Ambiguous Loss and Psychological Distress: A Qualitative Study of Well-Being Among Older Migrants Living in the United States

Abstract

International migration is a stressful life event that contributes to significant health disparities and well-being concerns among aging migrants living their retirement years in a host country. This study utilized a qualitative cross-sectional design employing semi-structured interviews with a diverse sample of 16 older migrants, aged 60 to 79, residing in the United States. Narratives were analyzed using thematic analysis with a reflexive approach. Three key themes emerged from the data, defining the experience of well-being and ambiguous loss: (1) The fluid nature of “Home” and belonging, reflecting profound identity-based ambiguous loss; (2) Active engagement and social connection as a foundation for well-being, highlighting structured activity as a vital coping mechanism against isolation and decline; and (3) Maintaining core identity and values, illustrating the participants’ successful selective acculturation strategies to preserve internal cultural, religious, and ethical values as a source of stability. The findings confirm that older migrants experience significant ambiguous loss centered on a disrupted sense of self and place. The study identifies active engagement and preservation of core identity as strategies for resilience and mitigating psychological distress. These results underscore the need for culturally responsive care practices that prioritize community integration, promote purposeful activity, and support the maintenance of transnational and internal cultural continuity to enhance the well-being of this growing population.

Introduction

International migration is now a defining feature of contemporary society and the process itself is widely recognized as a stressful life event, even under optimal conditions (Coffman, 1987; Ryan et al., 2021). Consequently, there are significant concerns regarding the well-being of the growing population of aging migrants, who are defined as foreign-born older adults who relocated late in life (at age 65 or around retirement) often due to family reunification or forced displacement, and are now experiencing their retirement years in a host country. Addressing the issue of well-being of older migrants is of critical importance given the demographic reality of the United States. The U.S. currently hosts 46.6 million immigrants, representing 14.2% of the national population. This figure is projected to increase to 17% within the next four decades (Camarota & Zeigler, 2022; Johnson, 2020), underscoring the growing relevance of migrants research.

While immigrants initially demonstrate a health status better than expected relative to their social position upon entry (Razum et al., 2000; Riosmena et al., 2013), this initial health benefit is observed to decline steadily over time spent in the receiving country (Stronks, 2003). This leads to a situation where the incidence of ill-health becomes particularly acute among aging migrants (Nazroo, 2024). Research examining the health of older adults consistently indicates that aging migrants often exhibit poorer health outcomes and higher levels of frailty compared to individuals born in the host country (Reus-Pons et al., 2018; Solé-Auró & Crimmins, 2008; Walkden et al., 2018). These observed health disparities are typically attributed to a complex interplay of factors, spanning socioeconomic status, behavioral patterns, psychosocial elements, and environmental conditions (Evandrou, 2000). Furthermore, immigrant health status is recognized to vary significantly based on the country of origin and sex of the individual (Oksuzyan et al., 2019).

With increasing global migration rates and a growing demographic of aging migrants, the concept of ambiguous loss has emerged as a central construct for understanding the psychological and social well-being of older adults (Boss, 2009). Ambiguous loss is defined as a deep psychological experience stemming from uncertainty and a fundamental lack of closure concerning significant relationships, one’s identity, and sense of belonging (Al-Hamad et al., 2025). This experience differs fundamentally from tangible losses (such as a death), as it defies clear resolution or finality (Mazzarelli et al., 2021). This makes the process of adaptation and coping profoundly challenging for migrants.

Ambiguous loss is particularly pertinent to aging migrants, who endure prolonged separation from both their homeland and extended family, often compounded by psychological disconnections related to cultural transition and acculturation difficulties (Kwak & Shon, 2020). The unresolved nature of losses stemming from disrupted family grieving processes (Boss, 2016) and the migration experience itself significantly increases the risk of depression, loneliness, and identity dissonance among aging migrants. These adverse psychological outcomes ultimately undermine their overall quality of life and hinder their integration into host societies (Kwak & Shon, 2020).

Current Study

The concept of ambiguous loss is a profound yet under-explored phenomenon that presents significant challenges to the well-being of older migrants. These individuals, having experienced migration, often face disruptions to their sense of belonging and identity across borders. Our study specifically targets individuals who relocated to the United States late in life. This focus is critical because immigrating at an advanced age is an increasingly prevalent phenomenon that involves distinctive risks and coping strategies compared to those who migrate during their working years (Dolberg & Lev, 2025). Unlike younger migrants who often integrate through professional environments, late-life migrants frequently move for family reunification or due to forced displacement, which fundamentally alters the acculturation process (Al-Hamad et al., 2025). Additionaly, research consistently indicates that aging migrants face elevated risks of economic hardship, physiological decline, and psychological challenges (Ten Kate et al., 2020). This study, therefore, uses a qualitative approach to explore the lived experiences of older migrants residing in the United States to understand how they experience ambiguous loss and how it is related to psychological distress. Our guiding research questions were: (a) What are the defining attributes of ambiguous loss experienced by aging migrants?; (b) How do these experiences of ambiguous loss manifest as psychological distress and impact their daily lives?; and (c) In what ways can this understanding inform the development of culturally responsive care practices to promote well-being and resilience in this population?

Methods

Participants and Data Collection

This study employed a qualitative cross-sectional design utilizing semi-structured interviews to facilitate the collection of rich, in-depth data regarding the experiences of older migrants. The sample consisted of 16 older migrants (10 females and 6 males) ranging in age from 60 to 79 years (M = 69.38, SD = 6.37) from various countries (Poland, Syria, Pakistan, Turkey) currently residing in the USA, with a residency range of 2 to 9 years (M = 4.56, SD = 2.42).

The inclusion criteria required participants to be a migrant for at least 1 year prior to the study and be 60 years of age or older. The inclusion criteria specifically targeted “late-life” migrants who relocated to the U.S. at or after age 60. This focus allows for an exploration of migration as a retirement-life event, distinguishing it from the experiences of long-term residents who migrated as young adults and aged in place.

Participation was voluntary, and no remuneration was offered. Potential participants were recruited through diverse methods, including advertisements in local papers, newsletters, online platforms, social media, and word-of-mouth. Given the specificity of the target population, snowball sampling was also used (Parker & Geddes, 2019) to facilitate referrals of eligible individuals within social networks. The invitation to participate included a brief overview of the study’s goals, researcher contact information, an outline of the risks and benefits, eligibility criteria, time commitment, and a guarantee of confidentiality. Data collection was conducted by the research team between October 20, 2025, and November 25, 2025.

Ethical approval for this study was obtained. The goals and procedures of the study were fully explained to the participants by the researcher, and written informed consent was obtained from them. Participants were assured of their voluntary participation in the research, their consent to record the interviews, their right to withdraw from the study at any stage. Semi-structured interviews were executed either in-person or virtually via Zoom, based on participant preference. Each interview was voice-recorded and subsequently transcribed verbatim. Interview lengths ranged from 20 to 70 min, with an average duration of 40 min. A semi-structured interview guide was developed based on the literature review and team discussions. Identifying information shared by participants was removed to protect confidentiality. To ensure methodological rigor, the authors maintained a reflexive journal throughout the data collection and analysis phases. This practice is crucial in qualitative research, as it acknowledges the potential influence of the researchers’ personal experiences, idiosyncrasies, and biases on the research process (Probst & Berenson, 2014).

Data Analysis

Consistent with the recommendations of Kallio et al. (2016) a pilot interview was conducted to test the guide. Data analysis began after each interview was conducted, recorded, and transcribed. The interviews were translated into English based on recommended translation methodologies (Yunus et al., 2022). The interview material was systematically analyzed using reflexive thematic analysis (Braun & Clarke, 2006; Clarke & Braun, 2018) to interpret meaning and develop key themes. The analytic process began with reading the entire text several times to gain a general understanding of its content and to familiarize themselves with the data. The next stage was to generate initial codes. This involved the researchers carefully reading the interview transcripts, making detailed notes and annotations, and assigning basic codes to short phrases to derive initial meaning from the text. Subsequently, the team moved to developing initial themes coding, which entailed re-reading the transcripts to identify patterns, establish connections between the initial codes, and determine the key analytic directions. Codes with similar content were grouped into sub-themes and themes. Discrepancies that arose during the thematic development were resolved through consensus among the research team. Participant confidentiality was maintained by substituting names with numerical identifiers (such as Participant 1) when presenting quotes in the report. The study sample (N = 16) reached the level of data saturation, which means that no new codes appeared, and redundancy was present in the data analysis.

Results

Three key themes were generated in a reflexive thematic analysis. These included: (1) the fluid nature of “home” and belonging, (2) active engagement and social connection as a foundation for well-being, and (3) Maintaining core identity and values. These themes are presented below with direct quotes that were used to demonstrate how participants’ perspectives supported these themes.

Theme 1: The Fluid Nature of “Home” and Belonging

This theme captures the complex, non-binary identity and sense of place expressed by many participants. They articulate a feeling of being neither 100% from their country of origin nor 100% American, resulting in a mixed or “half-and-half” identity.

You know when someone asks, 'Where are you from?' It’s the hardest question. I tell them I’m from here, and they look at my face and say, 'No, where are you really from?' So then I say Poland, and when I go back there, my cousins say, 'Oh, look, the American has arrived!' (Participant 1)

When we return to our home country (Indonesia), we don't feel fully Indonesian. And similarly, living here, we are not feeling entirely American either. We realize we simply cannot be 100% and belong completely in either place. (Participant 2)

My children laugh at my accent when I speak English, and the Americans look confused when I try to explain something complex. I speak English well, but when I get angry or when I'm truly sad, the words that come out are not English. (Participant 3)

Theme 2: Active Engagement and Social Connection as a Foundation for Well-Being

This theme focuses on the role of activity, work, volunteering, and community involvement in fostering health, security, and a sense of purpose in the US. It presents a clear contrast between the perceived sedentary lifestyle of peers in their home country and their active lives in the US. The necessity of remaining engaged was strongly articulated by participants, often framed as a vital antidote to decline. One participant drew a direct comparison between their current and potential experiences:

In the old country, retirement means you just fade away. Here, it’s different. . . I found new friends, and I feel so useful. Honestly, that feeling of being needed—it's the best medicine there is. If I were just stuck watching TV all day like my friends, I'd feel old and sick. (Participant 4)

Another participant explicitly linked the demands of establishing a new life to physical and mental well-being, arguing that the necessity to manage daily tasks independently in a different country “makes you healthy.” This individual maintained a highly structured schedule, noting engagement in diverse activities such as Sunday school, Meals on Wheels, and the Salvation Army:

Over here, at least I have activities Monday to Friday like each day. (Participant 1)

One of the participants specifically emphasized how immersion in the local community increased her overall life satisfaction:

I’m more involved in the community and it makes a big difference for me. I bond with the community members. I make friends, socialize, teach and learn, and give back. . . (Participant 2)

This engagement fosters not only social connection but also reciprocity and a renewed sense of purpose.

Theme 3: Maintaining Core Identity and Values

This theme explores the strategies interviewees employ to navigate cultural and social differences between their homeland and the US, specifically focusing on the concerted effort to retain fundamental cultural, religious, and ethical values while simultaneously adapting to the new environment. Participants articulated a clear internal distinction between external adaptations (e.g., language, dress) and the preservation of their core identity.

One participant differentiated between necessary external changes and inner identity, grounding this preservation in ritual:

This country cannot change the person I am inside. My children may be more American than Polish, but I still wake up every morning and say my prayers in my language. That part, the core of who I am—my faith, my values—that is my own. That is the thing I keep safe, no matter what language I have to use to buy groceries. (Participants 6)

One participant explicitly affirmed the role of core belief systems in her stability, advising younger generations to prioritize internal continuity and gave a piece of advice to a young person: “stay true to yourself. . . If you have your basic identity, keep it. . .”

Another participant advocated for a balanced approach–selective assimilation. She stressed the importance of protecting one’s identity and values:

It’s important to maintain your identity, your value system, but at the same time you should assimilate. (Participant 5)

Another participant highlighted the effort required to prevent cultural erosion for future generations:

I insist my children celebrate the holidays the traditional way, not the easy way. We are not just tourists here; we are planting new roots, but we must bring our old seeds. (Participant 7)

Many participants noted the significant challenge of sustaining connections with friends and family in their home country due to evolving life “priorities” and a growing “disconnect.” This difficulty in maintaining transnational ties further reinforces the critical importance of actively preserving personal values and forming new communities in the US that align with these established ethical frameworks.

Discussion

This qualitative study sought to explore the lived experiences of older migrants in the United States, specifically focusing on how the concept of ambiguous loss, stemming from migration and the associated lack of closure, interacts with their psychological distress and well-being. The findings, structured around the three key themes of fluid identity, active engagement, and core value maintenance, provide rich empirical evidence that both supports and extends existing literature on aging migrants and health disparities.

The first theme, “The fluid nature of 'Home' and belonging,” captures the essence of ambiguous loss as it pertains to identity and belonging. Participants’ descriptions of being “half-and-half” or “neither 100% from their country of origin nor 100% American” directly reflect the lack of clear resolution or finality that defines this type of loss. This finding confirms the theoretical connection between migration and ambiguous loss, demonstrating that for older migrants, home is not merely a geographic location but a perpetually uncertain psychological construct. The inability to fully belong in either the host country or the homeland creates an inherent identity dissonance that aligns with the established psychological risk factors such as loneliness and depression.

The second theme, “Active engagement and social connection as a foundation for well-being,” highlights a crucial coping mechanism and resilience factor among this demographic. Participants’ deliberate choice to remain active, volunteer, and work contrasts sharply with their perception of retirement in their home countries. This proactive engagement acts as a protective factor against the psychological distress associated with ambiguous loss, such as loneliness and a loss of purpose. By building new social connections and finding renewed sense of purpose, they mitigate the negative health consequences often attributed to aging migrants, which are typically linked to psychosocial elements and isolation.

The final theme, “Maintaining core identity and values,” details the selective acculturation strategies employed by the older migrants. This process involves the external adaptation necessary for functioning in the US (e.g., language, daily routines) while vigilantly preserving internal core values, faith, and traditions. This distinction is vital for maintaining self-stability and preventing the psychological distress that arises from profound identity erosion. The efforts to maintain traditional practices and the advice to “stay true to yourself” underscore the participants’ understanding that while their physical lives have been radically transformed by migration, the continuity of their internal self is paramount to well-being. This successful preservation of internal coherence can be interpreted as a form of successful coping that counters the identity dissonance.

The findings strongly suggest that culturally responsive care for aging migrants must move beyond simply addressing physical health to incorporate a focus on psycho-social continuity and community building. The emphasis on active engagement and value preservation provides a clear direction for intervention, suggesting that programs focusing on meaningful volunteer opportunities, intergenerational cultural exchange, and supporting transnational ties (despite the challenges noted) could significantly enhance well-being and mitigate the effects of ambiguous loss.

The findings of this research underscore that culturally responsive care for aging migrants must transcend physical health to prioritize psycho-social continuity and community integration. Because older migrants often experience significant ambiguous loss centered on a disrupted sense of self and place, psychogerontological practices should focus on strategies that mitigate psychological distress through purposeful activity (Hawkins et al., 2022). Specifically, interventions should prioritize the creation of meaningful volunteer opportunities to foster a sense of being needed. As noted by participants, the feeling of being useful serves as a vital “medicine” against the isolation and decline often associated with retirement in a host country. Furthermore, psychogerontological frameworks should incorporate intergenerational cultural exchange to support identity preservation. Programs that facilitate the sharing of traditional values and oral histories allow older migrants to maintain their core identity while navigating the complexities of living in the United States. Finally, supporting transnational ties is essential for maintaining internal cultural continuity (Olcese et al., 2024). Despite the challenges of evolving life priorities, assisting migrants in preserving connections to their homeland helps manage the identity dissonance inherent in transnational lives and provides a foundation for stability during the aging process.

It is important to consider the limitations of this study. A key limitation is a small sample which may limit the generalizability of the findings across the diverse US migrant population. Future research should employ larger, more demographically varied samples and could benefit from longitudinal designs to track how the experience of ambiguous loss and coping strategies evolve over time in the host country. Furthermore, while our findings provide a foundation across diverse contexts, future studies would benefit from a more nuanced comparative analysis of specific ethnic cohorts. Such research could elucidate how the unique cultural and historical backgrounds of the country of origin, like those of Latin American or Arab migrants, specifically influence psychological adaptation to ambiguous loss.

In conclusion, this study reaffirms that migration represents a profound psychological challenge for older adults, yet it also reveals the powerful resilience strategies, specifically, the active construction of identity, purpose, and community that allow them to manage the ambiguous loss inherent in their transnational lives.