Background: The world’s population is experiencing global aging. The population of older adults is growing faster in developing countries including Indonesia, followed by an increasing trend of the number of older women living alone due to the higher incidence of widowhood among older women and the higher life expectancy of older women than older men. Living alone among older women has been associated with psychosocial consequences, but literature to date includes conflicting findings of the association between living alone and psychosocial aspects. There are limited published works that have investigated the association of living alone and psychosocial problems among older women in Indonesia, including the experience of older women living alone in Indonesia.
Purpose: to appraise and summarize the existing scientific evidence concerning the psychosocial aspect of living alone among older women; to investigate the association of living alone and particular psychosocial aspects among older women in Indonesia; to understand the lived experience of older widowed women living alone in Indonesia.
Method: Multi-studies was designed to answer the purposes of this study. First, a systematic review was used to appraise and summarize the existing scientific evidence concerning the psychosocial aspects of living alone among older women. It was prepared following the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). Second, a secondary analysis study of data from the fifth period of the Indonesian Family Life Survey (IFLS-5) was conducted to investigate the factors associated with loneliness and depressive symptoms among older women in Indonesia. Third, a phenomenology study was designed to explore the lived experience of older widowed women who live alone in Indonesia.
Result: A total of 480 studies were identified and 12 studies were included in the systematic review. The major psychosocial problem of living alone among older women is depressive symptoms as investigated by seven studies, followed by loneliness, fear of falling, and vulnerability relative to encounter with troublesome persons. Loneliness was not associated with living alone as the social connectedness was well mediated. The secondary analysis study of IFLS-5 data indicated fewer than one in five older women in Indonesia lived alone, though half reported loneliness and 16% reported depressive symptoms. Living alone was significantly associated with loneliness and depressive symptoms. Lower education, lower economic status, and lower self-rated health were significantly associated with loneliness; while the number of chronic diseases, difficulty in instrumental activities of daily living (IADLs), and self-rated life satisfaction were significantly associated with depressive symptoms. The third study employed a qualitative phenomenological approach. Through systematic text condensation procedure, we identified six themes: 1) attachment to the original house, 2) becoming resilient to live alone, 3) needed help to support independent living, 4) negative feeling at times, 5) coping toward negative feelings, 6) being socially active to support themselves. Our findings illustrate the struggles of older women to live alone in their own homes. Despite the coping strategies they have developed over time, older women needed help during their hard times especially when getting sick. Families and neighbors were the main resources for them to maintain independent living. Improving the home environment to increase suitability for ageing residents and providing a support system are the options that best fit the needs and values that the older women believed.

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