Changing cultural and social environments: implications for older East Asian women

The world is aging and the trend is towards a global feminization of aging. In the Asia Pacific region, which already contains approximately 50% of the world's population over age 60, the number of older women exceeds that of older men in most countries. This article explores the changes that are occurring in East Asian social and cultural traditions for aging and discusses the implications of those changes for women who aged in that culture. In the traditional culture, Chinese, Japanese, and Korean families are influenced by values of family centrality and collective orientation to life that are mostly rooted in Confucian values and ethics. In those traditions, older women assume and maintain a valued status within the family and community through respected roles and productive contributions. However, various factors, such as migration to urban areas and demographic shifts, have precipitated modernization of these societies and alterations of traditional culture. These cultural shifts are relevant to the United States where, according to the 2000 U.S. Census, 71.0% of Asian and Pacific Islander-Americans over the age 65 are foreign-born. Immigration can prompt an immediate cultural shift and create a fast forward insight into the slower cultural evolution currently occurring in East Asian societies.     

Geographic variation in preventable hospitalization of older women and men: implications for access to primary health care

This study demonstrates how readily available data and small area analysis can be used to identify potential problems of access to primary care services for older women and men. Gender and socioeconomic differences in rates of preventable hospitalization are examined. Using hospital discharge data, five county and twenty-four intra-county areas in Upstate New York are studied. There is significant variation in preventable hospitalization within counties. Areas having significantly higher rates of these hospitalizations tend to have higher rates for both women and men. Problems of access are associated with lower income areas for women and men.     

Determinants of engagement in paid work following social security benefit receipt among older women

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.     

Alternative therapies and empowerment of older women

There has been a striking increase in Americans' awareness and use of alternative therapies over the last decade. Women, in particular, have been drawn to explore these unconventional health practices, which include herbal medicine, acupuncture, homeopathy, manual therapies, energy healing, and mind-body therapies. From a feminist perspective, the rise in alternative therapies' use in the United States represents a shift in cultural concepts of health from an out-moded patriarchical model which disempowers older women, to a more feminine, holistic model which can reempower older women. Throughout history, older women have developed, applied, and taught the principles and practices of what are now considered alternative healing modalities, in their roles as mothers, expert herbalists, midwives, wise women, and shaman. By becoming familiar with these therapies, older women can increase their control over their health, enhance prevention and self-care, and enjoy a health-care pathway that leads to wholeness in body, mind, and spirit.     

Global patterns of healthy life expectancy for older women

This paper focuses on patterns of healthy life expectancy for older women around the globe in the year 2000, and on the determinants of differences in disease and injury for older ages. Our study uses data from the World Health Organization for women and men in 191 countries. These data include a summary measure of population health, healthy life expectancy (HALE), which measures the number of years of life expected to be lived in good health, and a complementary measure of the loss of health (disability-adjusted life years or DALYs) due to a comprehensive set of disease and injury causes. We examine two topics in detail: (1) cross-national patterns of female-male differences in healthy life expectancy at age 60; and (2) identification of the major injury and disability causes of disability in women at older ages. Globally, the male-female gap is lower for HALE than for total life expectancy. The sex gap is highest for Russia (10.0 years) and lowest in North Africa and the Middle East, where males and females have similar levels of healthy life expectancy, and in some cases, females have lower levels of healthy life expectancy. We discuss the implications of the findings for international health policy.     

Woman to Woman (W2W): Adapting an HIV risk reduction intervention for older women

Woman to Woman (W2W) is a novel adaptation of the Sisters Informing Sisters about Topics on AIDS (SISTA) HIV prevention program. This article describes the process of adapting and piloting W2W based on recommendations from existing HIV prevention research. Six older women, all of whom had histories of homelessness and the majority of whom identified as African American, enrolled in the study, which piloted the adapted intervention and materials, evaluated the acceptability of the program, and assessed the measures related to the intervention. Participants described satisfaction with the program and had high rates of attendance; observations regarding the measures suggest the need to further develop assessments of HIV knowledge, condom use self-efficacy, and risk behaviors in this context.     

Perceived neighborhood social disorder as a predictor of depressive symptoms among unmarried older women and the stress-buffering effect of friends support

ABSTRACT

The current study examined whether perceived neighborhood social disorder predicted depressive symptoms among unmarried older women (N = 823) drawn from the 2016 Health and Retirement Study. This study also tested the stress-buffering effect of friends support. A negative binomial regression model showed that higher perceived neighborhood social disorder was associated with higher depressive symptoms. The number of close friends was a significant factor, but no stress-buffering effect of friends support was identified. This study highlights the adverse effect of negative perceptions of the neighborhood social environment on unmarried older women’s depressive symptoms.     

The importance of fairness and equity for the marital satisfaction of older women

In all societies, people are concerned with social justice. "It's just not right" is a fairly common lament. In these two studies, we interviewed 240 older women, who ranged in age from 50 to 82. We found that most older women (85%) considered their marriages to be fair and equitable. Older women were less concerned about existing inequities than their younger peers. Nonetheless, they were somewhat concerned with how rewarding and how fair and equitable their relationships were perceived to be. Those who felt over-benefited, for example, felt more guilty than did their less advantaged peers; those who felt under-benefited felt far more angry than did their privileged peers. Stressful life events--such as the arrival of children, retirement, serious illness, or the awareness impending death--often brought to awareness long simmering resentments over issues of fairness.     

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.     

"Life without line dancing and the other activities would be too dreadful to imagine": an increase in social activity for older women

The literature on aging is replete with the positive effects of physical exercise on the well-being of older adults. Some suggest, however, that the potential impact of social activities has not received adequate attention, and others note the importance of distinguishing between the physical and nonphysical impact of these activities. This study investigated whether line dancing, a physical activity, led to an increase in social activity. Thirty women over the age of 60 were interviewed to discover how line dancing affected them. Content analysis of the interviews helped identify various themes indicating that line dancing enabled these women to expand their repertoire of social activity, leading to positive reinforcements such as further community involvement, charitable work, inclusion in national sports events, self-expression, and personal development. The impact of line dancing plainly goes beyond the perceived physical benefits.     

Disability among older women and men in Fiji: concerns for the future

This study examines the composition of elderly population at risk of disability and speculates the impact of disability on the quality of their lives and their longevity. Using census and survey data collected in Fiji, life table estimates of unimpaired life expectancy across time are presented for older people and the potential costs of disability, in terms of productive years of life lost. From a planning perspective, the study discusses medical and support services that may be needed to support older individuals in Fiji. The study also describes policy implications of the findings, focusing on the older women, and considers the implications for older women of other developing countries.     

Strengthening resources for midlife and older rural women who experience intimate partner violence

ABSTRACT

Little is known about midlife and older women who experience intimate partner violence living in rural places and their resource needs. Guided by a strengths perspective, we provided insights into resources that midlife and older women use, or would like to use, in their journey in leaving an abusive partner. Eight women who had left an abusive partner participated in a face-to-face interview. They drew on a wide variety of paid and unpaid resources, while each woman had a unique set of resources that contributed to her being able to make such a significant life transition. It is clear that we need to have a variety of formal and informal resources available to older women experiencing intimate partner violence (IPV) in rural places, and new forms of resources need to be developed. Our results also indicate that increased efforts are needed in improving both public and professional education regarding older rural women and IPV.     

Meaning of housework and other unpaid responsibilities among older women

This study explores the meaning and conditions of housework and other unpaid responsibilities for older women. Taped, in-person interviews were conducted with 53 ethnically and economically diverse women, 55-84 years old. The interview guide contained open-ended questions regarding the process of taking on housework and other unpaid responsibilities and the centrality to personal identity. Participants reported shifts in perceptions of housework as work, decreased importance of housework with age, the attitude of care recipients affecting the experience and meaning of unpaid responsibilities, and the impact of historical racist events on viewing unpaid responsibilities as opportunity.     

Challenging social myths and stereotypes of women and aging: heterosexual women talk about sex

Cultural representations of aging and sexuality combine to paint a particular picture of mid and later life for women: menopause is constructed as a time when women either lose or renew their interest in sex, and later life a time when sexual activity no longer assumes importance yet remains vital to healthy aging. This article examines the importance of sexual activity to "older" women, paying particular attention to how they negotiate such representations. In-depth interviews were conducted with 19 women aged 50 and older recruited from Sheffield, UK. A material-discursive analysis revealed that whilst participants rejected the asexual discourse of aging they accepted it for women older than themselves. They constructed women per se as sexually complex, in comparison to men, making sexual activity "risky business" for women, and positioned their own sexual desire as responsive, either to a man's sexual desire or to their own hormones. Finally, sexual activity was constructed as having psychological and physiological benefits for couples within committed relationships. The findings are discussed in terms of their implications for research, theory and clinical practice.     

Labor market structure and fertility differences among Puerto Rican women: The effects of economic and social policies on opportunity costs

The oft-observed inverse relationship between economic activity in the formal or informal sector and levels of fertility is attributed to the opportunity costs of reproduction. The economic and social policies that initiate and maintain the substantial flow of federal transfer payments to the Puerto Rican population is likely to reduce the opportunity costs among women participating in the informal economy; therefore, informal labor market participants will have fertility levels more like women who have never worked than like women active in the formal labor market. Using data from the 1982 Puerto Rican Fertility and Family Planning Assessment, this paper compares fertility differentials among ever-married women who have never worked, who have ever worked in the informal economy, and who have only worked in the formal economy. Contrary to expectations, the fertility levels of informal labor market participants are more like those of formal labor market participants; economic activity in either sector is associated with bearing fewer children. Federal transfer payments do not appear to reduce the opportunity costs of reproduction among women employed in the informal economy. An earlier version of this paper was presented at the 1989 meeting of the Population Association of America.     

Patterns of active life among older women: differences within and between groups

This study examines the distribution of total, unimpaired, and impaired life for several groups of older women defined by race, education, and marital history. Using data from the 1984-1990 Longitudinal Study of Aging, we model transitions among functional statuses using discrete-time Markov chains, and use microsimulation to produce summary indices of active life. Remaining years of life and the proportion of remaining years with disability vary substantially, both within each group of women studied and between pairs of groups. Of all groups studied, never-married, more-educated white women live the longest, healthiest lives. Ever-married nonwhite women with low education have the shortest life expectancy, and experience the most disability. Our findings show that life expectancy is an incomplete indicator of the time women, in particular sub-groups, can expect to live with and without impairment. These findings highlight the heterogeneity of disability processes and life expectancy for older women.     

Intrapartum cardiotocograph monitoring and perinatal outcomes for women at risk: Literature review

ProblemCaesarean section rates have risen in high-income countries. One of the potential drivers for this is the widespread use of CTG monitoring.BackgroundIntrapartum cardiotocograph monitoring is considered to be indicated for women at risk for poor perinatal outcome.AimThis systematic literature review with meta-analysis examined randomised controlled trials and non-experimental research to determine whether cardiotocograph monitoring rather than intermittent auscultation during labour was associated with changes in perinatal mortality or cerebral palsy rates for high-risk women.MethodsA systematic search for research published up to 2019 was conducted using PubMed, CINAHL, Cochrane, and Web of Science databases. Non-experimental and randomised controlled trial research in populations of women at risk which compared intrapartum cardiotocography with intermittent auscultation and reported on stillbirth, neonatal mortality, perinatal mortality and/or cerebral palsy were included. Relative risks were calculated from extracted data, and meta-analysis of randomised controlled trials was undertaken.FindingsNine randomised controlled trials and 26 non-experimental studies were included. Meta-analysis of pooled data from RCTs in mixed- and high-risk populations found no statistically significant differences in perinatal mortality rates. The majority of non-experimental research was at critical risk of bias and should not be relied on to inform practice. Cardiotocograph monitoring during preterm labour was associated with a higher incidence of cerebral palsy.DiscussionResearch evidence failed to demonstrate perinatal benefits from intrapartum cardiotocograph monitoring for women at risk for poor perinatal outcome.ConclusionThere is an urgent need for well-designed research to consider whether intrapartum cardiotocograph monitoring provides benefits.     

Health profiles and profile-specific health expectancies of older women and men: The Netherlands

This study focuses on gender differences in health profiles, and examines which health profiles drive gender differences in remaining life expectancy in women and men aged 65 and over in The Netherlands. Data from the first two cycles of the Longitudinal Aging Study Amsterdam (n = 2,141 and 1,659, respectively) were used to calculate health profiles for individuals of 65-85 years. For both women and men, six profiles were found: I. cancer; II. "other" chronic diseases; III. cognitive impairment; IV. frailty or multimorbidity; V. cardiovascular diseases; and VI. good health. The further characterization of these types showed some gender differences. Remaining life expectancy for women was greater than for men in each health profile. A decomposition into health expectancies showed that both women and men could expect to live about 5 years in good health from age 66. The greatest gender differences in years spent with health problems were found for profile IV and for profile III. Their greater number of years spent in these health states have direct consequences for the type and cost of care women need.     

The development of social statistics and indicators on the status of women

In developing social statistics and indicators on the status of women, three requirements must be satisfied. First, existing measures of prevalent demographic, socio-economic, and socio-cultural conditions must be more fully utilized. Second, some improvements in these measures, together with certain new measures and data sets are needed. Finally, agreed standards of comparison for gauging the relative status of women must be established. In each of the above subject-areas, some widely available statistics and derived measures are examined with respect to their adequacy for describing women's living conditions and assessing their status. Proposals are then offered for additional measures and new data collection efforts designed to reduce the deficiencies or gaps in existing data and provide a sounder basis for assessing the status of women in different societies.