Exploring the meaning of a good life for older widows with extensive need of care: a qualitative in-home interview study

ABSTRACT

Introduction

Studies of older women’s life transitions is rare but gains relevance as the aging population, with older women as the majority, expands.

Purpose

To explore the meaning of a good life for older widows with extensive home care needs.

Materials and methods

Semi-structured interviews were carried out with eleven women, aged 80 and over (82–95 years, mean 90) residing at home with extensive care needs (≥4 daily sessions, averaging 2.5–6 hours, mean 3). Data were analysed by reflexive thematic analysis.

Results

The theme “This Day in My Home, the frame of my life” reflects the women’s experience of a good life. A good day imbued them with hope, trust and security, carrying them forward with the assurance that night would usher in a new day. However, there were moments when life was merely about navigating daily challenges. During such days, the women felt trapped in time, unsafe and lonely.

Conclusion

A day at home may seem static, yet it mirrors life’s dynamism, evolving with shifting circumstances. Older widows navigate challenges while maintaining their sense of self, independence, and connection to home. These findings have implications for aged care, recognizing the multifaceted aspects of life and the centrality of home.

KEYWORDS:

• Aged 80 and over
• independent living
• nursing care
• women’s health
• Thematic Analysis
• Aging
• Home Care Services
• Life Change Events
• Home Health Nursing
• Widowhood
• Qualitative Research

Introduction

The older population, aged 80 and older, is increasing worldwide, including in Sweden (Eurostat; Nations, 2019; SCB). Within this demographic, single-living women significantly outnumber men (SCB). In 2022, the total number of individuals aged 80 and over in Sweden was nearly half a million. This number is projected to surpass a million by 2070, with women remaining the majority (Statistics Sweden). Despite women’s longer life expectancy than men, they tend to experience lower well-being (A. D. Almevall et al., 2022; Ko et al., 2019; Näsman et al., 2020). Furthermore, widows have reported a lower quality of life and a higher prevalence of depression compared to widowers (Lee & DeMaris, 2007; Lee et al., 2001). It is important to highlight that women often receive more home care than men (Brändström et al., 2022). However, it is also noteworthy that their specific needs may not always receive the required attention (Tiilikainen et al., 2019). Shedding light on the specific needs, it is important to recognize that women who live alone are confronted with challenging life circumstances (Chiaranai et al., 2018; Ness et al., 2014) including navigating feelings of isolation and bearing the sole responsibility for their homes (Eshbaugh, 2008).

Home plays a pivotal role in the well-being of older individuals, encompassing physical, personal and social dimensions (A. D. Almevall et al., 2022; Felix et al., 2015; Vasunilashorn et al., 2012). Beyond its physical attributes, a satisfying living environment for older persons requires careful consideration of safety, access to services, social connections and opportunities for stimulation (Finlay et al., 2020). Both men and women value their independence in daily life (Darab et al., 2018; Eshbaugh, 2008). For women, their homes exert a dynamic influence over various aspects of their daily lives (Barry et al., 2018) serving as more than just a place of residence. It becomes a personal sanctuary, a nurturing space for self-definition and a hub for caregiving. Simultaneously, it acts as a secure base for venturing into the world beyond. This multifaceted relationship with their homes enriches their self-identity and empowers the women to embrace life’s adventures (Swenson, 1998). Older persons are encouraged to continue residing in their homes, even when faced with illness and extensive care requirements (Brink, 1990; Vasunilashorn et al., 2012). Nevertheless, it is crucial to acknowledge the challenges encountered by women living alone. Studies emphasize the significance of home, well-being, and their satisfaction with care and support. However, these studies often fall short in encompassing aspects such as maintaining independence, fostering social relationships, and engaging in meaningful activities.

As more older women continue to live at home rather than move to aged care facilities, understanding their intricate support needs becomes imperative. However, there is a dearth of research into the meaning of a good life while navigating life-altering transitions related to partner loss, heightened support needs, and sole household responsibility. To study this group, we have defined extensive need of care as a minimum of 4 visits per day and at least 15 hours of home care weekly.

The concept of the good life and its components has been a subject of theoretical exploration for decades and a research focus in the context of well-being. Various perceptions of a good life are observed to be commonly shared, while others vary among individuals and are influenced by factors such as culture, health, well-being, and age (Lawton, 1982; Willroth et al., 2023). In the realm of age-related perspectives, Lawton (Lawton, 1983) devised a model comprising four sectors (psychological well-being, perceived quality of life, objective environment, and behavioural skills) to delineate the notion of a good life among older individuals.

A study about the essence of living well in later life demonstrated that the loss of autonomy heightened the reliance on support from others. The body and its abilities or illnesses became more central, as the importance of embracing acceptance towards death (Toye et al., 2021). Another study illustrated that a good life involved turning inward, making peace with one’s life, and approaching death while grappling with health concerns (Andersson et al., 2008). In a study exploring the good life of older individuals in senior living facilities, the recurring phrase “I can’t complain” emerged. This expression might signify an awareness of the need to be grateful or feel a certain obligation towards those providing care. The study highlighted stability, a sense of autonomy, and independence as crucial for the quality of life among older residents. Furthermore, changing demands for what constitutes a good life have been described within ageing and shifts in health and life circumstances (Emiliussen et al., 2023). Based on the literature review, studies exploring the good life among older persons often occur within diverse aged care contexts. These studies frequently associate the concept of a good life with elements such as health care, support, physical health, and acceptance of death.

Nussbaums model for a good life (Nussbaum, 2000) has been applied in research regarding ageing in place (Grove, 2021) informal caregiving for older persons (Horrell et al., 2020) person-centred care (Entwistle & Watt, 2013) and for persons with dementia living in their own homes (Tellez et al., 2016). It has also been considered suitable for use by those providing care in local aged care settings (Pirhonen, 2015) and in the care of persons with dementia (Melander et al., 2018). Encompassing ten areas such as: health, bodily integrity, mobility, enjoyment, critical reflection on life planning, and maintaining relationships with others, the model seeks to explore the multifaceted aspects of a good life (Nussbaum, 2000). The model is associated with equity and well-being (Nussbaum, 2000, 2011).

At present, the existing body of research has not extensively examined the multifaceted experiences of older women as they navigate significant life transitions, including widowhood, increased care needs, and assuming sole responsibility for their households. This study distinguishes by conducting interviews in the participants’ ordinary homes, incorporating a model of a good life. The approach aims to extend the understanding of the phenomenon beyond traditional healthcare boundaries. Consequently, this study aims to explore the meaning of a good life for older widowed women with extensive need of care.

Materials and methods

Study design

The study was conducted using a qualitative design. The consolidated criteria for reporting qualitative research (COREQ) (Booth et al., 2014) checklist guide was followed in the study.

Participants and context

Eleven women, residing in their own homes in subarctic Sweden, participated in the study. The participants were recruited after the first author informed home care managers and coordinators about the study. Subsequently, the home care coordinator provided information about the study to individuals who met the inclusion criteria: a minimum of 4 home care visits per day, being at least 80 years old, widowed, not experiencing cognitive difficulties and interested to participate in an in-home interview study about the meaning of a good life. Those who wished to learn more about the study were contacted by the first author by phone, provided with study information, were given the opportunity to ask questions about the study and given the opportunity to decide on their participation. One woman initially interested in participating and who received information about the study via phone declined to participate shortly before the interview. The remaining women who were approached participated. All had previously cohabited and were now living alone. Their ages ranged from 82 to 95, with an average age of 90. They received a minimum of four home care sessions daily, lasting in total from 2.5 to 6 hours on average (mean = 3). Table I provides a detailed description of the participants.

Table I. Participant characteristics.

Pseudo-name	Age	Housing type	Hours of weekly care	Hours of daily care	Daily home-care sessions
Maria	94	house	21	3	6
Jean	89	house	17	2.5	6
Ida	87	apartment	15	2	4
Madeleine	82	apartment	20	3	6
Hildegaard	90	apartment	22	3	6
Miriam	89	apartment	44	6	8
Virginia	86	house	22	3	6
Dorotea	95	apartment	17	2.5	6
Joyce	90	apartment	17	2.5	4
Patricia	92	apartment	22	3	6
Anna	94	apartment	21	3	6

Data collection

Data were collected through individual interviews in the women’s homes with a semi-structured interview guide inspired by a theory of a good life (Nussbaum, 2011). The interviews were conducted between January and April 2017. The interview guide was developed in a collaborative manner involving the authors, educators specialized in easy-to-read Swedish and older persons with experience of home care. The interview guide underwent a pilot testing process, initially involving a group of older persons. Adjustments were made based on their feedback. Subsequently, a second pilot test was conducted, followed by two individual test interviews, resulting in the refinement of the final interview guide. By adopting this approach, the core of the theory was maintained while avoiding the use of overly complex language or jargon. All interviews were conducted with the interviewer sitting alongside the women and using a tablet to present the interview questions one at a time. This approach also included the option to enlarge text, ensuring accessibility for persons with impaired vision or hearing. The final interview question was, “Can you tell me what a good life means to you?” By posing the open question at the end, the intention was to engage in a conversation that covered aspects the woman might not have spontaneously reflected upon. The interviews ranged from 21 minutes to 61 minutes, with an average duration of 38 minutes. The interviews were recorded in audio format and transcribed verbatim by the first author, and checked for accuracy by a co-author.

Data analysis

Data were analysed using a reflexive thematic analysis following the framework of Braun and Clarke (Braun & Clarke, 2021). Reflexive thematic analysis allowed a systematic exploration of patterns, themes and meaning. The interviews were thoroughly read on multiple occasions, and detailed notes were taken to facilitate the familiarization process. Throughout the entire process, the first author practiced reflexivity through journalling. All authors furthered their reflexivity by critically reflecting on how their roles as researchers, personal experiences and professional knowledge influenced their engagement with the data (Braun & Clarke, 2019).

The interviews were systematically coded to encompass any content relevant to the aim of the study. The codes served to identify patterns and initiate the development of initial themes. The authors gathered to discuss the initial themes and their alignment with the research objective, as well as to explore the possibility of refining themes to better address the research question and the women’s narratives. Upon completion of the data analysis, the research team collectively revisited the dataset to ensure that the identified themes accurately encapsulated the dataset’s inherent meaning (Braun & Clarke, 2019). Quotes were incorporated as illustrative examples to substantiate the findings derived from data.

Ethical consideration

The study received approval from the Regional Ethical Board in Umeå (No. LTU-2706–2015). Participants were provided with both written and verbal explanations regarding the study’s objectives and procedures. They were explicitly informed that their participation was entirely voluntary and that they could withdraw from the study at any point without needing to disclose their reasons for doing so. Participants were also assured of the confidentiality of their information, and they were instructed to reach out to the researcher for any questions or concerns. The research data was securely stored in a locked facility and a secured box, accessible only with a coded key for enhanced protection by the first author. This measure guaranteed the confidentiality and safeguarding of the data, preventing unauthorized access.

All authors had experience in qualitative research related to older persons in home care settings or women’s health. Additionally, each had experience as registered nurses working with older persons in various care contexts. This prior experience informed our approach to the study, ensuring that we were attuned to potential adjustments needed during data collection and sensitive to the participants’ health and well-being, including their need for breaks or pauses during the interviews.

Findings

The results consisted of one theme and five sub-themes, presented in Table 2, followed by descriptive texts and illustrative quotes.

Table 2. Findings.

Theme	This day in my home, the frame of my life
Sub-themes	Finding strength when life holds meaning.
	Not being in charge anymore; life needs to fit other people’s priorities and demands.
	Wanting to be a good hostess and to feel valuable to guests.
	Being carried by faith and communion.
	Having a rhythm in the home that provides cohesiveness.

This day in my home, the frame of my life

The theme, This day in my home, the frame of my life, reflects the women’s lives in the face of perpetually shifting circumstances. The women described how their daily lives were constrained by physical limitations, waning energy and a shrinking social circle that limited their freedom to plan and engage in activities they once enjoyed, such as venturing outdoors, taking part of social gatherings, and continuing with hobbies and interests. Their narratives conveyed a message of transformation, marking a shift from a more expansive life to one centred on the present moment. Their homes had become their life’s arena, with their entire lives unfolding hour by hour within the walls of their homes. Home served as a sanctuary where they thoughtfully had crafted an environment for meaningful daily living. However, it was not without its difficulties, as they often grappled with a lack of control over the rules and adaptation to ever-changing conditions. When life was merely about navigating the daily challenges, the women felt concerns about their ability to manage. During such difficult days, they felt trapped in time, unsafe and lonely. Daily care sessions were often necessary for dealing with daily challenges, but sometimes disrupted their daily rhythm and further undermined their ability to manage the day. Equally, a good day imbued them with hope, trust and security, carrying them forward with the assurance that night would usher in a new day. In their narratives, the women described a good life composed of rhythm, independence, relationships, dignity and faith. These core elements resound throughout their stories and are reflected in the identified sub-themes. The relation between the core elements and the five identified sub-themes are illuminated in this section, and thereafter each sub-theme is described.

In the subtheme Finding strength when life holds meaning embodies the foundational rhythm that underscores their lives, empowering them to be independent and adaptable, and resonating with their quest for renewed relationships, even with those from the past. As they seek meaning, it results in the cultivation of new connections and the rekindling of past relationships, which contribute to a sense of dignity. Simultaneously, they sought meaning and dignity in their evolving identities and changing bodies. In the subtheme Not being in charge anymore; life needs to fit other people’s priorities and demands underscores their independence, revealing how they adapt and accommodate to the needs of others, even when compromising on important aspects of their lives. This connects to the sub-theme Wanting to be a good hostess and to feel valuable to guests, which revolves around their desire to create a welcoming environment, a role that brings them dignity, independence and pride. In the subtheme Being carried by faith and communion reveals an integration with relationships, both in the immediate surroundings and in the broader scope of life. Even in challenging days, their faith served as a guiding light, although they acknowledge the struggles in drawing upon it during the most trying of times. The sub-theme, Having a rhythm in the home provides cohesiveness, portrays the everyday experiences and the support they find at home and in the surrounding environment. It complements their independence, as it is in the familiarity of their homes from which they draw strength to be self-reliant and cultivate their relationships.

Description of the sub-themes

Finding strength when life holds meaning

In their stories, the women described the search for and the creation of meaning and the feeling of strength and competence this produced. The stories were based on events of everyday life, concerning their relationships, but they also relayed more general stories about whom and what they identified with, often through more abstract and non-linear narratives.

The women sought to understand their situation by comparing it to their past experiences, finding strength in the meaning they discovered in their present circumstances. They also compared themselves to peers dealing with various challenges, leading them to appreciate that they were in a better situation. Despite feeling the constraints of time and the demands of life, they found life worth living. Their narratives also told a broader story of womanhood marked by courage, independence and resilience. Despite physical tolls and a lifetime of prioritizing others, they still saw themselves as independent individuals, whether in their past roles caring for family or engaging in paid work. However, the wear and tear on their bodies now required assistance from others. In moments of vulnerability, they recalled their past courage and independence, emphasizing the strength they drew from their female predecessors. While their stories primarily focused on the present, discussions of loved ones no longer present provided a pathway to cherished memories. This allowed them to transcend time and place, finding meaning in connections from the past. However, their families and caregivers struggled to fully grasp the importance of this unique pathway.

Their narratives challenged the notion of living solely in the present, advocating for a life that encompassed a broader spectrum of experiences across different time periods. The women sought to find meaning by integrating their present selves with their past identities existing within a spectrum of time. The women described how people around them did not understand their lack of interest in current trends and news, but instead wanted them to live in the present. Still, the women grappled with the complexities of ageing. Their bodies felt foreign, and they wrestled with the ambiguity of accepting an older woman’s style and interests.

I’ve never looked like this. I’ve been medium height and then I had bangs, and now I have these things like … it’s not me at all. And then all my female friends said, “Oh, you’re so pretty.” I said I want to forget what is now. It [hair] will never get as long as it used to be. It’s become curly too; it wasn’t before. Virgina, 86

Adding to their challenges, external influences from caregivers, friends and family urged them to conform, creating a complex dynamic between their evolving identity and external expectations.

Not being in charge anymore; life needs to fit other people’s priorities and demands

The women’s narratives unveiled that their sense of control and physical capability held a central role in their perception of autonomy. However, their capability of exercising autonomy was at risk. This was not solely due to their changing bodies; it was primarily influenced by their reliance on family and staff for assistance and approval, leading to a shift where their lives needed to align with other people’s accessibility and values.

Yes, if the staff wants and can help me, then we can take a real walk and go and see birds there. Then we will go there and feed them [the birds]. It’s like it’s sporadic. It depends on the staff if I can get out. It has become so nowadays that I sit in a wheelchair, because I’ll be easier for them then… so that I don’t fall over. It’s the balance… so I am not allowed to go out by myself anymore. Joyce, 90

Getting through each day demanded strength and focus, as the support they received often fell short of fulfilling their needs. Eating had lost its previous connotations of joy, pleasure and community, reducing it to the mere act of consuming ready-made food as swiftly as possible. Previously, meals served as a respite during the day, offering both the body and mind a moment of rejuvenation.

Good food … [laughs] I love food. Before, there were a few of us, my sister and her husband, and we could eat together and have a good time like that. Now I order at home from a home service so that I can get home for a few days and then warm up. It’s not good. Hildegaard, 90

The women’s stories conveyed the message that they aspired to be in charge but had to temper their expectations due to limitations related to their bodies, relationships and finances. Aspirations that were too ambitious risked causing them to lose control in the delicate balance of managing their dependence on others while also navigating their own needs and values.

Wanting to be a good hostess and to feel valuable to guests

The women sensed the loss of dignity they once held, and they put in considerable effort to uphold their relationships, as means to retain and reinforce their sense of dignity. Welcoming guests and caregivers into an adorned home was an integral aspect of being a gracious hostess. Expressing care and compassion towards their visitors provided the women with a sense of worth. Their interactions with caregivers remained a significant part of their lives, even when the relationship extended no further than assistance with essential daily tasks.

Establishing close relationships with some care staff meant experiencing friendship and a genuine sense of closeness. Concurrently, there were relationships with care staff whose names they did not know and whom they had never met before. The sense of responsibility to be a good hostess was closely tied to their feeling of worth and value to others. However, hosting visiting caregivers was challenging, because the women relied on their assistance. The women’s narratives carried the burden of insecurity tied to their belief that they had to excel as hostesses to be deemed valuable. This perspective left them susceptible to a diminished sense of self-worth if they could not uphold this accommodating hostess persona.

[laughs] Yes, I tend not to be unpleasant with them [the home care]. No … but enough … I can be nice enough. I think they think it’s nice to come here. I think that they like to talk to me, too. It’s good because I think it’s fun when they come because they are someone to talk to.

Can you show when you are feeling sad or lonely?

Well, I could show it, but I do not know whom I should show it to. I do not meet anyone. If they [home care] come, no, then I want to be a little happier; otherwise, they will be sad if I am sad. Too little half-happy in any case … so they feel that I’m happy. Ida, 87

The woman’s life had transitioned from a life filled with companionship to one marked by solitude, fostering insecurity and casting a dreary shadow over her experience of life. Social activities had lost their significance, as they could no longer participate as a couple, spend time with friends or enjoy nature. Loneliness became particularly pronounced during mealtimes, bedtime and throughout the night.

It’s so boring when you’re alone [cries], like in the evening… also at night… You usually throw your arm over his bed … Now there’s no one there. It’s very sad … and not having someone to reason with. Then I remember something one night … and then I would say it and now he’s not there. It’s sad. We were together for sixty-five years. [laughs] Oh, well, now it’s empty … no one to talk to. Maria, 94

One woman expressed that while others might view her life as satisfactory, she has personally experienced an intense sense of loneliness. Yet, the women felt that their loneliness was not prioritized by others. Engaging in phone conversations with friends and children provided some relief from this loneliness, albeit temporarily. At times, this profound loneliness brought tears and a sense of despair to the women. Even in moments when loneliness was alleviated, such as during visits or even in anticipation of planned future visits, the woman’s energy halted the joy for the upcoming visits or activities.

You know now, I would have jumped [for joy]because, oh, they are coming [a phone call that was about a visit during the week]. And then I think, “Will I be able to do it?” Afterward … now… I feel that it is so awful. I feel like I can’t give anything back. Madeleine, 82

In the narratives comparing the lives of older persons, there were no accounts or stories of other women facing similar circumstances. This absence of affinity could contribute to the sense of loneliness.

The women’s stories describe a current solitary life, characterized by the losses of relationships and abilities that have led them to their present circumstances. This complexity adds depth to a seemingly straightforward role, that of a hostess, particularly when considering their loneliness and the absence or loss of close relationships.

Being carried by faith and communion

The women’s narratives of a good life included faith and hope, spanning from a cautious optimism, where they felt cared for, to a profound sense of meaning and security associated with God, rituals, and community activities. God and their parish community played pivotal roles. Comfort and security were recurring themes, and the women described finding solace and reassurance in God. Their congregations used various methods to stay connected with these women. Some received visits from priests and fellow parishioners, while others engaged in virtual church services. Belief in God and a church that stayed in touch provided strength for their daily lives. However, when a day grew stressful and difficult to navigate, it became more difficult for them to exercise their faith. Feeling togetherness with God and the church carried the women forward, making the hours become a day—a day of meaning.

God gives me comfort, well-being and security and satisfaction with life. Miriam, 89

In their narratives, the women also expressed hope in politics, despite the feeling that their influence was limited. They hoped for advocates with stronger voices to improve their circumstances through political means. In essence, these women’s narratives on faith and communion were rooted in a shared sense of hope, believing someone was there for them. Their experiences with hope and faith varied in relation to the church and God. In politics, the women’s narratives of hope carried a hint of resignation, yearning for advocates to support their cause but with little certainty of its fulfilment. An intricate relationship unfolds between hope and faith, resonating beyond the boundaries of both religious and political domains. It mirrors a sense of security and comfort that reaches beyond the women’s individual sphere.

Having a rhythm in the home provides cohesiveness

An inner and outer rhythm shaped their perception of time, bringing forth feelings of well-being and meaning. The women felt a sense of security, knowing they could navigate through each day and night until the arrival of the next. A good day was one that flowed seamlessly, while its opposite was a fragmented experience, where time seemed to pass slowly, resulting in feelings of struggle and hardship and creating a barrier, preventing it from becoming a cohesive day. The women cherished their homes, changing them for the seasons and creating welcoming spaces. Fond memories of building cozy homes with their late partners filled their hearts, and they wished to continue living there.

The rhythm of daily life within their homes encompassed significant routines and activities, such as handicrafts, crossword puzzles, reading and watching television, providing both engagement and leisure. Appreciating the outdoors and the nearby natural beauty held equal importance. For several women, engaging in handicrafts transported them to a state where time and space seemed to dissolve, a feeling deeply missed by those who could not participate due to health concerns or mobility limitations.

I enjoy being alone … but only if I have something to do. But if I do not have it, then [I] become so restless. It’s just like sitting with my hands like this [folding her hands in her lap], because I do not read during the day. But I do [read] when I go to bed and solve crossword puzzles at night, when I am not sleeping. But during the day, I will do useful things for me. It feels so nice. It’s just that it starts to go a little worse and slower.

Are you worried about that?

Well, I think about it. What should I do when I do not see and do something? How will I manage? Should I just sit straight up and down then? It won’t be easy for those who come here and help me. [laughs] Dorotea, 95

Enduring days without structure became difficult, giving rise to a sense of purposelessness and a yearning for closure. Conversely, good days at home propelled them forward, fostering the belief that the night would usher in the next day and beyond.

Discussion

This study aimed to explore the meaning of a good life for widows with extensive need of care. Findings are illustrated by the theme This day in my home, the frame of my life. The women’s narratives revealed how their daily lives were constrained by physical limitations, waning energy and a shrinking social circle, affecting their freedom to plan and engage in activities they once enjoyed, such as venturing outdoors, participating in social gatherings, and pursuing hobbies and interests. Their narratives conveyed a message of transformation, marking a shift from a more expansive life to one centred on the present moment. Within this transformed context, their homes had become the central stage where their lives unfolded, consistently shaping their concept of a good life.

The role of home for older persons is described as influencing well-being (A. D. Almevall et al., 2022) self-worth (Søvde et al., 2022) and overall sense of a good life (Galvin & Todres, 2011; Oswald & Wahl, 2005). The women in this study positioned the day within the home at the core of their experiences. This can be likened to the writings of Hupkens, Machielse, Goumans and Derkx (Hupkens et al., 2018) who depicted a day at home as a river, constantly changing, illustrating the ongoing transformations. This enhances the understanding of the challenges the women faced in adapting to the ever-shifting circumstances and their struggle to establish a rhythm that worked amidst this constant change. The significance of rhythm in older persons life has been previously demonstrated (Cederbom et al., 2014; Fæø et al., 2019; Søvde et al., 2022) and it plays a role in well-being (Fæø et al., 2019; Søvde et al., 2022) supporting daily activities, relationships and self-care (Cederbom et al., 2014). Considering this, the women’s narrative about rhythm emerges as an integral component across various facets they deem essential for a good life.

Previous research indicates that home encompasses more than its physical aspects, including living conditions, surroundings and familial relationships (Allassad Alhuzail, 2018). For older women, home could also represent burdens, resources and reflections of cultural expectations (Barry et al., 2018). Despite the challenges encountered, women may draw strength from less obvious aspects of home, enabling them to develop coping strategies in their familiar environment. Considering the women’s descriptions of home in our study, a study conducted by Bjerkmo, Helgesen, Larsen, and Blix in a similar context (Bjerkmo et al., 2021) found that women coped with a greater need for rest and solitude by living one day at a time. Both studies noted a loss of the ability to leave home, potentially altering the impact on their immediate environment. Reflecting on this, the experiences of older persons could provide a unique perspective on home, especially in subarctic and Arctic living environments where the possibility to stay and move outdoors may be further limited due to the cold climate.

Regarding maintaining a daily rhythm, previous research underscores the significance of independence and self-management among older women living alone, especially in household chores and routines (Abdi et al., 2019; Eshbaugh, 2008; Percival, 2002). However, the extensive need of care as for women in this study, add complexity. Coordinating support for older persons has been recognized as a challenge potentially influencing their daily routines (Abdi et al., 2019) which often necessitate adjustments based on their energy levels (Birkeland & Natvig, 2009). Furthermore, managing their health and understanding available support systems have been described as leading to feelings of insecurity for older persons (Portacolone, 2015). A good life, closely tied to the hope of enjoying one’s home, may be threatened when care falls short (Hupkens et al., 2019; Krause & David Hayward, 2012). In terms of the findings from this study, women described how caregiving sometimes disrupted their rhythm, causing it to become erratic and out of step.

Another aspect of daily rhythm involved relationships. In this study, women utilized strategies like reaching out to loved ones through phone calls, fostering connections with healthcare professionals and preserving emotional bonds with departed loved ones or places they could no longer physically visit. These strategies align with how older persons cope with existential loneliness, as documented in previous research (Sjöberg et al., 2019). Loneliness has also been found to be more common among widows than widowers (Naef et al., 2013).

Our findings illustrate that older women struggle in the context of an altered life situation. Similar findings have been observed, with older persons expressing a quest for a new identity in the midst of life changes (Moore et al., 2006; Naef et al., 2013) . The inner processes of older persons, such as their philosophy for living, have been shown to be critical components in creating a meaningful life (Moore et al., 2006). Moreover, older women are observed to seek validation from others and require space for spirituality to navigate challenging life circumstances and find meaning (Can Oz et al., 2022). Additionally, older persons prioritize well-being over the fear of risk, emphasizing the importance of feeling alive despite experiencing losses and grief (Søvde et al., 2022). Embracing the strategies employed by older persons to sustain their relationships and navigate challenging life situations appears to be an important aspect in promoting a good life.

Findings emphasize older women’s ability to sustain independence while maintaining relationships, including those with home care personnel. A previous study (Kaldestad & Nåden, 2022) shows that women want to be seen and understood, both in conversations and in caregiving situations. However, the challenges women face in receiving home care, especially when dealing with unfamiliar caregivers who fail to fulfil their promises, lead to distress and resignation (Jakobsen & Lind, 2023). This highlights the impact of the relationship with home care staff on a woman’s life. Our findings show that older women’s aspirations to excel as hostesses align with routines and the home environment, reinforcing their independence and priorities, such as maintaining a welcoming home (Percival, 2002). A good relationship for older women has been described as one marked by pleasant interactions and closeness, which along with awareness of their care providers (Watz & Ingstad, 2022) enhances their ability to effectively receive and accommodate individual caregivers.

The relationship between older persons and registered nurses in home care have been described as characterized by a mutual bond rooted in the need for care and personal affection for the patient, fostering feelings of safety and security (Claesson et al., 2021). This approach, where nurses foster relationships rather than just providing care, as previously shown (Hupkens et al., 2019) promotes independence and dignity. This can help older women balance their extensive need of care with their desire for independence at home. By addressing both the women’s needs and the quality of the relationship, nurses could contribute to crafting a meaningful day for older women in their home environment. This study complements and extends prior research about the good life by an increased understanding about the meaning of a good life for older widowed women.

Nussbaum’s theoretical framework is grounded in the emphasis on women and their rights (Nussbaum, 2000) drawing upon studies that have used the framework in their research designs (A. Almevall et al., 2022; Entwistle & Watt, 2013; Grove, 2021; Horrell et al., 2020; Melander et al., 2018; Pirhonen, 2015; Tellez et al., 2016). Relating to Nussbaum’s model, this study uncovers two aspects of meaning for good daily lives of the widowed women—relationships and the ability to shape one’s life. Nussbaum’s model of a good life highlights the archetypal roles of affiliation and practical reason as shaping the overall human experience. Nussbaum proposes that affiliation and practical reasoning can function as pivotal tools during challenging situations. In the context of this study, this could imply that the women’s need for a cohesive day could become more seamlessly integrated with their active participation in planning the numerous visits and interventions from healthcare professionals. These elements, namely affiliation and practical reasoning, are intricately linked to the women’s opportunities to a good life. This connection strengthens the narrative by highlighting how these abilities play a central role in shaping the participants’ experiences and empowering them in their daily lives.

Methodological considerations

The insights from this study, intended to explore the experiences of a specific group of women within their individual life contexts, should be considered with a nuanced perspective. This study could serve as a step in exploring and enriching the comprehension of the intricate narratives relevant to women in this life phase, but additional research is needed to further illuminate the multifaceted stories they hold.

This qualitative study examined a relatively small number of widowed women aged 80 and over with extensive care needs. While our study provides valuable insights on the meaning of a good life for the group under study, the results can not be transferred to the examined group in general, or to other populations without further investigation. Measures have been made to ensure the trustworthiness of the findings by an extensive and detailed method description, which also can enable further equivalent studies. To address the researcher influence and positioning in qualitative studies we have described our own backgrounds and research experiences.

A strength of this study lies in the cooperation with older adults, both in the study design and in the development of the interview guide. The method employed in our study reflects an accessible and inclusive approach to conducting interviews with older women in their homes. Studies (Davies et al., 2010; Goodwin et al., 2023; Liljas et al., 2017) have provided an explanation for the scarcity of research addressing the challenges of availability and mobility within this age group. They emphasize the importance of conducting data collection within the homes of older adults, irrespective of their living arrangements or need for assistance.

In the context of our study involving interviews with older widows we did consider the potential vulnerabilities and ethical challenges that came with exploring sensitive topics or, in this case, a potentially delicate life situation. Throughout our study, we have aimed to uphold ethical awareness and utilize continuous reflexive methods. We have also recognized the researcher’s need to navigate the balance between obtaining detailed descriptions and ensuring the well-being of participants.

Conclusions

This study contributes to our understanding of how women navigate the challenges of ageing, health and shifting circumstances while maintaining their sense of self, independence and connection to their homes. These findings have implications for providing aged care for women, while acknowledging the multifaceted aspects of their lives and the centrality of home. In the context of this study, the women’s need for a cohesive day could become more seamlessly integrated with their active participation in planning the numerous visits and interventions from healthcare professionals.

At first glance, a day spent at home may seem unchanging, but much like a river, it embodies life’s dynamism, constantly evolving in response to changing circumstances and surroundings. Our findings emphasize how older widowed women’s lives are intertwined with their homes. In contemplating This day in my home, the frame of my life, it highlights the importance of giving due consideration to the experiences and life circumstances of widowed older women. Such an approach can ensure that the concept of “home” remains a sanctuary of comfort and fulfilment, enhancing day-to-day experiences and contributing to a good life.

Author’s contribution

The author contributions for this manuscript are as follows: AA, PJ, and KZ made substantial contributions to the conception, design, acquisition of data, and analysis and interpretation of data. AA, CM, PJ, and KZ were involved in drafting the manuscript or critically revising it for important intellectual content. Final approval of the version to be published and taking public responsibility for appropriate portions of the content were performed by AA, CM, PJ, and KZ. Additionally, AA and KZ agreed to be accountable for all aspects of the work, ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Patient or public contribution

The interview guide was developed through a collaborative process that engaged older persons with firsthand experience of home care and educators specializing in easy-to-read Swedish.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

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

Notes on contributors

Ariel Almevall

Ariel Almevall, RN, specialist nurse in the care of older people, is a Phd-student in Nursing at Division of Nursing and Medical Technology, Department of Health, Education and Technology, Luleå University of Technology. Her PhD research focuses on older persons aged 80 and above, emphasizing the pivotal role of personal experiences and caregiving relationships. Additionally, it explores health, well-being, and survival in a longitudinal context, aiming to promote health and well-being in later life.

Päivi Juuso

Päivi Juuso, PhD, RN, Public health nurse, is Associate professor in Nursing at Division of Nursing and Medical Technology, Department of Health, Education and Technology, Luleå University of Technology. Päivi Juuso has directed her research towards comprehending individuals’ capacities to attain health and engagement, particularly amidst illness and its impact on daily life. Her current research focuses on nature and its importance in promoting health, mainly in Nordic and Arctic regions. She is involved in and leads cross-disciplinary projects in the field of nature and health.

Catharina Melander

Catharina Melander, PhD, RN, Specialist nurse in the care of older people, is Assistant professor in Nursing at Division of Nursing and Medical Technology, Department of Health, Education and Technology, Luleå University of Technology. Her research is dedicated to advancing the understanding of older people’s health and wellbeing, with a specific emphasis on the integration of digital technology, and on persons with dementia. Additionally, she acts in the management team of an interdisciplinary network focused on supporting junior researchers in the field of aging and health.

Karin Zingmark

Karin Zingmark, PhD, RN, is Professor in Nursing at Division of Nursing and Medical Technology, Department of Health, Education and Technology, Luleå University of Technology. She has an extensive experience of aged care and research in the field. Her research is now mainly focusing on ethical care issues, people with dementia and healthy aging. As a formal research manager, and as director of development, she has been leading the work with establishing conditions for clinical research in care organizations.