VIEWPOINT
Good (virtual) grief: The potential of online communities for bereaved older adults in the wake of Covid-19
Samantha Teichman
Department of Gerontology, Simon Fraser University, Vancouver, Canada
Rachel Weldrick
Department of Gerontology, Simon Fraser University, Vancouver, Canada
Abstract
During the pandemic, older adults were at risk of heightened social isolation and bereavement overload. However, engagement in online grief communities can facilitate meaningful social connections and promote healthy bereavement practices. This paper highlights the benefits of engaging in meaning-making, community building, and griefwork in later life. We engage with recent literature on virtual bereavement practices and discuss the ongoing potential for bereaved older adults to engage in online grief communities amid the new realities of Covid-19. We consider what it means to process grief in a virtual space and how this may shape approaches to death, dying, and bereavement during and after a global pandemic. We conclude with a call to action to develop accessible and affordable online engagement technologies for older adults to help mitigate a decline in well-being and promote healthy bereavement practices.
Keywords
grief, older adults, online communities, bereavement, Covid-19
Implications for practice
•For older adults, engaging in online grief communities offers new kinds of long-lasting support that can meet the specific needs of older age, grieving, and what it means to face mortality.
•To help mitigate a decline in well-being and promote healthy bereavement practices, online engagement technologies for older adults must be affordable and accessible.
•Technological developers must consider older adults in their design, and consider how these technologies translate after death, and the implications for survivors.
Introduction
While death is a natural and unavoidable part of life, ongoing and/or repeated exposure to death – especially for older adults who have experienced the loss of multiple friends and loved ones – can have detrimental effects on well-being (Mason, 2022; Treml, 2022). Relatedly, bereavement in older age is a major stressor associated with a decline in mental and physical health (Cohen, 1992; Hansson, 2007; Segal et al, 2018). The paradox of promoting healthy aging and increased longevity is that as lifespans are extended, we are more likely to have encounters with death that can challenge well-being and healthy aging. In the midst of a global pandemic, exposure to death can increase exponentially. The ongoing realities of the Covid-19 pandemic have led to concerns from experts in hospice and palliative medicine regarding ‘complicated grief’ linked to the disruption of traditional end-of-life and funerary practices, formal bereavement support, and access to social connection (Wallace, 2020).
One way to minimise this risk when grieving and promote healthy bereavement is through social connectedness (Bui, 2018). Throughout Covid-19, online communities and other virtual programs (eg virtual church services) have become essential for facilitating social connectedness for bereavement. This commentary, therefore, engages with recent literature on virtual bereavement practices and discusses the ongoing potential for bereaved older adults and online engagement technologies amid the new realities sparked by Covid-19. Here, we define online engagement technologies as technology that promotes social interaction and connection, such as communication technologies, social media platforms, and discussion forums. Given the shifting landscapes of Covid-19, grief, and bereavement practices in later life, we consider the emerging online practices employed by bereaved older people, as well as the potential for these practices and communities to support bereavement going forward.
Grief and death during COVID-19
In March 2020, the World Health Organization declared the spread of the Covid-19 virus a global pandemic (WHO, 2020). Physical distancing restrictions and other precautionary measures that were taken to curb infection resulted in a disruption of everyday life; many individuals and families experienced isolation, loss of employment, financial insecurity, and a loss of routine (Joaquim, 2021; Petry et al, 2021; Visser, 2021). In addition, individuals and families infected with Covid-19 experienced challenges related to caregiving, overburdened healthcare systems, and difficulties accessing desired end-of-life care (Ersek, 2021; Hanna, 2021; Şimşek Arslan & Buldukoğlu, 2021). For individuals who lost loved ones to Covid-19, the difficulties of grief were amplified by the obstacles of navigating restricted mourning and funerary practices (Burrell & Selman, 2020; Cardoso, 2020). In this sense, the Covid-19 pandemic magnified grief while simultaneously disrupting the systems and supports people turn to when navigating death, dying, and bereavement.
The Covid-19 pandemic has also exacerbated what medical and sociological literature refers to as ‘bad deaths’, wherein end-of-life is marked by characteristics that restrict comfort, such as difficulty breathing, psychological distress, physical pain, being treated without dignity, and being deprived of desired treatments (Carr et al, 2020; Krikorian et al, 2020; Han et al, 2021). Under normal circumstances, bad deaths are distressing, but the pandemic has intensified the pain of loss through concurrent stressors such as social isolation, financial precarity, health concerns, and anxiety about one’s own mortality (Carr et al, 2020). Each of these challenges has significant implications for bereaved people’s symptoms of depression, anxiety, and anger (Carr et al, 2020). In addition, Covid-19 has prevented many individuals from performing desired mourning rituals and funerary practices, often creating a sense of unfinished mourning (Farahmandnia et al, 2020; Mortazavi, 2021).
For many older adults, these challenges were further aggravated by the extent to which they were able to connect with others. Broadly speaking, older people were labeled as a ‘vulnerable’ population through the pandemic and were strongly advised (ie through institutional policies) to physically distance themselves from other people to avoid infection. As a result, many older people – both community-dwelling and in congregate settings – have experienced heightened risk of social isolation (Cosco, 2021; Sayin Kasar & Karaman, 2021). For some, this risk of isolation has been exacerbated by the ‘digital divide’ – that is, the unequal access to technology and internet – which disproportionately affects older adults (Charness & Boot, 2022). For older adults facing the digital divide, this has meant facing a ‘double burden of exclusion’, as they have been deprived of both physical and virtual methods of social connection (Seifert et al, 2021, p1). Additionally, older adults may disproportionately experience the death of loved ones (Verdery, 2020). This heightened risk of Covid-19 infection and death, paired with severe levels of social isolation (Cosco, 2021; Sayin Kasar & Karaman, 2021) and risk for bereavement overload – grieving more than one loss at the same time or shortly after each other (Zoler, 2006; Verdery, 2020) – has significant implications for the well-being of older people.
Healthy bereavement and technological intervention
It is known that social and emotional support is essential for supporting bereaved individuals (Ha, 2008). Building a support network is integral to the grieving process. Social connection through professional, familial, and community support can mitigate symptoms of loneliness, depression, and even suicidality in grievers (Breen, 2021; Cacciatore, 2021; Ha, 2008; Li, 2020; Scott, 2020; Stroebe, 2010). In addition to relieving psychological distress, social support can help facilitate the process of working through grief through expressions of caring, compassion, trust building, and mutuality (Cacciatore, 2021). Through an exchange of resources between the bereaved and their social network, social support is intended to enhance the well-being of the bereaved (Stroebe, 2010). This is supported through theorisations of the social determinants of health, which underscore the ways in which social support is a primary factor that influences health outcomes (Raphael, 2016).
The pandemic posed a challenge in terms of social distancing restrictions and fear of contracting the disease. Accordingly, alternative methods of connection have been used to achieve social and emotional support. Throughout the pandemic, we have seen the myriad ways technology has and can be used to strengthen social connections (Abel & Taubert, 2020; Cosco, 2021; Sayin Kasar & Karaman, 2021). Virtual spaces, such as online communities and social media, are examples of how technology can be productive and empowering for individuals to process their grief (Brubaker & Hayes, 2011; Sofka & Gilbert, 2012; Berthoud, 2021). Technology and virtual spaces have played a key role in the bereavement process for countless people since well before the Covid-19 pandemic. For example, online memorialisation, virtual funerals, and bereavement forums have been used in both effective and healing ways (Walter, 2012; Cann, 2014).
Despite the immense value that various technological supports can provide to bereaved individuals, older adults can face unique obstacles when attempting to engage with these technologies. Barriers to accessing technology for older adults can be divided into three main issues:
•Structural barriers, such as care facilities not equipped with proper wi-fi access or technological devices (Cosco, 2021; Visser, 2021).
•Digital literacy barriers, meaning that some older adults do not have the skillset required to identify and utilise the technology available to them (Tsai et al, 2017; Blažič & Blažič, 2020; Tyler et al, 2020).
•Financial barriers related to technology acquisition, such as financial constraints due to cost of purchasing and/or subscribing to technology and applications. (Visser, 2021). This can also include difficulties in acquiring tech that meets accessibility needs.
Efforts to remedy barriers to accessing technology in later life should consider all three aforementioned challenges. For instance, care, service, and/or housing providers serving communities of older adults should ensure that critical infrastructure such as wi-fi is integrated into residential settings (eg long-term care homes) and other locales frequented by older adults (eg community centers) the way that it is for younger people (eg schools, shopping centers). This will help to ensure that older people have access to the internet in public spaces, particularly if they do not have access in their home. Programming efforts could also include expanding upon device lending and digital literacy learning programs, services which are offered through many public libraries (Horton, 2018).
Research can also play a role in addressing these barriers through meaningful and participatory methods. For instance, Barbosa Neves and colleagues (2019) demonstrated this by collaboratively creating an accessible communication app to send and receive photos, audio, video and text messages. Participants reported feeling a sense of closeness to their family, particularly with their children and grandchildren (Barbosa Neves, et al 2019). In addition, all participants, even those who were digitally illiterate at the beginning of the study, reported perceived usefulness of the app for social interaction due to its simplicity in usability (Barbosa Neves, et al 2019). Given the research evidence above, this article is a call to action to develop accessible and affordable online engagement technologies for older adults to help mitigate a decline in well-being and promote healthy bereavement practices.
Online grief communities as care
Much of the literature published during Covid-19 notes the importance of exploring technological intervention in terms of bereavement support (Boelen & Smid, 2017; Abel & Taubert, 2020; Burrell & Selman, 2020; Carr, 2020; Berthoud, 2021), but there is little discussion about what it means to process grief in a virtual space. Whether this is through virtual support groups, communicating online with loved ones, or sharing their grief online, these virtual grieving practices hold the potential to mitigate the harmful effects of social isolation and bereavement overload in older adults. Special attention should be paid to the role of online communities as spaces to facilitate caring social relations for bereaved older adults.
Traditional definitions of community note key distinguishing elements of a geographical area where social relations, a sense of identity, and structures for the gratification of social and physical needs occur within a particular bounded area (Bell & Newby, 1972; Stebbins, 1987; Hale, 1990; Johnson, 1996). Managing physical distancing regulations and the risk of contracting Covid-19 during the pandemic means older adults may not be able to engage with their communities. However, there is the ability to foster these key elements of social relations, a sense of identity, and structures for the gratification of social and physical needs within online spaces. Removing geographical barriers through virtual spaces results in ‘a spatial expansion of the social processes around death and bereavement’ (Brubaker, 2013, p160). In other words, engagement with an online bereavement community offers new paths of accessibility in the realms of grief and mourning. Online communities have the ability to foster supportive environments through their networks, such as social integration, emotional self-esteem and informational support, tangible aid, and the feeling that individuals are needed (Baym, 2010). In terms of grieving, it is argued that some individuals may seek online support as a result of a lack of offline support (Carroll & Landry, 2010; Brubaker, 2012; Döveling, 2017).
To conceptualise grieving in an online space, bereaved individuals engage in ‘griefwork’, where ‘the work of grieving is shared and negotiated between and among grieving persons and supportive others, rather than the work done alone as in grief work, a psychological concept’ (Davidson & Letherby, 2019, p52). This development of griefwork captures the collective nature of online spaces. In the context of bereaved older adults during Covid-19, engaging in griefwork through virtual spaces can provide social connection without the risk of contracting the disease while simultaneously mitigating the risk of complicated grief.
For instance, online widow support sites like ‘The Sisterhood of Widows’ (Francis, 2022) offer resources including handbooks, blog posts, videos, and Facebook groups to connect with other widows. This type of community-building rooted in common experiences of grief is elevated through online infrastructure, highlighting the relationships between grief, virtual spaces, and social connection. Connecting bereaved individuals with similar grief experiences helps create a shared identity, which can work against risk of loneliness and social isolation. When the grieving experience is shared, online spaces embody griefwork and foster community, which in turn strengthens social connectedness and well-being. In terms of older adults, it is important to recognise that there is high value placed on close ties to meet emotional needs (Carstensen, 1992; Carstensen et al, 2003). Engaging in online grief communities offers new kinds of long-lasting support that meet the specific needs of older age, grieving, and what it means to face mortality. Thus, what is possible in a post-pandemic world is that older adults with means to online engagement will move forward with new social connections and community. We have yet to learn whether this online format will be maintained. However, it is likely that offering both in-person and online bereavement support is the most effective means of providing inclusive support to bereaved older people going forward.
Future directions
Future efforts to support healthy bereavement for older people must include considerations for equitable access to online communities and support both during and beyond Covid-19. Online bereavement communities offer a place to process the overwhelming emotions tied to loss. Like other approaches to death and grief involving spaces and objects – such as benches, roadside shrines, bumper stickers, tattoos, and jewelry – online spaces become ‘third spaces’ (Maddrell, 2012, p54) to promote healing. In addition, these online bereavement communities provide the opportunity to foster new social connections, which can reduce the risk of social isolation. The emergence of the Covid-19 pandemic has underscored the value of social connection, revealing the efficacy of technology as a means to attain it.
Direct engagement with older adults in the research process is critical. Community-based participatory research is needed to address these concerns to ensure that the needs and lived experience of bereaved older adults remain at the forefront of emerging inquiry. In addition, technological development must consider thanatosensitive design, which refers to the ways in which ‘technologies blend within people’s homes and personal experiences of loss in ways that are not dominated by market needs’ (Pitsillides & Wallace, 2021, p70 referencing Massimi, 2014). Thanatosensitivity can, and should, be applied to research methodologies and practices. In terms of social gerontology, thanatosenstivity can inform research methods and design by critically analysing traditional methodologies to ask how they can be adapted to sensitively, ethically, and morally address these issues (Massimi & Charise, 2009).
Additionally, this calls for technological research and design that actively seeks to integrate mortality, dying, and death in the creation of interactive systems. For instance, when an individual dies, the bereaved are faced with their digital legacy and issues concerning control and protection of their digital presence. When designing technologies that represent the living, thanatosensitive design considers how this translates after death and the implications for the survivors (Massimi & Baecker, 2010). We therefore encourage researchers and developers in this space to apply thanatosentive design principles in the creation of new tech. In doing so, virtual death practices will be more successful in meeting the needs of memorialisation, bereavement support, and communication. Long after the last Covid-19 lockdown, physical distancing restriction, and vaccine development, online social connections will remain. We must actively engage with older adults and promote the value of online grief communities as a method of meaning-making, community building, and griefwork.
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