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.     

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.     

Care arrangement decisions for frail older women: quantitative and qualitative perspectives

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.     

Perspectives of LGBTQ Older Adults on Aging in Place: A Qualitative Investigation

This qualitative study conducted by a community-research partnership used multiple types of data collection to examine variables relevant for LGBTQ older adults who wished to age in place in their urban Denver neighborhood. Focus groups, interviews, and a town hall meeting were used to identify barriers and supports to aging in place. Participants (N = 73) identified primarily as lesbian or gay, aged 50–69, and lived with a partner. Ageism, heterosexism, and cisgenderism emerged as cross-cutting themes that negatively impact access to health care, housing, social support, home assistance, and legal services. Resilience from weathering a lifetime of discrimination was identified as a strength to handle aging challenges. Recommendations for establishing an aging in place model included establishing welcoming communities and resource centers and increasing cultural competence of service providers. This study provides a unique contribution to understanding the psychosocial, medical, and legal barriers for successfully aging in place.     

Older Women Caring for Older Women: The Rewards and Challenges of the Home Care Aide Job

As our population ages, the need for personal assistance services increases. Paid personal care is predominantly provided by women, often older women, and has been considered low-status, low-wage work. This article reports on a mixed-method, longitudinal study of 261 home care aides; study participants were 46 years old, on average. Predictors of termination included younger age and lack of health insurance. Study participants reported more rewarding than challenging aspects to the job, though low and inconsistent compensation often forced them to leave the work they loved. Implications of the study with regard to older women caring for older women are explored.     

Personal meanings of occupation for women in later life: two women compared

Understanding the meaning of occupation for older women presents challenges to care providers because of the highly individual manner in which they enact those meanings. Two women interviewed in depth over a two-year period demonstrate the unique characteristics of activity patterns of older women, the meanings they ascribe to them, and the contribution of those activities to quality of life. The women were demographically similar, and described engaging in several common activity categories (connection to others, doing good, spiritual expression) that were particularly meaningful to them. The specific activities that they undertook were quite different. Findings suggest the importance of obtaining detailed information about older women in making plans for intervention to support desired activities in later life.     

Personal Meanings of Occupation for Women in Later Life: Two Women Compared

ABSTRACT

Understanding the meaning of occupation for older women presents challenges to care providers because of the highly individual manner in which they enact those meanings. Two women interviewed in depth over a two-year period demonstrate the unique characteristics of activity patterns of older women, the meanings they ascribe to them, and the contribution of those activities to quality of life. The women were demographically similar, and described engaging in several common activity categories (connection to others, doing good, spiritual expression) that were particularly meaningful to them. The specific activities that they undertook were quite different. Findings suggest the importance of obtaining detailed information about older women in making plans for intervention to support desired activities in later life.     

Combining vertical service with horizontal service to promote family planning]

How Bazhong County of Sechuan Province, China, carries out family planning through a combination of what are termed vertical and horizontal services is described. Vertical service refers to assistance such as premarital education, prenatal hygiene, child health care, and family planning, while horizontal service refers to household assistance for married women. Premarital education is designed to help young people acquire sufficent knowledge about family planning, hygiene, and eugenics, and stresses the disadvantages involved in marriages between close relatives. Prenatal hygiene provides safe and convenient medical accommodations for delivery of the child as well as maternal care. Child health services assure that the best facilities are to be made available for physical examinations, vaccinations, and medical treatment. The family planning program involves comprehensive measures such as distribution of contraceptives and safe sterilization. In addition, the county provides medical assistance for couples unable to have children. Horizontal service providing household assistance for married women promotes scientific farming (e.g., how to use fertilizer), helps people increase their income by teaching them skills, and provides social services to improve life style and education. These vertical and horizontal services have brought about substantial improvements in the standard of living, family harmony, and population control.     

Functional Health of Older Women:

Many elderly women need long-term care assistance to help them remain independent. A stresscoping framework was used to test predictors of functional health in a sample of 110 community- residing, older women. The causal relationships among hardiness, self-esteem, social support, stress, coping, and service utilization were examined. Results from the regression analyses indicated that 36% of the variance in physical and independent health was explained by hardiness, stress, coping, and service utilization and 52% of the variance in psychosocial health was explained by hardiness, selfesteem, stress, and coping. The discussion is orgaruzed according to the stress-coping paradigm and explicates the various relationships found.     

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.     

“I knew there has to be a better way”: Women’s pathways to freebirth in Poland

BackgroundEach year a small number of women decide to birth at home without midwifery and medical assistance despite the availability of maternity services in the country. This phenomenon is called freebirth and can be used as a lens to look into shortcomings of maternity care services.AimBy exploring women’s pathways to freebirth, this article aims to examine the larger context of maternity services in Poland and identify elements of care contributing to women’s decision to birth without midwifery and medical assistance.MethodsA qualitative methodology was used employing elements of ethnographic fieldwork, including digital ethnography. Semi-structured interviews with twelve women who freebirth, analysis of online support groups, secondary sources of information and elements of participant observation were used.FindingsWomen’s decisions to freebirth were born out of their previous negative experiences with maternity care. Persistent use of medical technology and lack of respect from maternity care providers played a major role in pushing women away from available Polish maternity services. While searching for a better environment for themselves and their babies for the subsequent births, women experienced a rigidity of both mainstream and homebirth services and patchy availability of the latter that contributed to their decisions to freebirth.ConclusionsFreebirth appears to be a consequence of inadequate maternity services both mainstream and homebirth rather than a preference. Women’s freebirth experiences can be used to improve maternity care in Poland and inform similar contexts globally.     

Unclaimed treasures:older women's reflections on lifelong singlehood

Ever-single, older women are a diverse group, whose experiences of singlehood have received little attention from researchers. In this qualitative study, eight women between the ages of 65 and 77 living in a mid-sized Southwestern Ontario city were interviewed about being ever single, including their perspectives of the benefits and drawbacks of this status at their current age. Data were collected in semi-structured interviews, and the constant comparative method was used for data analysis. Emergent themes illustrated how the women's stories of singlehood were affected by the sociopolitical contexts of their youth. Upon reflection, the women articulated the benefits of lifelong singlehood, strongly emphasizing their independence and "ability to be alone," which was viewed as very important as they aged. The drawbacks of singlehood focused on loneliness and the absence of a social support network, which took on particular importance as the women experienced increasing age and frailty. Overall, the participants expressed satisfaction with their marital status and defied common stereotypes about older, single women. Implications of these findings relate to the social structure of marital status and its impact upon the lives of women who remain single.     

De novo Families: Lesbian Motherhood

The aim of this recent Australian study was to explore the experiences of lesbian women choosing motherhood. Participants included 30 self-identifying lesbian mothers. Data were collected via interviews, data collection sheets, and online journaling. The interview and journaling data were analyzed using constant comparative analysis and subsequently illuminated three main themes: becoming mothers, constructing motherhood, and legitimizing our family. These papers described the journey to motherhood and specifically explored the various methods of conception and other decisions that participants made when planning their family, the challenge of heteronormativity in health care, and legitimizing the role of the non-birth mother in de novo families. This article aims to present the participants’ experiences of motherhood that was a constant topic found woven throughout all three of the identified themes. Participants identified that they had a unique opportunity to create their own mothering roles in the absence of significant “lesbian mother” role models and that they were able to adjust and to adapt their roles depending on fluctuating circumstances.     

Treatment decision-making among older women with breast cancer

This study examined breast cancer treatment decision-making among older adults, including professional and lay involvement. Thirty respondents were interviewed for this study; cancer survivors (70%) and newly diagnosed (30%) women with breast cancer. Respondents reported making treatment decisions in consultation with their oncologists. However, women differed on the extent to which they perceived their participation in the treatment process. Respondents' oncologists appear to be the primary factor associated with older women's breast cancer surveillance decision-making and adherence. The influence of women's support systems on their treatment decisions and surveillance activities appears to be minimal. Informal support systems, however, likely enhance women's ability to be active participants in their care. The growing need for interventions which target older women has been indicated. Interventions, however, cannot be adequately developed without first identifying the physical and psychosocial phenomena which affect decision-making.     

Caregiving and Care-Receiving:

Many aspects of aging are women's issues. Yet research on aging has, until recently, focussed little attention of gender differences in the experience of growing old. Older women are more likely than older men to be poor, widowed, living alone in poor health, receiving assistance from both formal and informal supports, as well as being institutionalized in long-term care facilities. This secondary analysis of data from the 1982 Survey of the Elderly in the Waterloo Region attempts to address a gap in our knowledge concerning gender differences in the giving and receiving of social support in later years. Gender differences in (1) need for social support, (2) turning to formal assistance, (3) amount of formal assistance used, and (4) amount of informal assistance received were examined using analysis of variance and logistic regression procedures. The profile of social support that emerged suggests both similarities and differences in the way elderly men and women experience the giving and receiving of social support. Older women in this sample were found to be disadvantaged in the areas of income, health, years lived alone, and loneliness, relative to older men. Low-income was related to formal service use for older women, but not for older     

“You’re a ‘high-risk’ customer”: A qualitative study of women’s experiences of receiving information from health professionals regarding health problems or complications in pregnancy

BackgroundExperiencing complications in pregnancy is stressful for women and can impact on fetal and maternal outcomes. Supportive encounters with health professionals can reduce the worry women experience. Further research is needed to understand women’s perspectives on communicating with their healthcare providers about their concerns.AimThis study explored women’s experiences of receiving information about pregnancy complications from healthcare providers and their interactions with multiple professionals and services during pregnancy.MethodsThis was a qualitative interpretive study. Semi-structured interviews were conducted with 20 women experiencing pregnancy complications recruited from antenatal services at two hospitals in Sydney. Inductive thematic analysis was used to analyse the data.FindingsWomen had a range of reactions to their diagnoses, including concern for their baby, for themselves and for their labour. Most women reported that communication with healthcare providers was distressing, they were not listened to and staff used insensitive, abrupt language. Women were also distressed by delays in education, receiving contradictory information and having to repeatedly share their stories with different health professionals. In some cases, this damaged the therapeutic relationship and reduced trust towards healthcare providers. Midwives were generally preferred over doctors because they had a more woman-centred approach.ConclusionTo improve women’s experiences of care for pregnancy complications, it is critical to improve the communication skills of maternity service providers. Women’s need for information, resources and support can best be provided by continuity of care with a named health professional, for example, a midwife working within an integrated multidisciplinary antenatal service model.     

Returns on Lifetime Investments in Children in Egypt

Parental expectations about the companionship and assistance they will receive in later life from their children are key considerations in family formation decisions. We explore patterns of parents’ investment and the support and contact they receive from adult children in Egypt, where fertility is falling and sources of support at all life stages are in flux. Using data from a survey of older adults in Ismailia governorate, we consider parents’ past investments in childbearing, child survival, and children’s education and marriage, as well as recent assistance to adult children via housing, care for grandchildren, gifts, and money. The returns from children considered include economic assistance, instrumental support, and visits. Most parental investments are associated with frequent visits from children. The assistance children provide to parents is gendered: sons tend to provide economic transfers, whereas daughters tend to provide instrumental help. A greater number of surviving children is most strongly associated with parents’ receipt of multiple types of later-life returns. Investments in children’s education and marriage are not associated with assistance, but recent assistance to children—especially economic transfers and provision of housing—is associated with receiving instrumental assistance from adult children.