Religion and Spirituality in Adaptation to Late Life Widowhood: A Systematic Review

Background and Purpose: Spousal death is one of the most distressing events in late life. Worldwide, more than 50% of people over 65 are widowed. Widowhood is associated with numerous negative psychological, physical and social outcomes, which present big challenges to the health care system. Religion and spirituality may assist the bereaved elderly in coping with the distresses as they provide a philosophical orientation that affects individual’s understanding of life events. Recently, there is a growing body of literature exploring the connection between religion/ spirituality and spousal bereavement. This systematic review discussed the effects of religion/spirituality on the adaptation to late-life widowhood by adopting the ecological model as an overarching framework.

Methods: Keyword and reference search were conducted in PubMed, Web of Science, Scopus, PsycINFO, CINAHL, Family & Society Studies Worldwide, SocINDEX with Full Text; Women’s Studies international, and Cochrane Library. The inclusion criteria included: study design (randomized control trial, cohort study, longitudinal study, or cross-sectional study); population (the widowed elderly); main outcomes (psychological and social well-beings); article type (peer-reviewed publication); and language (English). Studies were excluded if they examined changes in religion/spirituality as a result of bereavement. The validity of studies was assessed according to the following criteria: (1) Was the research question clearly stated? (2)Were the objectives relevant for review questions?  (3) Were the participants randomly recruited from a well-defined population? (4) Were the subjects in the study represent of the older widowed population? (5) Were the inclusion and exclusion criteria clearly stated? (6) Were religion/ spirituality clearly defined? (7) Were the potential confounders properly controlled? (8) Were the subjects in the study represent of the older widowed population? (9) Were the outcomes clearly defined? Scores for each criterion range from 0 to 2, depending on whether the criterion was unmentioned or unmet (0), partially met (1), or completely met (2). The total quality score ranges from 0-27. Information about author(s), publication year, study design, sample size, age, religion, education, proportion of the widowed, proportion of women, length of follow-up, outcome measures, and study results was abstracted from each study.

Results: 16 studies were included in the review, including 7 longitudinal studies and 9 cross-sectional studies. Following the ecological model framework, the results were categorized into three levels: First, at the individual level, religiosity/spirituality had mediated the negative impact of widowhood on psychological well-being in general, reduced grief symptoms, such as depressive symptoms, psychological distress, functional disability, anxiety, anger, and yearning, and assisted post traumatic growth; Second, at the relationship level, religiosity/spirituality positively associated with social supports and social engagements. Third, at the community level, elderly widowed with high religious coping scores tended to have fewer outpatient physician visits.

Conclusions and Implications: Religion/spirituality promotes the adaptation to late life widowhood. Knowing about individual’s religion/spirituality may help palliative care professionals to meet the spiritual needs before and after the spouse’s death. It is critical as the goal of palliative care is to provide holistic care to the dying patients and their families.