbeing of older adults.

Our results indicate that the extent to which an older adult can counterbalance the different dimensions of impact due to spousal loss (loss of the disruption of daily life and of the loss of a close relationship) will possibly determine the extent of recovery of the socio-emotional wellbeing and thus reduce the impact of the loss. Enhancing older adults’ individual abilities to cope with spousal loss could reduce the risk of a low socio-emotional wellbeing and the risk of discontinuing aging in place. This resonates with the Capability Approach as developed by Sen (1993, 2014), which gives prominence to the values of human beings and their diversity in determining individuals’ capabilities and functioning to develop “a good life” (Gopinath, 2018). This also resonates with the concept of resilience in older adults, also referred to as the dynamic process encompassing positive adaptation within the context of significant adversity (Luthar et al., 2000). Moreover, revising the concept of aging in place and examining how and why a place-to-age-in is meaningful to older adults could also benefit older adults (Andrews et al., 2007; van Hees et al., 2017) and contribute to continuing aging in place after spousal loss. The practical implications of our results and of future research are the directions generated for formal and (partners as) informal carers for prevention and reduction of the impact of social network change due to spousal loss.

Strengths and limitations

A strength of this study was that the open interviews enabled the older adults to contribute with the issues of their choice and generated rich content. This enabled us to examine the narratives of a rather homogeneous subgroup of older adults (white, northern European, home-residing women with middle and high incomes), which revealed remarkable differences between the cases and gave an insight into the complexity of experiences with social network change due to spousal loss. To enhance understanding of -diversity in- bereavement after spousal loss, however, an exploration of more subgroups is recommended for future research. Opportunities to explore diversity in bereavement can be found in examining subgroups of widowed men, people in a homosexual relationship, people who lost their spouses in a lockdown due to COVID-19 and older adults with a non-Western background. Evidently, one limitation of this study is its small number of participants. Another limitation is that we did not verify the narratives with the six participants; nor have we done follow-up interviews to study the impact in the long term. Due to a shortage of personnel and a high work pressure in all four home care organizations, the recruitment of participants was difficult and took more time than expected, and the number of applications remained low. Verification visits and follow-up interviews would have taken place during the pandemic COVID-19, which would have put further burden on the homecare organizations and was hard to reconcile with prevailing COVID-related restrictions. However, the rich content of the interviews revealed three dimensions of impact that offer a comprehensive understanding of the experiences of those at stake and draw quite a complete picture of the subgroup examined.

Conclusion

This study aimed to explore how social network change due to spousal loss impacts older adults who are aging in place. We found that similar experiences of spousal loss among the participants evoked a different individual impact. The impact appeared to vary in three dimensions: (1) impact due to a disruption of daily life; (2) impact due to the loss of a close relationship; and (3) social support as a counterbalance to the impact of the loss. Variations in the depth and kind of impact (negative, less negative, and sometimes even slightly positive) appeared to depend on: (1) the well-being or satisfaction with daily life before the loss; (2) the balance in the marital relationship before the loss; and (3) the alignment between the needs and expectations of the remaining spouse and the available social resources. Overall, our results confirm earlier findings from the literature and add a more comprehensive understanding of the experiences of those at stake. The results emphasize the complexity of the impact after spousal loss and the three dimensions provide a way to encompass this complexity and urge for a considerate approach toward older adults who are aging in place after spousal loss. Future research could focus on different subgroups to explore the heterogeneity of older adults who are aging in place. The implications for practice are that the three dimensions provide a framework aimed at the prevention of overburdening of informal care providers due to spousal loss.

Acknowledgements

This research received no specific grants either from a funding agency or from a commercial or not-for-profit organization. We are grateful to the participants, for welcoming us into their homes and for sharing their personal stories. Furthermore, we would like to thank the Surplus, Joriszorg, Zorgboog and Sint Annaklooster home care organizations for their efforts with the recruitment of participants. The authors declare that they have no competing interests.

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Funding

The author(s) reported there is no funding associated with the work featured in this article.