[Futuregen] Widowhood paper: Rejected by Journal of Gerontology

[Afshin Vafaei]

Well Sterfanai not the best news but the reviews are in general positive. I
have a feeling if it was a journal rathert than this high demand GSA
journal you would get a major revision decision and most of the concerns
could have been addressed with clarifications in the response letter.

I see reviewer #3 careful and detailed comments particularly useful for
improving the manuscript.

Looking forward to seeing your resubmission plan.

Cheers,

Afshin



On Mon, Apr 5, 2021 at 8:21 AM Stefania Ilinca <ilinca at euro.centre.org>
wrote:

> Dear all,
>
> I keep bringing bad news after important holidays - sorry about that.
> Unfortunately, the widowhood paper was rejected by the Journals of
> Gerontology, but this time both the reviewers and the editor have
> provided detailed and useful comments - see copied below. None seem
> insurmountable at a first read.
>
> I look forward to discussing this once you would have had a chance to
> read through the comments. In the meanwhile, I will prepare a plan for
> re-submission (including planned changes to the manuscript and the
> analyses, as well as a few target journal proposals).
>
> My best regards, Stefania
>
> From:
>
> JGeronSoc at Geron.org
>
> To:
>
> ilinca at euro.centre.org
>
> CC:
>
> Subject:
>
> Journal of Gerontology: Social Sciences - Decision on Manuscript ID
> JGSS-2021-012
>
> Body:
>
> Dear Author,
>
> On 12-Jan-2021 we received your  manuscript entitled Gender Differences
> in Access to Community-Based Care: A Longitudinal Analysis of the
> Effects of Widowhood and Living Arrangements for possible publication in
> the Journal of Gerontology: Social Sciences. The thoughtful comments of
> the reviewers are enclosed for your consideration.
>
> The reviewers are very accomplished in their research and knowledgeable
> of the topic of your manuscript.  I am quite impressed by the careful
> and constructive reviews that they have submitted.
>
> Although the reviewers value the topic of your study, they raise a
> number of fairly serious concerns about your manuscript. The reviewers'
> comments are thorough and quite explicit.  After carefully considering
> the judgment of the reviewers, I am sorry to write that we will not be
> able to publish your paper in the Journal of Gerontology: Social Sciences.
>
> To put this editorial decision into perspective, let me add that the
> Journal accepts less than 20% of all manuscripts submitted.
>
> When I reread the paper with the reviewers' comments in mind, I had many
> of the same reactions: the topic is very interesting, and the paper has
> great potential. Probably the most significant limitation derives from
> the study design.
>
> This is a study using SHARE to examine the risk of unmet care needs
> among widowed men and women. Findings indicate that women who transition
> into widowhood are more likely to receive care than men.  Living alone
> and widowhood have independent influences on likelihood of receiving
> care.  As population ages in Europe, the degree to which functional
> needs are being met in the community is an important line of inquiry.
>
> The reviewers expressed enthusiasm for the general question, but pointed
> out a number of weaknesses with the present manuscript, both
> conceptually and methodologically.  In my own reading of the manuscript,
> I concur. I will not reiterate all of their points here but will note
> some of the key ones that drove this decision. Foremost, the study is
> grounded in a very delimited question, attempting to parse the influence
> of widowhood from living arrangement on receiving care.  Conceptually,
> bereavement, widowhood, and living arrangement are not clearly
> separated. Methodologically, the analyses test simultaneously for
> effects of widowhood, health needs, living alone, and household size
> with little attention to their measurement overlap. Second, the analyses
> did not provide formal contrasts by gender even though the results were
> interpreted in this way.  Third, the statistical model may be a novel
> contribution to the literature but this needs further elaboration for
> the reader as to its strengths over traditional fixed and random effects
> models.  It seems that indicators of model fit are missing, as well,
> making it difficult to evaluate impact of the findings.  These are not
> insurmountable critiques but careful attention to them would likely
> yield a completely different manuscript.  I hope that the feedback is
> helpful as you revise your manuscript for another journal such as
> Research on Aging.
>
>
>
> I wish that this letter could have brought you better news, and I thank
> you for considering the Journal of Gerontology: Social Sciences. I hope
> that you will continue to submit your work to us in the future.
>
> I also encourage you to exploit the thorough and constructive comments
> of the reviewers. They felt that the paper has promise, and I am sure
> that their comments will help you in revising the paper to fulfill that
> promise.
>
> Best regards,
> Jessica Kelley,  Editor
>
>
>
> Reviewer(s)' Comments to Author:
>
> Reviewer: 1
>
> Comments to the Author
> This manuscript examines gender differences in getting help among older
> adults, and trying to separate out the effects of widowhood and living
> arrangements.
>
> The premise: Although this topic of older adults needing care is an
> important one, I'm not sure I understand this way of approaching the
> question.  Why do we need to separate out the effects of living alone
> and widowhood? How does this help us make sure that people who need care
> get it?
>
> There are some vague terms used and I'm not sure that I followed. For
> example, "fairness" in European long-term care systems.
>
> I'm not sure if it might be useful to look at why people are not
> receiving care?  Is it because they don't want it, or because they can't
> get it, or can't afford it?  If you're interested in issues of access,
> then affordability might be a dimension to examine.
>
> If you want to stick with this question, try to explain what we gain
> from separating out the effects of widowhood vs living arrangements.
> I'm not sure that that case was made.
>
> Reviewer: 2
>
> Comments to the Author
> This study examines the impact of gender, widowhood, and living
> arrangements on the use of home and community-based care among older
> adults. The study demonstrates the important influence of gender,
> particularly in the use of informal and formal health care settings
> among the widowed population. The study is well written and uses
> rigorous data analysis, but I still have questions about its approach to
> separating widowhood from bereavement.
> 1) On page 4 lines 26 – 40. The study defines widowhood as “a long-term
> and ongoing state” while bereavement is a short-term experience of the
> death of a spouse. However, the study also states both widowhood and
> bereavement have “immediate and long-lasting effects”. These two
> statements contradict each other. If bereavement has lasting effects,
> then it is widowhood. Could the author clarify the definition of
> widowhood and bereavement and how to use them in the study?
> 2) There are three independent variables in the study: sex, widowhood,
> and living arrangements. The study mentions that “A binary variable that
> identifies widowhood was generated based on self-reported marital status
> in each panel wave – married living with a spouse, married not living
> with a spouse or widowed” (page 9 line 36 – 40). It is not clear how the
> study measures “bereavement”. Since separating widowhood and bereavement
> is a significant contribution of the study to the field, the study needs
> to tell readers how to make it.
> 3) In tables 1 -3, the study also has variables for “transitions into
> widowhood” and “transitions out of widowhood”. How to define these two
> variables and why they are important in this study?
> 4) The study mentioned that due to the limited number of
> regional-specific analyses by
> “the size of the longitudinal sample in SHARE” (p15, line 47-50).
> However, according to Table 1, there were 7554 women in the continental
> area, 2553 women in the Nordic region, 5874 women in the Southern
> region, and 5991 women in the Eastern region. This study seems to have
> enough people to analyze the regional impact on people's use of home and
> community care. It is well known that local health policies and
> culturally based information care systems can significantly influence
> people's behaviors of trust and use of informal and formal health care.
> As the study mentions, support for widowhood is also gender-based and
> influenced by local culture and policies. Since these regional data is
> available for this study, could the authors tell us how the region
> influences these gender-based behaviors? Maybe a moderation effects
> analysis can help.
>
>
> Reviewer: 3
>
> Comments to the Author
> The present manuscript presents a cross-national analysis of thousands
> of older adults from across Europe. The manuscript aims to “explore the
> complex pattern of associations between widowhood, living arrangements,
> and use of home and community-based care”. I think this is a worthy
> topic of study and the authors effectively convinced me of the
> importance of the research questions. At the same time, I think there
> are some fundamental problems with the ways that some of the analyses
> were conducted and presented. I provide more detailed comments below in
> the hopes of helping to strengthen a future iteration of this important
> and interesting manuscript. I also want to couch my comments with the
> caveat that while I feel comfortable conducting and interpreting
> multilevel models, REWB models are new to me and I apologize for any
> misunderstandings that occurred because of my ignorance.
>
> Major comments:
> 1) The second objective, it seems to me, is concerned with the
> interaction between a) sex and bereavement (within effects) and b) the
> interaction between sex and widowhood (between effects), but my
> understanding of the analyses is that no interactions were tested.
> Instead, statistically significant effects for one sex (usually females)
> along with statistically non-significant effects for another sex
> (usually males) were treated as if they indicated a sex difference.
> Likewise, the third objective states that it wants to, “…reflect on how
> disadvantages in [financial and human capital] can intersect with sex to
> influence patterns of [HCBS] use”. Here interactions of interest appear
> to be those between sex and the stated dimensions of capital.
> 1a. Here are some other statements that lead me to think the manuscript
> was concerned with, and interpreted results as if there were,
> interactions, despite not testing interactions: “Our results further
> confirm previous findings of a differential effect of socio-economic
> status indicators across sexes”; “We next turn our attention to the
> possibility that the above results are moderated by country specific
> characteristics and institutional factors that are not fully captured by
> country specific dummy variables.”; “This suggests older widows are
> better able to access care resources following bereavement, whereas
> older widowers are less likely to do so”; “We found socio-economic
> status indicators were associated with care use only for older women,
> suggesting a modifying effect of sex.”; “More specifically, we find
> gender differences in the effect of widowhood and living arrangements on
> probability to receive long-term care are attenuated in countries that
> emphasize defamilialization (of care) through public provision, shifting
> responsibility for care from the family towards the state (Saraceno,
> 2016: 317).”
> 2) It seems that the analyses for males in Table 3 are almost definitely
> underpowered (because the 168 bereavement events are spread across 4
> countries) and that this may also be the case for females (especially if
> there is disproportionate sampling or disproportionate observation of
> bereavement events across the welfare clusters). I do not believe there
> was a discussion of power in the manuscript but given that there were
> some large effects in Table 3 that did not achieve statistical
> significance, this seems to support the contention of insufficient power.
> 3) In this study the primary outcome is a binary indicator comprising
> any care participants have received, combining informal and formal care
> as well as different quantities of care. I think the authors adequately
> address the lack of quantity information in the discussion. I am less
> satisfied with the rationale for combining formal and informal care.
> This seems like an important question that future readers of the
> manuscript will be curious about. Perhaps a future iteration of the
> manuscript might disaggregate formal and informal care. I am sensitive
> to the need to fit within restrictive word limits, so I would completely
> understand if such a sensitivity analysis ends up in supplemental
> materials along with a stronger rationale for the aggregation of formal
> and informal care in the main text.
> 4) “both widows and widowers have a higher probability of receiving care
> than older individuals with partners” Is it possible that this suggests
> that there is a problem in measurement wherein people underreport the
> care provided by their spouses? If one has needs, and someone is in the
> home with them, are they not likely to receive the necessary support?
> According to the manuscript, it seems to be the case that live-in
> partners provide support, especially when carers are female (e.g.,
> “Finally, the surviving spouses in our study (i.e. the widows and
> widowers) were likely previously providing informal care to their
> deceased spouse. There is evidence that households where the wife is the
> informal carer tend to receive less formal care service due to
> persistent gender stereotypes of women's roles as caregivers (Schmidt
> 2017, Larsson et al. 2014). I would like to acknowledge that I am not
> saying there is a measurement problem, but I would be interested to hear
> the authors’ thoughts on the matter and why they think there is evidence
> for/against such an error.
> 5) Overall there is extensive focus on statistical significance with
> relatively little focus on effect sizes. This seems particularly
> problematic because the analyses for males are so underpowered in some
> circumstances (e.g., the rather sizeable effect of bereavement for males
> in Eastern countries, which is the third largest effect in Table 3 and
> is in the opposite direction of most of the findings). I’m not
> advocating for interpreting null effects, but I do think statistical
> significance and effect size should carefully be considered in concert.
> 6) The consistency of the findings across the four models in Table 2 and
> the four types of countries in Table 3 was neat to see! I was especially
> surprised to see that was the case in model 4 since the variables
> included in that model were likely highly correlated with
> bereavement/widowhood effects. Bravo to the authors for testing and
> reporting that model (and also presenting the others, which likely have
> fewer issues with collinearity).
>
>
> Minor Comments:
>
> 1) “The care literature has overwhelmingly focused on intergenerational
> support patterns and caregiving by children to older parents,” this
> seems like a tough statement to backup. There is a vast literature on
> caregiving focused on spouses. Indeed, in the bereavement-care
> literature, I would argue that spouses are focused on to a larger extent
> than adult-children because some studies suggest (and lay-wisdom
> overwhelmingly suggests) that the adverse consequences of bereavement
> for former caregivers is greater than that for adult-children.
> 2) The manuscript mentions excluding waves 3 and 7, but it was unclear
> why. Did these waves not include necessary data?
> 3) I believe Table 1 presents (for the most part) observation N’s as
> opposed to participant N’s (I believe transitions into and out of
> widowhood are likely participant N’s, though I guess they may not
> necessarily be). I wonder if there might be an interesting way to
> incorporate participant N’s in this table along with observation N’s.
> For instance, it seems like an interesting data point to include how
> many participants received care at any point in the study versus the
> number who never received care. Based on my reading of the results
> section, it seems that there is interest in this level of analysis and
> that much of the first paragraph of the results section interprets the
> findings of Table 1 as if it presented results at the individual level.
> It seemed especially surprising to me that variables like “low
> education” were presented at the level of observations, given that such
> a variable is probably not very likely to change over time for this
> older sample (though it would be neat to know if it did change for the
> sample).
> 4) Terms like gender and sex seem to be used interchangeably in this
> manuscript, though my impression based on the method section is that
> “sex” is what was actually measured. I therefore tried to confine my
> terminology to sex and the associated categories of it that I believe
> were measured here (except for quotes from the manuscript).
>
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