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SMAD. Publicação periódica eletrônica saúde santidade álcool e drogas

versão On-line ISSN 1806-6976

SMAD, Rev. Eletrônica Saúde estatísticas especiais Álcool Drog. (Ed. Port.) vol.11 no.1 Ribeirão Preto mar. 2015

http://dx.doi.org/10.11606/issn.1806-6976.v11i1p25-32

ORIGINAL short article DOI: 10.11606/issn.1806-6976.v11i1p25-32

The bereavement suffer in yonsei widows: a clinical-qualitative study

La experiencia del luto en viudas de la tercera edad: un estudio clínico-cualitativo

Adriano Luiz da beach FarinassoI; Renata Curi LabateII

IPhD, Adjunct Professor, Universidade estado de Londrina, Londrina, PR, Brazil IIPhD, Professor, escolas de Enfermagem de Ribeirão Preto, universidade de eles são Paulo, who Collaborating centre for Nursing research Development, Ribeirão Preto, SP, Brazil

Correspondence

ABSTRACT

This aprender aims to understand ns significance of grief in ns elderly by the death of the spouse/husband. This is a clinical-qualitative pesquisar that ser estar conducted with an intentional sample, composed of seis elderly widows. Encontro was gathered through unstructured interviews e observation. After data analysis was conducted a following categories to be listed: 1) grief and longing, 2) background of losses e resilience, 3) denial as der defense system in mourning, 4) mourning mediated by guilt, and 5) depression as naquela reaction come loss. We emphasize the importance of this findings as der foundation ao the practice of health experts working com bereaved elderly.

Você está assistindo: Como superar o luto do marido

Descriptors: Grief; Aged; Qualitative Research.

RESUMO

Este aprender objetiva para entender os significados da vivência do luto em idosas, para o morte a partir de cônjuge/marido. Trata-se de um pesquisar clínico-qualitativo, executar em uma amostra intencional, composta através seis viúvas idosas. Os dados foram coletados pela meio de entrevista que estruturada e observação. Após análise de conteúdo foram elencadas as próximo categorias: 1) luto e saudade; 2) histórico de perdas e resiliência; 3) negação como mecanismo de defende no luto; 4) luto mediado para o culpa; e 5) depressão gostar de reação à perda. Ressalta-se a importância destes significados gostar alicerce para atuação do profissional de saúde que trabalha alcançar idosos enlutados.

Descritores: Pesar; Idoso; inspeção Qualitativa.

RESUMEN

Este estudio tiene gostar objetivo comprender sobrenome significados de la experiencia del luto en personas de la tercera edad, por la muerte del cónyuge/marido. Se trata de un estudio clínico-cualitativo, realizado en una muestra intencional, compuesta por seis viudas de la tercera edad. Ela datos fueron reunidos por medio de entrevista enquanto estructurada y através da la observación. Tras el análisis de contenido fueron enumeradas las siguientes categorías: 1) luto y melancolía; 2) historicamente de pérdidas y superación; 3) negación como mecanismo de defensa en el luto; 4) luto condicionado por la culpa; y 5) depresión como reacción der la pérdida. Se destaques la importancia de estos significados como base para la actuación del profesional de la salud que trabaja con ancianos guardando luto.

Descriptores: Pesar; Anciano; Investigacion Cualitativa.

Introduction

The aging population is increasing more rapidly in Brazil when compared to emerged countries, which has actually important results for all sectors that society(1). This boost in proportion of older civilization does not occur equally in between men e women; com advancing agir the variety of women in relationship to guys is higher. In addition, countless of them estão widows and are in naquela fragile position, fragile to physics illness, and also mental and developmental disabilities(2-3).

In one epidemiological context, where the majority of a elderly population ~ ~ women, widows, vida in nuclear families, com comorbidities and often com impaired useful capacity(1-3), der husband"s death may exacerbate this problem, leading to mourning to occur differently, many times it is more complicated than in a non-elderly(4).

Considering that physical frailty in ns elderly is viewed as der vulnerability to wellness problems, mourning in the elderly can be experienced as an overwhelming event because in older civilization there is naquela risk that multiple and sequential casualty of family e friends. Thus, the addition of much more events com negative aftermath can be expected; since of a immediacy the mourning naquela wide variety of stressful events ~ ~ associated com aging together as: diseases, ecological changes, jae won problems, amongst others(4-5).

The bereavement experience in the elderly may typically emerge as depression or various other anxiety disorders and, as is characteristic of this population, may have actually various forms and symptomatology(6). Follow-up studies verified that widowed elderly teams showed high levels the depression, when compared to non-widowed(7-8).

On the other hand, a increase of resilience in a bereaved elderly have the right to be considered der facilitating fator in coping with grief(9). Resilience is displayed as a phenomenon, that is function, sometimes, is the artes to adapt to adverse situations, occurring abilities attached to internal resources (intrapsychic) and external sources (environmental); this permits appropriate mental development suitable porque o social inclusion(10). In other words, overcoming previously losses can lead to a development the perspective and of a concept itself, facilitating adaptation to more losses(4).

It is possible to overcome losses, when the distinguível can count on support, reflection e treatment. Ns loss of der loved uma creates high levels on the stress scale and individuals suffering losses become an ext vulnerable to diseases, specifically at the time that loss, when they depend on internal resources to overcome it(9).

As previously stated a mourning process in the elderly can be presented as der complex event and has a great impact on both physical e mental health. Thus, the instrumentalization of health and wellness professionals who work with this populace is necessary, suggesting a need porque o understanding ns specifics of ns grieving process. In this context, this estude aims come understand a significance of the grief endure in the elderly, by a death of ns spouse/husband.

Method

In this pesquisar we used a clinical-qualitative method, as naquela refinement that the general qualitative methods. This method foi ~ chosen because its features correspond with the objectives proposed in this study. Ns clinical-qualitative technique allows the researcher come go with bereavement with the person grieving and share a anxiety and anguish arising from the experience of loss; they are able come seek knowledge of the issues proposed, e at the same time identify with a other person. This existentialist attitude, properties of the clinical-qualitative technique allows researchers to uphold a anguish and anxiety that this, while maintaining naquela clinical attitude, com qualified eyes e ears porque o the existential knowledge of experiencing that affects a other person. Ns clinical-qualitative an approach of scientific pesquisar searches for interpretations the senses e significations brought by individuals, a phenomena pertinent to ns health-disease process, allowing a use of an eclectic frame of theoretical references porque o discussion within the interdisciplinary team(11).

In order to study phenomena the have a complex structure, in naquela personal setting (intimate) and/or is naquela subject difficult to verbalize, as in ns case of fatality of ns partner/spouse, a clinical-qualitative methodology has actually been an especially helpful. Thus, this an approach allows a detailed investigation com intimate e loaded questions around suffering, welcoming the anguish e anxiety the these topics with naquela clinical attitude, providing effective parameters para determining ns validity of ns results.

This research took place within the area of coverage the the família Health regime (FHP), in a city with about 100,000 inhabitants, located norte of Paraná state. An intentional sample era studied, com variety, created of six elderly women who experienced ns grief procedure by death of naquela spouse, selected são de the arquivo of the family Health Teams. Consists criteria were: a) age less 보다 60 years, b) female, c) living in city areas com coverage of ns FHP, in the city of Arapongas, PR, d) having had experienced the death of she husband for more than 1 month e less than 13 month before a interview, e e) agree come participate.

Considering a structure of the clinical-qualitative method, the researcher served as the main instrument to collect and record data. In ~ this concept, your perceptions captured the phenomena and represent your consciousness e work. Unstructured interview technique and observation were supplied as auxiliary instruments to carry out the data collection. Encontro analysis foi ~ performed de acordo com to the content analysis techniques, defined specifically ao the clinical-qualitative method(11).

In relation to honest guidelines, this research was authorized by the research Ethics Committee of the Northern university of Paraná (UNOPAR) through Protocol PP 0222/08, following the standards and regulatory guidelines para research involving human beings, arranged in Resolution 196/96 national Health Confederation (CNS). Also, it ser estar guaranteed the elderly participants were complimentary to give up the pesquisar at any type of stage, by signing a Informed Consent Statement.

Results e discussion

The outcomes of ns interviews were organized in categories, without hierarchy of encontro but em ~ the presumed prestige or frequency of illustration in ns statements. Ns full border of categories discovered were videotaped under five categories para presentation. A choice of this categories developed through ns correlation between the developed theme and proposed objectives. No decorrer results presented der generalized insurance claim beyond the sample studied, in which a inferences e interpretations occurred refer specifically to a context in which the research took place. However, the reflection of these findings can cabe as der theme porque o understanding a work of mourning in ns elderly, in der broader context.

Category 1. Ns grief e nostalgia

One of a most common qualities of mourning is not deep depression, but acute illustration of pain, with der great transaction of anxiety e psychological pain(6). In these situations, a mourner feels that they really miss a person who died; castle cry or call fora to the person. A word "nostalgia" have the right to be defined as a soft e melancholy memory of der missing person, lugar, colocar or point that you desire to see novamente or possess(12). Nostalgia offers naquela historical referral of an distinguível existence(13). That resembles naquela testament to the memory, naquela reminder of a heritage and presence in a continued presence of ns bereaved: <...> in ns beginning it seemed we were much more okay com it, right? yet like everything, one day passes, it seems worse, right? We estão longing, we miss out on him more e more <...> (Benedicta).

The nostalgia, naquela characteristic of a grieving process, is linked to another manifestation: a search or seek of a deceased(6). The preoccupation com thoughts of the falecer person and the events leading come their fatality is common in bereavement. These memories ~ ~ striking e the dead person have the right to be seen exactly as they were, or in various other situations, the bereaved widow deserve to feel the presence or expectation that a husband will "soon arrive", as if he had actually just come casa from der trip or something similar: <...> we miss him in the living room, us miss aqui at the tabela where he sat. Then there are days as soon as you feeling sad, discouraged, there ser estar days once we vai excited around little e life goes by so <...> (Cecilia).

For many bereaved, particularly those quem have perdido lifetime companions, days such as birthdays, death, Christmas or any kind of other days that have der strong relationship with the deceased may trigger attention come anniversary reactions. Ns anniversary reactions are related phenomena attached to mourning, in which the unconscious processes and is elucidated by temporal determinants that method the individual relives past situations, in der deformed e masked manner(14). These reactions ser estar explained by a date and make the separado go through numerous processes: anxiety, sadness, psychotic episodes, somatization, amongst others: <...> that is two months still, you have ns impression that he is coming back, the he foi ~ on a trip. Alas you involved your senses, you pertained to your senses the he no coming back, climate comes the holidays, similar to it ser estar on Father"s Day, and it is difficult! <...> (Dulce).

Category 2. Background of loss and resilience

It is typically found in the literature ns claim that ns more an separado experiences ns in their life, a greater the likelihood of an abnormal grieving process; i.e., the accumulation the previous accident is checked out as one of ns factors associated to ns difficulty in mourning(5-6,15).

Studies show that regardless of some bereaved elderly exhibited proof of emotional and physical suffering, plenty of of them ser estar shown to be extremely resilient(16-17). In this context, resilience can be linked to overcoming previous losses, facilitating ns adaptation of additional losses, explaining this result. In naquela prospective study, 46% of a elderly showed naquela resilient pattern throughout grief, with low levels of depressive symptom before a death of a spouse and after 18 month of loss(18).

These outcomes corroborate com findings obtained in this estude since there was occurrence of previous losses, back they to be verbalized by many interviewees, it seems to not have contributed to a worsening of current mourning. Although 4 of the six interviewed mentioned death of família members e very close loved ones, it ser estar not noticeable that these occasions caused worsening of current morning. This is reinforced by a fact that only 1 widow reported a poor suffer of mourning, during ns interview, e did no verbalize various other previous accident to a death of she husband.

Another important allude found in this classification concerns ns relationship in between resilience and religious beliefs: <...> it way that I"ve been through the mourning that 3 family members right?, yet what have the right to I são de about it? ... We need to accept what God walk ... Every little thing that God go is good! .... There ~ ~ people quem mistreat Jesus, the Jesus could not a partir de what he has done, take it my son, take it my oldest son, I never ever opened mine mouth come complain. That does what he wants to do, right! i still don"t recognize what is walk to take place to me, now my sisters is in the ICU, i don"t recognize if she is going to die or not, I have actually put it into ns hands that God <...> (Divine).

Spirituality is revealed as der strong indicator the resilience, specifically when acknowledging a joining of ns meaning in life, são de faith(9). That is worth noting that, resilience should not be considered as der fixed attribute of the person, yet as a process where ns family, community and society must administer resources therefore that a person can develop an ext fully(16). Whereas, resilience have the right to be learned through individuals, through significant others and role models(9), this requires that particular strategies ser estar developed to face adversity, as in mourning, and that castle address ns religiosity e spirituality phenomenon.

Category 3. Denial as der defense system in mourning

Denial deserve to be interpreted as the refusal to recognize a stimulus that reasons anxiety(19). Denial serves to postpone a pain, until realidade becomes inevitable, helping a bereaved come prepare for it(6). A use of refusal as naquela defense mechanism in the grieving process was realized in dois of the six interviewed: <...> that day I"ll tell you that i have tiny recollection <...> my head refuse to accept, and I think when the notícia came to me, ns remember tiny of that day, e I felt an extremely strong, right? com great confidence <...> (Dulce). <...> i did no cry, ns did no complain, it seems that i did every little thing that looks favor it ser estar not me <...> my niece who lives in Ourinhos said this: ‘Auntie, you haven"t figured it o fim yet! You will certainly still cry a lot too! ‘<...> (Eve).

Dulce recalls exactly a refusal to expropriate her husband"s death on the o primeiro dia day after the loss. Denial, is an unconscious defense mechanism, the is used to avoid contact with naquela hard to accept event. However, feel can also be avoided consciously e deliberately(20). Nevertheless, dissociation, denial and repression by an separado may be necessary skills para survival e control that trauma e loss. However, a maintenance the these standards may have dysfunctional consequences, complicating the grieving process(21).

Category 4. Grief mediated by guilt

Irritability and anger throughout mourning vary a partir de person come person, família to family e from period to period(6). Periodically these feelings ~ ~ directed to the mourner themselves, together self-accusation or reprimand <...> this thing keeps hammering e we lose sleep right?... I"m already bad sleeper ... And then ns wake up e wonder this point is pounding in my head, because we didn"t a partir de it? because we didn"t dá it? and that is bad porque o us, right! <...> (Benedicta).

Assigning blame have the right to be der way for a person to protect themselves são de feelings of helplessness, fear of no psychic survival, abandonment and feeling much less helpless in the face of loss, e difficulty constructing ns meaning that respect(22). In naquela study that London widows(6), seven of the 22 surveyed ladies expressed ideias of self-reproach, focusing on part omission or action that might have caused damage to your husband or disturbed his peace of mind. Often, these events were trivial and suggested that the bereaved seek to punishment themselves, accepting a blame and believing in part way, in ns reversal of events, to have her lost husband ago <...> we wondered how could we have done this, we might have excellent it, or the doctor, the doctor who was careless not take care of him, right? however I think us cannot it is in blaming <...> So then we talk with one another, we são de not need to blame. Then day comes, right, ns think us have der day the people, right! <...> (Benedicta).

Category 5. Depression as a reaction to ns loss

In the case of usual grief there is no complications, a search step of the lost person, extreme in the first weeks and months will slowly decrease giving way to the despair phase, where the bereaved recognizes the immutability that loss, experiencing apathy, absence of motivation e depression(20).

One of a interviewees report that dois months after the death of her husband she began seeing difficulties such as depression, lowering self-esteem, lack of motivation and lack of interest, leading she to psychiatric treatment com antidepressants: <...> but only over time ... I went in e I ... E I to be still <...> I have actually undergone psychiatric treatment, <...> now a week ago I have been taking other medication to view if i react better ... However it is very difficult ao me <...> (Dulce).

Depression as result of unmanageable mourning is widely described in the literature, with naquela strong combinação between advanced açao and vulnerability to depression(4,6,23). In a literature review(23) it ser estar found that, depending on ns sample e measurement procedures, in between 15% e 30% of the elderly showed clinical manifestations the depression within one year after ns death of der spouse and between 40% e 70% showed retratação of dysthymia.

The explain of Dulce makes it clear her feelings the sadness, discouragement e low self-esteem, together characteristic of naquela depression, due to her husband"s loss: <...> i have durante desire to walk out, I são de not feel like dressing up, many dia I do not even want to shower, ns am simply going through ns motions. My mundo is in a little room wherein I have actually my computer and TV, there in my world I são de not want to talk, ns spend ns entire afternoon, I just leave to dá physical therapy, hydrotherapy <...> (Dulce).

Within ns psychoanalytic suggest of view, the first approach in between grief and depression is a classic message "Mourning e Melancholia" by Sigmund Freud(24). In it, Freud points fora that melancholy differs são de the usualmente mourning, by ns presence of low self-esteem e self-recrimination; unlike usualmente mourning, where a choice of the object is of naquela narcissistic nature. This narcissistic object values the subject itself e when lost, it causes ns lowering that self-esteem. Ns criticisms e accusations to themselves, in fact, ~ ~ directed to the object, expressing the intense emotional ambivalence of ns relationship. Thus, a subject does no accept ns hostile feelings towards the object and blames herself for losing him, due to ns death wishes of a object.

By analyzing harder a story told by Dulce, how she viewed herself is proof of ambivalence in her partnership with the deceased spouse. Years before his death, she husband started to have health problems and was gradually forming der strong relationship of dependency. De acordo com to Dulce"s account, when she felt useful and valued in this dependence relationship, feeling of irritability e anger denote the ambivalence of a relationship: <...>as I era projecting myself, he ser estar shrinking, right. E then he came to be increasingly dependency on ns issues I ser estar supposed come solve, I fui as longe as para him to speak to me mother, mom this, mother that, right! for this reason then, i faulted this dependence, you understand ... It actually irritated me that dependency "Mother what time it is" ... And so on, and he thought I need to know, regularly I did no know, e thus he excited me, however at the same equipe I feeling useless ... You recognize that gap, that absence will vai you thinking<...> (Dulce).

Another element found in Dulce"s decided is Stoicism, taken as a way to guarda the strong ego, attempting come endure any type of adversity. Ns conformation/resignation is a submission, often as der silent rebellion. This defense device is really valued by society of a twentieth century, with strength and silence a pain checked out as very desirable(25) : <...> the mother foi ~ always wonder woman, e was going, forward, the wonder mrs gave der trouble e it era ugly! ... So ao me, now, this time is very difficult <...> (Dulce).

Final Considerations

Among the losses resulting são de the aging process, mourning ns death of naquela spouse is in naquela major event, because of its affect on a social, emotional e health of ns elderly. From the findings explained above, you deserve to see that longing e the search porque o the love one are evident traces of the grieving process, e lead to episodes of lot pain, grief e emotional distress.

In this study, ns history that previous casualty to the current mourning appears to have not contributed to worse preparation com loss. Therefore, the concept that resilience, where ns experience of past losses can aid overcome more losses, applies to the sample.

It was evident in ns interviews the there era denial the loss, anger command at themselves, taking ns blame para the lose or failure to carry fora any desire of a deceased e depression. Although these mechanisms and responses ser estar part the the normal grieving process, this exacerbations have the right to complicate coping with ns loss, and must it is in acted upon in dealing com bereaved elderly.

Given the high frequency the mourning situations among a elderly and the magnitude of emotional and physical difficulties that together losses may result in, this emphasizes ns importance of considering these implications, as der foundation ao performance of health experts working with the elderly.

Ver mais: Como Saber Se Estava Gravida E Perdi Arquivos, Acredito Que Estava Grávida E Perdi

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Correspondence adriano Luiz da de praia Farinasso Universidade estadual de Londrina. Central de ciência da saúde departamento de Enfermagem Av. Robert Koch, 60 cidade Operária CEP: 86038-350, Londrina, PR, brasil E-mail: adriano_farinasso