Graduation Year


Document Type




Degree Name

Doctor of Philosophy (Ph.D.)

Degree Granting Department


Major Professor

Constance G. Visovsky, Ph.D., R.N., ACNP, FAAN

Co-Major Professor

Harleah G. Buck, Ph.D., R.N., FPCN, FAHA, FAAN

Committee Member

Cindy S. Tofthagen, Ph.D., APRN, AOCNP®, FAANP, FAAN

Committee Member

Laura A. Szalacha, Ed.D.


bereavement, caregivers, loss, stress process


Background: It is estimated that 10-15% of bereaved people in the general population are experiencing prolonged, complicated grief after a loss. Persons with complicated grief experience a disruption of usual, pre-death activities, destructive thoughts and actions, and can develop or find a worsening of comorbidities and impairments. All of these, in turn, worsen the experience. Complicated grief reactions can compound the stress of the loss, disrupting the normal functioning of the central nervous, immune, cardiovascular, neuroendocrine, and gastrointestinal systems, which in turn can contribute to poor quality of life for the surviving family member. However, due to a paucity of research, the effects of complicated grief on quality of life are not well known.

Purpose: The purpose of this mixed methods study was to describe quality of life of older adults with complicated grief via the analyses and integration of qualitative and quantitative data in three aims. Aim #1: To qualitatively describe self-reported quality of life of older adults with complicated grief treated with Accelerated Resolution Therapy as measured by transcription and coding of semi-structured interviews. Aim #2: To quantitatively examine changes in quality of life of older adults with complicated grief pre-, post-, and eight-weeks after Accelerated Resolution Therapy as measured by the CDC HRQOL-14, Healthy Days Module testing the hypothesis that older adults experiencing complicated grief will report improved quality of life with completion of Accelerated Resolution Therapy. Aim #3: To understand changes in quality of life of older adults with complicated grief treated with Accelerated Resolution Therapy by integrating the qualitative and quantitative data.

Methods: This study was a sub-analysis of a randomized wait list controlled treatment study titled “Accelerated Resolution Therapy for Treatment of Complicated Grief in Senior Adults” (R21AG056584). The parent study measured quality of life qualitatively and quantitatively for this sub-analysis. Demographic and clinical characteristics were analyzed with descriptive statistics. Thematic analysis techniques were used to code the qualitative data for Aim #1. Paired t-tests and repeated measures analysis of variance were conducted on the CDC HRQOL-14 aggregate responses. Then a multilevel linear model was fitted to the data to test for a significant change in quality of life over the course of the Accelerated Resolution Therapy intervention and if there was a significant effect of the intervention for Aim #2. Lastly, an informational matrix with select patient characteristics, qualitative themes, and quality of life scores at the end of study and change in scores from baseline to end of study was created to compare variables to variables and groups of variables to individual variables for Aim #3.

Results: The majority of participants (n = 29) were female, widowed, White, non-Hispanic/Latino, retired, educated at a bachelor's or graduate level, and had a mean age 68 years. Four main themes or domains emerged from the thematic analysis. Quality of life includes: Mental Function (sub-themes were mental health, joy, and happiness), Self-management (sub-themes were self-efficacy and self-agency), Social Support, and Physical Function for Aim #1. For Aim #2, the older adults who were experiencing complicated grief reported improved quality of life with the completion of Accelerated Resolution Therapy. Quality of life scores statistically decreased (improved) over time. Both time and group contributed to the model suggesting that Accelerated Resolution Therapy had a positive effect on participants’ quality of life. When bringing the two types of data together to create a richer understanding of changes in quality of life with treatment it was found that those who endorsed the most themes had at least one comorbidity and those reporting the greatest improvement in quality of life scores all had a history of multiple deaths.

Conclusion: The results of this study contribute to the body of knowledge related to older adults, caregiving, complicated grief, mind-body therapies, and quality of life. Participants reported between one and four quality of life themes. These former family caregivers with complicated grief who received Accelerated Resolution Therapy reported improved quality of life which sustained eight weeks after active treatment. Integrated data revealed having at least one comorbidity may lead to a richer description and endorsement of quality of life and a history of multiple deaths may contribute to a greater response to treatment. Additionally, this is the first longitudinal, randomized controlled trial to examine the quality of life of family caregivers with complicated grief receiving Accelerated Resolution Therapy. This study provides encouraging preliminary data supporting further research on the effect of treatment on complicated grief and quality of life.

Included in

Nursing Commons