Factors associated with advance care planning among older women in Southwest Florida

As the nation's population continues to age, many older women will face care needs that can be anticipated in advance. However, little is known about the advance care plans of older women and the characteristics of those who plan. This study utilized a stratified random sampling design to survey older women (n = 124) in the state of Florida regarding their attitudes toward future care and planning behavior in social-environmental, health, and financial domains. Regression analyses were conducted to determine factors most predictive of attitudes toward future care and planning behavior by domain. Results suggest that advanced age predicts greater planning behavior, while living alone is associated with less advance care planning behavior. Other factors associated with less planning by domains of care needs include income status, chronic health conditions, educational attainment, and religious status. Nonaccepting attitudes toward planning were associated with a decreased likelihood to have advance care planning documents.     

Self-regulation in older Thai women with self-reported knee osteoarthritis: A path analysis

Abstract

This study aimed at testing factors influencing coping behavior and health status among older women with knee osteoarthritis. A total of 274 participants completed questionnaires. Model testing revealed that self-efficacy was the most powerful predictor of coping behavior. Illness representation had a significant direct and indirect effect on health status and was a better predictor of health status than were the other variables. Understanding the complex relationships among study variables should help to tailor future interventions to better address the symptoms of osteoarthritis and to promote optimal health in older Thai women who report knee osteoarthritis.     

Another country,another language and a new baby: A quantitative study of the postnatal experiences of migrant women in Australia

BackgroundGovernments and service providers have consistently acknowledged the importance of support for women and families in the transition to parenthood. Lower levels of satisfaction and concern about postnatal depression have highlighted women's needs at this time. Migrant women may also face relocation, distant family and support networks, language barriers and potentially discriminatory or culturally insensitive care.ObjectiveThe present study evaluates the unique contribution of migrant status, comparing the experience of this group to that of native-born English-speaking women.MethodSecondary analysis of data from a population-based survey of maternity care in Queensland. Experiences of 233 women born outside Australia who spoke another language at home were compared to 2722 Australian-born English-speaking women with adjustment for demographic differences.ResultsAfter adjustment, differences between the groups included physical, psychological aspects and perceptions of care. Women born outside Australia were less likely to report pain after birth was manageable, or rate overall postnatal physical health positively. They more frequently reported having painful stitches, distressing flashbacks and feeling depressed in the postnatal period. Few differences in ratings of care providers were found, however, women born outside Australia were less likely to feel involved in decisions and to understand their options for care. However, they were more likely to report being visited by a care provider at home after birth.ConclusionsThe findings represent an important addition to existing qualitative reports of the experiences of migrant women, reflecting poorer postnatal health, issues associated with migration and parenthood and highlighting areas for care improvement.     

Women,Aging, and Schizophrenia

SUMMARY

Schizophrenia is a psychiatric disorder of unknown etiology that typically has an onset in early adulthood and persists for the remainder of the life span. For most affected individuals, the illness is recurrent with psychotic symptoms that tend to be episodic in nature. The illness has pervasive and disruptive effects on many life domains; for example, women with schizophrenia are less likely to marry, bear children, and raise their own children than are women in the general population. The age of onset of schizophrenia is later on average in women than men, and women are overrepresented among those who develop the illness after the age of 45. Among younger patients with schizophrenia, women tend to have less severe symptoms than men and better outcomes; however, there are fewer gender differences among older patients with schizophrenia. Older women with schizophrenia are vulnerable to problems of both schizophrenia and aging. Schizophrenia symptoms typically continue in later years and include ongoing psychotic symptoms. Problems of aging such as cognitive decline and chronic medical conditions may be exacerbated by schizophrenia and the disorder is associated with premature mortality. Older women with schizophrenia are at risk for neglect of psychiatric and other health needs that are further compounded by limited social support and low socioeconomic status. More research and clinical attention is needed for the problems of older women with schizophrenia.     

Older Women on the U.S.-México Border: Exploring the Health of Hispanics and Non-Hispanic Whites

ABSTRACT

Research on ethnicity and socioeconomic status (SES) suggests that Hispanics are more likely than non-Hispanic Whites to experience poverty and low levels of education, which may relate to poorer health status. This study used a health survey to examine income, education, ethnicity, birthplace, and age on self-reported health factors of women age 60 and older on the U.S.-México border. Results show that income, age, and education were significantly associated with several health factors (Physical Health, Emotional Health, General Health, Energy Level, and Activity Potential). Older women with lower SES, regardless of ethnicity, reported poorer health than younger-old women with higher SES.     

Maternity waiting homes in times of crisis: Can current models meet women’s needs?

BackgroundMaternity waiting homes (MWHs) located close to birthing facilities are a conditional recommendation by the World Health Organisation, based on very low-quality evidence that they contribute to improvements in maternal or perinatal health outcomes. In addition, several studies suggest that more vulnerable women are less likely to use them. Yet significant investments continue to be made in building and running MWHs within conflict-affected and under-resourced health systems.AimsWe critically examine the literature to shed light on the challenges and opportunities provided by MWHs during health emergencies and in conflict situations.Findings and discussionMWHs are difficult to utilise during crises because they require women to be away from home, are often designed as dormitories, can lack security and be over-crowded. Some MWHs have been adapted during situations of political conflict to incorporate birthing and broader reproductive health care, thereby improving the availability of care away from over-burdened health facilities. How MWHs are adapted during times of crisis may provide insights into what systems of care are more appropriate in meeting women’s needs more broadly.ConclusionThe current global pandemic is an important time to reflect on whether MWHs are meeting the needs of a diverse range of women, in times of stability and during emergencies, and engage in genuine dialogue with women about the kinds of maternity care they want. We need to co-create those systems now so that they are more resilient during the inevitable crises we will face in the future.     

Disclosing Lesbian and Gay Male Sexual Orientation in Later Life: Attitudes of Younger and Older Generations in Eight Latin American Countries

ABSTRACT

The purpose of this research was to explore attitudes toward older lesbians and gay men disclosing their sexual preferences in eight Latin American countries. The sample consisted of 1,539 participants belonging to three age groups (18–29 years, 60–69 years, and 70 years and over). Their answers to two open-ended questions were content-analyzed, and binary logistic regressions were run on the extreme attitudinal categories. Results showed that although most attitudes were positive, a solid percentage of participants still expressed different kinds of derogatory attitudes. Men (as compared to women) and participants who were more religious and less educated tended to hold more negative attitudes toward lesbians and gay men. Both older samples were more prejudiced than the younger one, and attitudes also varied according to country. There was a general trend showing more positive attitudes toward older lesbians and gay men in those countries where sexual minorities’ rights are better assured, which suggests that measures to protect sexual minorities and to make sexual diversity in older age visible could be advisable.     

Older Women and the Health Care System: A Time for Change

SUMMARY

In spite of women's active involvement in a woman's health care movement, the mainline health care system continues to hold tight to its androcentric focus. If women are to be subjected to a health care system that employs sexist and ageist practices, the quality of life in their later years will continue to be jeopardized. The purpose of this paper is to first, recognize the existing health care practices which limit the health care opportunities and choices of older women; and secondly, to discuss how such basic feminist principles as education, egalitarianism, empowerment, and inclusion can be used to improve an older woman's experience.     

Working with Terminally Ill Older Women: Can a Feminist Perspective Add New Insight and Direction?

SUMMARY

While sexism and ageism in the health care system have been systematically documented, nowhere is the treatment of aging women more androcentric than in the care for the terminally ill. In fact, a terminally ill older woman is too often disadvantaged by a health care system which excludes her from decision-making and renders her powerless. In response, we propose a feminist approach to health care for terminally ill older women and argue that it is this approach which will not only put knowledge and power into the hands of women, but will change the fundamental ways in which women approach death.     

Care Arrangement Decisions for Frail Older Women: Quantitative and Qualitative Perspectives

ABSTRACT

This study uses both quantitative and qualitative methods to investigate how a range of care arrangement decisions for frail older unmarried women are made. Quantitative data from the 1989 National Long-Term Care Survey provides information concerning factors that predict the probability of five categories of care arrangements, including self only care, nursing home care, informal only care, formal only care, and a mix of formal and informal care. Qualitative interview data provides information on what occurs during care arrangement decision-making processes. Results are combined to explain the choice of care arrangements for a small sample of chronically disabled older unmarried women. Results show that need factors, such as age and disability, are strong predictors of the need for assistance. Family members played a central role in determining care arrangements and often helped an older woman to avoid an unwanted care arrangement. The use of a broad measure of impairment resulted in high levels of disability for the sample participants. Both disability status and care arrangements were transitory in nature.     

Perception of Aging and Ageism among Women in Qatar

The objective of this study was to find out the perceptions of age and aging among women in Qatar. Respondents consisted of 250 women aged between 20 and 70 years, selected from those attending the health centers in Doha city, the capital of Qatar. They were interviewed using a pretested validated questionnaire, and data were collected through direct face-to-face interviews using the incidental sampling method. It was found that physical appearance and mental alertness were the most important criteria for defining aging in men and women. A statistically significant association was found between age of respondents and physical criteria for aging such as hair color (p < .000) in women and body image in men (p < .0298). As for aging characteristics, decreasing hearing ability (p < .000), performance as before (p < .004), more irritability (p < .0227), ability to travel alone (p < .0429), needs check up (p < .001), and needs a geriatric home (p < .001) were statistically associated with age of women studied. Both positive (socializing factors, independence, housework, retirement, and geriatric care) and negative stereotyping (care for self, learning capabilities, irritability, and worries) with regard to aging were evident among the Qatari women. In general, Qatari women had several positive attitudes toward aging. Such attitudes could be utilized in any health promotion for elderly people.     

Hungarian Medical Students’ Knowledge About and Attitude Toward Homosexual,Bisexual, and Transsexual Individuals

ABSTRACT

Discrimination that LGBTQ individuals experience in health care settings might affect their health and intention of using health care services. However, health needs of LGBTQ patients are still inappropriately addressed in the medical curriculum. First-, third-, and fourth-year medical students (N = 569) from the four Hungarian medical universities participated in a study in 2017 to assess knowledge about homosexuality, homonegativity, and their attitude as health care professionals toward sexual minorities. We found that higher levels of knowledge about homosexuality were associated with lower levels of homonegativity, upper-grade level in university, not being religious, and having close LGBTQ acquaintances. Our results suggest that it may be necessary to introduce LGBTQ themes in the medical curricula (not only in Hungary, but also in other countries) in order to improve the knowledge and attitude of medical students and thereby improve the health care of LGBTQ individuals.     

Reasons for women's non-participation in follow-up screening after gestational diabetes

BackgroundDue to the increased risk of type 2 diabetes, follow-up screening after birth is recommended to women with previous gestational diabetes. Low participation in such screening has been shown to delay detection of diabetes with potentially serious consequences for the women's future health. The women's experiences of treatment and care during their pregnancies may affect participation.AimThis study aimed at understanding the women's experiences with treatment and care during pregnancy and to understand how these experiences influence participation in follow-up screening.MethodsA qualitative study was undertaken drawing on a phenomenological methodology. Seven women treated for gestational diabetes at a university hospital in the North Denmark Region participated in interviews.FindingsThe women experienced lack of continuity in care between hospital departments and health sectors. We identified the following causes for low participation in follow-up screening: poor coordination, little elaboration of information, a lack of clear coordination of responsibility for follow-up screening among health care professionals and absence of focus and inclusion of their individual needs and preferences.ConclusionThe women wished to be reminded of screening to increase their sense of safety. The women's experiences seem to reflect a lack of patient-centeredness during the pregnancy, which may be remedied by increasing the focus on the women's need for improved continuity in treatment and care. Participation in follow-up screening after gestational diabetes may be increased by sending reminders to the women. Raised awareness of the women's individual needs and preferences for treatment and care offers potential for improvement.     

Coffee intake,health-related quality of life,and associated factors of overactive bladder in older Korean women living in rural South Korea

ABSTRACT

Overactive bladder (OAB) is a common health problem in older women. The aim of the study was to investigate coffee consumption, health-related quality of life (HRQOL), and associated factors of OAB in older Korean women living in rural South Korea. A total of 248 women aged 65 years and older participated in this study. Chi-square tests, t-tests, and multivariable logistic regressions were performed. The means of coffee consumption between OAB and non-OAB groups were not significantly different. Women with OAB showed significantly lower HRQOL than women with stress urinary incontinence only. OAB was associated with high body mass index and poor health status.     

“Figuring Out Whether They Can Be Trusted”: Older Widows' Intentions Relative to Hired Non-Professional Home-Care Helpers

ABSTRACT

The purpose of this phenomenological study was to describe the experience of older women relative to trusting hired non-professional home-care helpers. Open-ended interviews were done about the home-care experience with 25 women over three years, and 14 women (age 80–93) shared data about hiring and trusting helpers. The women perceived risks to personal safety that adversely influenced willingness to seek new helpers. After hiring a helper, the women were still trying to discern whether the helper could be trusted. Primary-care providers should enable older women to recognize and reduce the risk of having helpers and to monitor helpers' behavior, as well as assessing the psychosocial status of women who have such helpers.     

Care Arrangement Choices for Older Widows: Decision Participants' Perspectives

SUMMARY

This research examines how a wide range of care arrangement decisions for frail older women are made. Interviews were conducted with 11 older women (ten of whom are widows), nine of their family members, and six professional service providers. Maintaining the older woman's independence was identified as a major theme. While all decision participants identified it as an explicit or implicit decision-making goal, their meanings of independence were different. The older women's meanings were flexible, changing in response to changes in their physical condition and need for assistance. Adult children tended to identify their mothers as independent when they did not actually need assistance, or when they received help from other sources (e.g., home health care). Professional service providers were inclined to define independence narrowly, as avoiding nursing home placement. Minor themes associated with independence include responsibility, reciprocity, and the family's importance in maintaining independence. These themes help to clarify the complex dynamics that take place during care arrangement decisions and explain how care arrangement choices are made.     

An emerging model of maternity care: Smartphone,midwife, doctor?

BackgroundMobile technology in the form of the smartphone is widely used, particularly in pregnancy and they are an increasing and influential source of information.AimTo describe the diverse nature of pregnancy related applications (apps) for the smartphone and to flag that these apps can potentially affect maternity care and should be considered in future planning of care provision.MethodsThe 2 smartphone platforms, Apple and Android, were searched for pregnancy related apps and reviewed for their purpose and popularity.FindingsiTunes and Google Play returned 1059 and 497 pregnancy related apps respectively. Forty percent of the apps were informative, 13% interactive, 19% had features of a medical tool and 11% were social media apps. By far the most popular apps, calculated as the number of reviews multiplied by average reviewer rating, were those with interactive features.DiscussionThe popularity of pregnancy-related apps could indicate a shift towards patient empowerment within maternity care provision. The traditional model of ‘shared maternity care’ needs to accommodate electronic devices into its functioning. Reliance on healthcare professionals may be reduced by the availability of interactive and personalised information delivered via a smartphone. This combined with the fact that smartphones are widely used by many women of childbearing age, has the potential to modify maternity care and experiences of pregnancy. Therefore it is important that healthcare professionals and policy-makers are more aware of these new developments, which are likely to influence healthcare and alter health-seeking behaviour. In addition healthcare professionals need to consider whether to discuss the use of apps in pregnancy with the women in their care.