¶ … Therapeutic Massage on Elderly, Grieving Widows The prosperity of a country is in accordance with its treatment of the aged," states an ancient Jewish Proverb ("Massage for the Mature Adult," 2001). This is an honorable and true statement. Too often many of our elderly people's needs are not noticed or attended to by family, friends, or medical practitioners. This is especially true for older women whose husbands have died.

Widowhood can have a tremendous impact on the health of older women (Ferraro, 1989; Bowling, 1987; Gass & Chang, 1989). The death of a spouse or partner has been described as the most disruptive and difficult role transition that an individual confronts throughout the life course (Lopata, 1987). In the United States, over 49% or 8.4 million women over the age of 65 are widows (Bradsher, 2000). Houdin (1993) states that "although the literature abounds with subjective pieces concerning bereavement, little is known about the complex biological processes that follow in its wake. However, there is a growing body of evidence that suggests psychological distress may compromise immunocompetence and that support strategies may enhance immune functioning." Houdin comments further about the data from his study which indicates that women who had a strong family group with whom she could interact daily and by whom she could be hugged and appropriately touched, had a smaller incidence of opportunistic diseases and lower occurrence psychological problems such as grief-induced depression. He concluded that there were two key factors without which the outcome would have been markedly different: living in the midst of a supportive familial group and having appropriate skin to skin contact with another person frequently. The key factor appears to be the touch of another human being. Studies which address the necessity of interaction and touch for an infant's physical and psychological health abound, and the pictures of the hollow-eyed babies in the nurseries linger in our minds. "Failure to thrive" can kill an infant. Therefore, it is reasonable to assume that the same needs and consequences exist at the opposite end of the life cycle.

Among the numerous life changes a widow must undergo, one of the most personal, but most needed is the opportunity to touch another person. While this may mean touching in a sexual situation, it also means the need for touch that all humans crave (Ott & Seffanie, 1998). Several studies have documented the positive effects of therapeutic touch on stress, anxiety, wound healing, and the qualitative lived experience of individuals (Kreiger, Peper, & Ancoli, 1992; Gagne, & Toye, 1997). Other studies and the experiences of those in clinical practice suggest that therapeutic touch decreases autonomic nervous system arousal and reduces stress or anxiety (Sneed, Olson & Bonadenna,(1997).

The purpose of this descriptive research study is to compare and contrast the responses on the Geriatric Depression Scale of recently widowed women (age 65 and older) who have received a 30 minute massage from a trained massage therapist three times per week for at least three months with those of the same age and marital status who have not received massage therapy

It is thought by this researcher that the level of stress or depression will be significantly lower in the experimental group (those who had massage therapy for at least three months),

Chapter Two

Review of the Relevant Literature

The follow questions will frame this review of relevant literature: 1) for the purposes of this study, what is a widow; 2) what are the possible medical outcomes of being widowed; 3) what are depression and anxiety and what is their placement in the grieving process; and 4) what effects on the body do massages have?

What is a widow?

A widow is one whose spouse has died within the past 18 months (Websters New Collegiate Dictionary, 2000). Widows become widows the moment their spouse ceases to live. Kelly (1971), has identified a number important factors that shape the bereavement experiences of women.

The largest portion of research on widowhood has focused on the personal and social consequences that accompany the loss of a spouse. The physical symptoms of grief: sighing, sobbing, crying, and weeping are common and normal physical signs of grief. Some psychological studies show that these forms of feeling are necessary physical release of stress and sadness mechanisms. Stress and sadness that are not relieved arise in other physical effects such as: not being able to pay attention to present experience, lack of concentration, poor memory, disrupted sleep patterns, little or no appetite, abusing drugs or alcohol, and/or thoughts of suicide.

Almost...

Nearly 700,000 women lose their husbands each year and will be widows for an average of 14 years. Men who lose a spouse are several times more likely to remarry - in part because it is socially acceptable for them to choose younger mates. But only 8% of widows 55 to 64 remarry, and once they pass the 65 mark only 2% do. Meanwhile, women outlive men by nearly six years, but tend to marry men several years older. The result: There are 11 million widows to 2.6 million widowers, a ratio of 4.3 to 1. Within 25 years, some demographers predict, the gap could widen to 10 to 1 (Shapiro, 2000).
What are the Medical Outcomes of being a Widow?

Psychologists and medical doctors have identified some common physical symptoms of grieving which include: tightness in the throat, a choking or suffocating feeling, shortness of breath, sighing, empty stomach feeling, lack of muscular power, tension, pain, and absent mindedness. These are physiological and/or biochemical reactions. Grief can have major physical health consequences. There can be (especially among older people) compromised immune function, increased hospitalization or surgeries, and/or increased mortality rates (Kelly, 1991). After a major loss, such as the death of a spouse or child, up to one third of the people most directly affected will suffer detrimental effects on their physical or mental health, or both. (Parkes, 1998).

In a study entitled, "Psychological adjustment to sudden and anticipated spousal loss among widowed persons," Carr and House compared the extent of grief and loss felt by widows whose husbands were expected to die, with the same kinds of feelings that widows whose husbands died suddenly and without any warning experienced (Carr & House, 2000). Their somewhat surprising findings debunked the long held popular belief that grief is more severe if death is sudden and suggest a more complex relationship between bereavement and the circumstances of spousal death (Carr & House, 2001).

Another important study was conducted by Barry, Kasl, and Prigerson concerning whether or not the lack of preparedness of a spouse could be an indicator for mental illness. Their preliminary results suggest that perceptions of the death and the feeling of lack of preparedness may be indicators of persons at risk of developing psychiatric morbidity secondly to that of bereavement (Barry, Kasl, & Prigerson 2002).

What are Depression and Anxiety and What are their

Placements in the Grieving Process?

Stress to illness to disease is not an enviable double play" states Janice Strubbe Wittenberg, author of The Rebellious Body: Reclaim Your Life (Insight Books, 1996). Unfortunately, this "double play" occurs much too frequently in widows. Stress and illness are linked with depression in the lives of widows (Turvey, 1999). During the initial period of bereavement, a widow may lose all sense of self-care. This type of depression is not to be confused with clinical depression which is a systemic disease. This depression (labeled by psychologists as "syndromal depression") is an effect produced by the variety of stressors which fall at once upon a widow's lap.

Anderson and Dimond in the Journal of Advanced Nursing (1995) describe their longitudinal study, "The experience of bereavement of older adults," many of the factors which lead to anxiety and then to depression among older widows who have been widowed less that two years. One of the major categories under their heading, "Special Hardships" was loneliness. The greatest challenge for these older individuals during the two years following their spouses' deaths was facing the fact of having been left alone. Many of the women interviewed had been part of a marriage which had lasted 60, 65, even 70 years in some cases. And now they were alone. (Anderson & Dimond, 1995).

Widows over 70 years old who had been married to their spouses for 50 or more years were the subject of a study conducted to investigate the association between conjugal loss and syndromal depression. Their results were very interesting because it was found that neither age, sex, prior psychiatric problems, nor the expeditions of death made any difference in the widow's grieving process (Turvey et al. 1999)

Massage

For centuries, the use of massage has been recognized for its therapeutic value. Massage was essential to healing rituals in most ancient cultures. Hippoctrates described the value of massage for treating a variety of ills from sprains to constipation (Kreuen, Kootke, & Ellwood, 1966; Messi, 1985; and White 1988).

Geriatric massage is a form of massage designed to meet the specific needs…