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.     

Older Women,Their Children,and Grandchildren: A Feminist Perspective on Family Relationships

SUMMARY

Using gerontological and feminist frameworks, we explored the relationships older women have with their children and grandchildren. In-depth, qualitative interviews were conducted with 34 women, ranging in age from 55 to 88. From our analyses of the women's perceptions of their family relationships, two themes were prevalent: the centrality of children and the peripherality of grandchildren in their everyday lives. The women had varying degrees of involvement with their children and grandchildren, and these relationships contributed to their sense of self and family. Their relationships were not stagnant, but were continually reshaped as both the women and their family members proceeded through the life course.     

Promoting Older Women's Health and Well-Being Through Social Leisure Environments: What We Have Learned from the Red Hat Society®

ABSTRACT

The purpose of this study was to describe the ways that participation in a leisure organization contributed to the health and well-being of middle-aged and older women. We analyzed 1,693 members' responses to a query about meaningful experiences garnered through participation in the Red Hat Society®. Results suggested that older women's lives have been enriched and changed by their experiences, with the women in this study citing multiple psychosocial health benefits from their participation in the Red Hat Society®. Main themes encapsulating these health benefits were creating happy moments, responding to transitions and negative events, and enhancing the self. These findings are related to research on positive psychology, social support and coping, transformative leisure processes, and social identity formation. We conclude by providing suggestions for applying these findings to leisure and health promotion programming to enhance women's health and well-being in later life.     

Determinants of Engagement in Paid Work Following Social Security Benefit Receipt Among Older Women

ABSTRACT

Work behavior among older men approaching or following retirement has received considerable research attention over the past two decades, but research on older women's work behavior is still in its incipient stage. Based on data from the 1982 New Beneficiary Survey (NBS) and the 1991 New Beneficiary Follow-up (NBF), this study analyzes the extent and determinants of employment among women who received their first Social Security benefits between 1980 and 1981. More than one fourth of the women continued to work or rejoined the labor force following their first Social Security benefit receipt. Financial need was found to be the primary reason for and the most significant determinant of women's continuing work or (re)entry into the labor force. But the level of education, health, spouse's work status, and previous work history were also found to be significant determinants of the likelihood and duration of their employment following Social Security receipt.     

Women's frequency of alcohol consumption prior to pregnancy and at their pregnancy-booking visit 2001–2006: A cohort study

BackgroundWith evidence of offspring harms and concern for younger women's drinking behaviours, this study uses a hospital cohort to trend the use and changes in women's reported alcohol consumption.AimsTo examine (i) the trend of women's reported alcohol consumption over time, (ii) whether any increases in the frequency of alcohol consumption prior to a pregnancy are accompanied by increases in the frequency of alcohol consumption in pregnancy and (iii) the characteristics of women consuming alcohol at these times.MethodsMidwives collected routine data on 19,699 women between 2001 and 2006. Data on women's alcohol use prior to pregnancy and at their pregnancy-booking visit were analysed using a non-parametric test for trend and with bivariate and multivariate tests adjusting for possible confounders.FindingsThe proportion of women reporting at-least weekly alcohol use prior to pregnancy was 25.4% and 5.9% at their pregnancy-booking visit. A significant linear increase over time (p < 0.001) was found in the rate of women aged 20 years and older reporting at-least weekly alcohol use prior to pregnancy. Tertiary-educated women were more likely to consume alcohol at-least weekly prior to pregnancy. Women aged less than 20 years were less likely to report at-least weekly alcohol use at both time points. Having more children and Asian ethnicity were associated with a lower risk of at-least weekly alcohol use at these times.ConclusionThe majority of women reduce their alcohol consumption once they learn they are pregnant, with some evidence this trend may have increased in recent years.     

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.     

Who decides the position for birth? A follow-up study of a randomised controlled trial

BackgroundPhysical benefits are suggested for women and their babies when women adopt an upright position of their choice at birth. Available care options during labour influence women's impressions of what intrapartum care is. This indicates that choice of birth positions may be determined more by midwives than by women's preferences.QuestionThe aims of this study were to investigate factors associated with adherence to allocated birth position and also to investigate factors associated with decision-making for birth position.MethodAn invitation to answer an on-line questionnaire was mailed.FindingsDespite being randomised, women who gave birth on the seat were statistically significantly more likely to report that they participated in decision-making and that they took the opportunity to choose their preferred birth position. They also reported statistically significantly more often than non-adherers that they felt powerful, protected and self-confident.ConclusionsMidwives should be conscious of the potential impact that birth positions have on women's birth experiences and on maternal outcomes. Midwives should encourage women's autonomy by giving unbiased information about the birth seat. An upright birth position may lead to greater childbirth satisfaction. Women's experience of and preferences for birth positions are consistent with current evidence for best practice.     

Women and Retirement

SUMMARY

A feminist analysis of retirement is presented by questioning the applicability of traditional definitions and theories of retirement to retired women. The effects of marriage, caregiving and other family obligations on women's retirement are examined within the context of salient social, psychological and economic factors. An empowerment-oriented perspective that considers interactions and connections between family and work roles, public and private and personal and political levels are recommended to alleviate the high poverty rates among older women, to promote parity among men and women during retirement and to emancipate women from substantial involvement in unpaid work, specifically, caregiving and home labor.     

Unanticipated Consequences: A Comparison of Expected and Actual Retirement Timing Among Older Women

ABSTRACT

The present study adds to the growing body of literature on women and retirement by means of a comparative analysis of the factors associated with anticipated retirement timing (among pre-retirees) and actual retirement timing (among retirees). Adopting a political economy of aging perspective, we argue that socially-structured patterns of gender inequality related to women's multiple roles across the life course affect patterns of retirement timing. Specifically, we hypothesize that the gendered nature of women's work-retirement decision-making is unanticipated during pre-retirement years. Logistic regression analyses are performed on data drawn from a sample of 275 women aged 45 and older living in the Vancouver area of British Columbia. A central finding is that while actual timing of retirement is affected by family caregiving responsibilities and by health/stress factors, pre-retirees do not perceive these to be important in their own expected retirement timing. Implications for social policy, education, and women's financial and psychological well-being in old age are elaborated.     

When it hurts I think: Now the baby dies. Risk perceptions of physical activity during pregnancy

BackgroundA decrease in the level of physical activity from pre-pregnancy to pregnancy seems to be a general problem, despite the obvious health benefits of physical activity. Quantitative studies indicate that pregnant women's fears might explain why they reduce their level of physical activity, but still no qualitative research has investigated the experiences influencing these women.QuestionTo explore healthy women's perceptions of risk associated with physical activity during pregnancy.MethodAn interpretive narrative approach was used to gain insight into pregnant women's personal stories and lived experiences. Five Danish pregnant women aged 26–36 years participated in semi-structured, in-depth interviews between September and December 2010. The analysis method was based on two types of narrative inquiry: (1) a narrative analysis to cover the story, and (2) a paradigmatic analysis to cover the themes.FindingsMost of the pregnancy stories highlighted a specific experience, which made the women anxious. These experiences were: previous miscarriages, fertility treatment and shortened cervix. Also bodily challenges and pain scared the women, such as hypertonic pelvic muscles, Braxton Hicks contractions, abdominal pain, exhaustion, and shortness of breath. The stories also described the impacts of women's relatives and friends on their perceptions of risk.ConclusionSpecial consideration should be given to pregnant women who have had negative experiences in previous pregnancies and bodily challenges, which make them anxious and discourage them from being physically active. Healthcare professionals could also pay attention to the fact that women's relatives and friends play a major role in women's perceptions of risk.     

Women's use of complementary and alternative medicine in pregnancy: A search for holistic wellbeing

BackgroundA number of studies have found increased use of complementary and alternative medicine (CAM) during pregnancy and birth. However, little is known about women's motivation in seeking CAM during pregnancy or their experiences of use in relation to their pregnancy and childbirth journey.MethodsA narrative study sought to explore the meaning and significance of CAM use in pregnancy from the perspective of CAM users. Narrative style interviews were conducted with 14 women who had used a range of CAMs during pregnancy and birth. Data analysis focussed on the meaning and significance of CAM use in pregnancy and a number of core themes emerged.FindingsThis paper focusses on the theme which illustrates the meaning behind women's use of CAM in pregnancy and childbirth as one of seeking holistic wellbeing.ConclusionParticipants engaged with CAM as a way of fulfilling their physical, emotional and spiritual needs during pregnancy. Use of CAM signified women's desire to be proactive in health seeking behaviours.     

Does antenatal education affect labour and birth? A structured review of the literature

ObjectiveTo undertake a structured review of the literature to determine the effect of antenatal education on labour and birth, particularly normal birth.MethodOvid Medline, CINAHL, Cochrane and Web of Knowledge databases were searched to identify research articles published in English from 2000 to 2012, using specified search terms in a variety of combinations. All articles included in this structured review were assessed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).FindingsThe labour and birthing effects on women attending antenatal education may include less false labour admissions, more partner involvement, less anxiety but more labour interventions.ConclusionThis literature review has identified that antenatal education may have some positive effects on women's labour and birth including less false labour admissions, less anxiety and more partner involvement. There may also be some negative effects. Several studies found increased labour and birth interventions such as induction of labour and epidural use. There is contradictory evidence on the effect of antenatal education on mode of birth. More research is required to explore the impact of antenatal education on women's birthing outcomes.     

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.     

Nausea and vomiting in pregnancy: Blooming or bloomin’ awful? A review of the literature

BackgroundNausea and vomiting in pregnancy (NVP) is a normal, commonly experienced affliction of early pregnancy. Despite this, its impact on women's lives is not necessarily minimal. For some women, the implications of NVP are substantial with multi-faceted effects, hindering their ability to maintain usual life activities, and particularly their ability to work. In an effort to understand the effect of NVP, several researchers have developed NVP measurement tools, which enable an understanding of NVP's effect on quality of life (QOL).ProblemThis paper seeks to provide a review of the literature to explore the impact of NVP on women's quality of life, particularly their ability to maintain social and professional commitments.MethodMedline, CINAHL, PsychINFO, Ebsco, Science Direct, Health Source, Academic Search Premiere, Cochrane databases were extensively searched using Boolean operators with various combinations of relevant terms: nausea, vomiting, pregnancy, emesis, quality of life, QOL, NVPQOL, PUQE, SF-12, SF-36 and limited to those published from 1999 onwards. Papers were scrutinised to include those discussing the impact of normal NVP on women's lives, particularly their QOL with careful exclusion of those addressing hyperemesis gravidarum (HG).FindingsNVP has a significant effect on women's QOL and therefore their ability to maintain day-to-day activities as well as work capacity. This has implications for the woman, her partner, her family and her employers.ConclusionIt is important that all maternity care workers consider the impact of NVP on the woman's QOL and that care is given not to minimise this experience. Further research is warranted which considers ways in which women can best manage this experience in relation to social and professional commitments. Given the authors were able to identify only one Australian study in this area, published in 2000 and utilising non-NVP specific QOL measurement tools, there exists scope for additional local studies using NVP-specific QOL tools to determine the impact of QOL for Australian women and therefore Australian society.     

The Red Hat Society®: Exploring the Role of Play,Liminality, and Communitas in Older Women's Lives

ABSTRACT

There is an extensive literature on play. Yet, the role of play in older adults' lives has received limited attention. Strikingly absent is research on play and older women. Missing from the literature is how older women use play as a liminal context for social interaction and communitas. This is odd because by 2030 one in four American women will be over the age of sixty-five. The primary purpose of this study is to explore the roles of play, liminality, and communitas in older women's lives. The focus is the Red Hat Society®, a social group for women over age 50 that fosters play and fun. Using qualitative interviews with focus groups and participant observation of a regional Red Hat Society® event, the study highlights some of the strengths and weaknesses of current conceptualizations of play, liminality, and communitas.     

Women's access needs in maternity care in rural Tasmania,Australia: A mixed methods study

ObjectivesThis study investigates (i) maternity care access issues in rural Tasmania, (ii) rural women's challenges in accessing maternity services and (iii) rural women's access needs in maternity services.MethodsA mixed-method approach using a survey and semi-structured interviews was conducted. The survey explored women's views of rural maternity services from antenatal to postnatal care, while interviews reinforced the survey results and provided insights into the access issues and needs of women in maternity care.FindingsThe survey was completed by n = 210 women, with a response rate of 35%, with n = 22 follow-up interviews being conducted. The survey indicated the majority of rural women believed antenatal education and check-ups and postnatal check-ups should be provided locally. The majority of women surveyed also believed in the importance of having a maternity unit in the local hospital, which was further iterated and clarified within the interviews. Three main themes emerged from the interview data, namely (i) lack of access to maternity services, (ii) difficulties in accessing maternity services, and (iii) rural women's access needs.ConclusionThe study suggested that women's access needs are not fully met in some rural areas of Tasmania. Rural women face many challenges when accessing maternity services, including financial burden and risk of labouring en route. The study supports the claim that the closure of rural maternity units shifts cost and risk from the health care system to rural women and their families.     

Older Women's Body Image and Embodied Experience: An Exploration

ABSTRACT

This paper presents and analyzes findings from unstructured interviews with women aged 61 to 92 regarding their perceptions and feelings about their aging bodies. The data are discussed in light of the existing literature on women's body image which has largely ignored the experiences of women in later life and which has tended to focus on adolescent and middle-aged women. Given the fact that beauty is equated with youthfulness and thinness in our society, older women face unique challenges as they strive to construct and maintain positive evaluations of self. The women in the study exhibit the internalization of ageist beauty norms even as they assert that health is more important to them than physical attractiveness and comment on the ‘naturalness’ of the aging process.     

Measuring women's experiences of maternity care: A systematic review of self-report survey instruments

BackgroundRecognition of the measurement of women's experiences of their maternity care as a critical component of care quality evaluation has led to a proliferation of instruments to measure this concept. However, the suboptimal methodological and psychometric quality of these instruments, or the lack of reporting of same, hinders the credibility and efficient use of the arising results, which often serve as an indicator for the direction of limited resources within maternity services.AimTo review systematically and critically appraise self-report survey instruments measuring women's experiences of their maternity care.MethodsA systematic review was conducted using comprehensive searches of the CINAHL, OVID MEDLINE and EMBASE citation databases. Inclusion and exclusion criteria were applied, and a stepped approach employed to facilitate evaluation of the methodological and psychometric quality of included instruments.Findings4905 records were obtained from database searches. Additional records were obtained via reference checking and by expert suggestion. Following stepped screening, 40 papers related to 20 instruments are included in this review. Findings indicate that evidence of the methodological and psychometric quality have not been reported for many included instruments.ConclusionsPublished evidence of the methodological and psychometric quality of self-report survey instruments to evaluate women's experiences of their maternity care is lacking. The conduct and reporting of future development processes of such instruments can be improved.Systematic review PROSPERO registration: CRD42018105325.