Introduction: the need to address older women's mental health issues

Women are the primary consumers of mental health services. Ironically, research addressing their unique needs lags behind that of men's issues. The aging process introduces an important variable that accentuates the relative lack of information and specific treatment guidelines for older women who are confronted by mental health problems. This volume offers a comprehensive overview for the health professional who is seeking a greater depth of understanding with respect to the study of mental health problems in general, and how these issues pertain specifically to women and the aging process. A second goal of this project is to provide the practicing therapist and counselor with a research update and a broad clinical perspective offered by seasoned clinicians. Using current psychiatric diagnosis as a framework, the contributions address the range of mental health problems, including dementia and cognitive impairment, schizophrenia, alcohol abuse, mood and anxiety disorders, traumatic and dissociative conditions, sexual and eating disorders, and personality disorders. It is hoped that this book will inform, inspire and encourage students and health professionals in their work with middle aged and older women who are facing mental health challenges.     

Sexuality and the Older Adult: An Overview with Guidelines for the Health Care Professional

Research emphasis in sexuality and aging has progressed beyond earlier questions of whether sex exists and whether sexual capacity is maintained as one ages. Clinical research is thus moving into the practical realm of (1) educating health care professionals who work with, and must deal with the sexual issues of older adults, and (2) addressing neglected areas such as widowhood sexuality and homosexuality. This paper provides a current overview, along with guidelines for program development within the area of sexuality and aging. It is emphasized that any educational or therapeutic intervention should reflect a respect for the continuity of one's sexual lifestyle, and a readiness to explore alternative methods of meeting sexual and affectional needs of older adults who remain interested in their sexuality but who are disabled, without partners, or find themselves in a restricted environment.     

Some myths and anomalies in the study of Roman sexuality

This paper seeks to dispel several myths prevalent in the scholarship on Roman sexuality: that a freed slave was still obligated to serve his former master's sexual demands (I.A.), that the cinaedus cannot be the same as the modern male homosexual because the cinaedus was thought capable of performing cunnilinctus (I.B.), that exoleti were male prostitutes (I.C.), that the Romans were implacably hostile to lesbianism and that they constructed the lesbian as a phallic monstrosity (II.). It also draws attention to some neglected, unfamiliar, or misinterpreted evidence-anomalous on the current understanding of Roman sexuality, where women, boys, and lower-class men are supposed to have equal standing as potential passive sexual partners for adult men-for adult men whose sexual partners are exclusively male, and either active or passive: exoleti as active partners (I.C.), a puer delicatus who is prized for a masculine appearance rather than a feminine one (I.D.), and the Warren Cup, which glorifies a world of exclusively male-male sexuality (I.E.).     

Sexuality and HIV/AIDS: An Exploration of Older Heterosexual Women's Knowledge Levels

Sexuality research tends to ignore older populations, and little is known about older women's sexual health knowledge. To fill this research gap, 186 Canadian heterosexual women 50 years and older were surveyed about their knowledge regarding sexuality and HIV/AIDS. Respondents had moderate levels of overall knowledge of sexual health and aging, correctly answering, on average, 60% of the 35 questions. They had lower levels of HIV/AIDS knowledge, correctly answering just over 50% of the 25 questions. Results indicate the need for social awareness and education in this group regarding both general sexual health later in life and HIV/AIDS.     

Sexual Preferences and Partnerships of Transgender Persons Mid- or Post-Transition

The process of gender transition has varying effects on various aspects of sexuality. The purpose of this study was to investigate the effects of transitioning on transgender persons’ sexual preferences and partnerships. Data were collected through an anonymous online survey. Questions focused on timing of gender transition in relation to change in sexual preference. Transgender individuals have a variety of sexual partners, predominantly cisgender, and may change sexual preference when they transition. Transitioning can be associated with having no primary sexual partner, despite past sexual partnerships. Length of time between identifying as transgender and starting the transition might be associated with changing sexual partner preference, particularly in transgender women. The emerging trends of sexual partnerships and changing sexual preferences related to the transition in this study warrant further investigation. These data provide more understanding of the relationship between transitioning and sexual preferences and partnerships.     

Same-Sex Sexuality and Educational Attainment: The Pathway to College

Research finds lower levels of academic performance among sexual minority high school students, but some studies suggest sexual minorities have higher levels of educational attainment in adulthood. To further our understanding of how and why sexual orientation is associated with educational success, this study turns attention to the pathways to college completion, examining points along educational trajectories in which sexual minorities fall behind or surpass their heterosexual peers. Using data from the National Longitudinal Study of Adolescent to Adult Health, we find that sexual minority women are less likely than women with no same-sex sexuality to complete college, in part due to their high school performance and transition into college. Men who experience same-sex sexuality only in adolescence struggle in high school, but men who experience same-sex sexuality for the first time in adulthood are more likely to earn a college degree than men who do not experience same-sex sexuality.     

Sex and the unspoken in male street prostitution

Although the overwhelming majority of male prostitutes work through agencies or by placing their own ads, most studies of male prostitution focus upon young men who work on the street. Remarkably, these studies seldom identify the dynamics of poverty and street-level violence as important elements of their examination. Investigations of male sex work-few though they are-focus almost exclusively upon sexual aspects of "the life." Despite the importance of these networks in shaping the contours of street life, and often in enabling one's very survival, the primary research focus has remained on questions of sexual identity, sexual practices with clients, and sexual abuse as a causative factor. Meanwhile, studies that do examine the dynamics of male street life typically do not examine questions of prostitution or other issues related to sexuality. A dominant theme within this literature consists of specifying the social mores of the most aggressive and socially problematic participants within street society, particularly gang members and drug dealers. The dissimilar nature of these images relates directly to the political projects of the dominant culture, which, in a very general way, seeks to "rescue" (reintegrate) deviant white youth, while controlling and excluding deviant youth of color. The political aim of reintegrating runaways into middle-class trajectories has the effect of authorizing certain discourses regarding their behavior on the streets, while marginalizing or completely disallowing others. This article seeks to examine and challenge these trends of representation.     

Homosexual experience, desire and identity among young adults

Is young people's sexuality becoming more fluid and less tied to steady, stable identity patterns? Are we developing into a society where sexual relationships between individuals of the same sex are no longer reserved for the small minority of gay men and lesbian women? Adherents of so-called queer theory have promulgated such views. Using a population-based sample of young adults (aged 19 to 26, N 2753), we investigated homosexual experiences, desire and identity. We found that levels of prevalence of homosexuality were primarily a function of the criteria we used. Using the most restricted ("narrow") definitions, we found that about one percent of both genders reported "exclusive" homosexual interest and identity. Using the most inclusive criteria, we found that one of ten young men and one of four young women reported having some homosexual experience, interest or identity. Still, the most striking finding involved the substantial gender-specific differences: homoerotic activity and interest are far more interwoven with heterosexual activity for women. There are strong indications that homosexuality is a lot more threatening and potentially in conflict with traditional male gender roles than we find to be the case for women. In other words, while there may be signs of more fluid sexual identity categories, this phenomenon primarily applies to women.     

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.     

Staff Member Reactions to Same-Gender,Resident-to-Resident Sexual Behavior Within Long-Term Care Facilities

The current study assesses ageism and heterosexism relating to older adult sexual activity within long-term care facilities. To assess caregiver reactions, 153 residential care facility staff members read one of three vignettes. Each vignette described a scenario in which a staff member walks in on two residents (male/female, male/male, or female/female) engaging in sexual activity. Although no main effects were discovered for vignette type, exploratory analyses revealed that the facility where participants were employed was significantly related to their ratings of approval. Furthermore, an interaction effect between vignette and facility types was also discovered for caregivers’ approval of sexual activity among residents. Additionally, a strong overall approval rating of older adult sexuality was reported by staff members. The results of this study warrant that further research is necessary regarding older adults’ perception of caregiver bias, as well as further investigation of caregivers’ perceptions of older adults’ sexual activity.     

Posttraumatic stress disorder and older women

This article examines the literature related to the identification and treatment of post traumatic stress disorder in older women. From this review, several key findings emerge. Consistent in the research literature is the fact that American women are more at risk for PTSD than are men as a result of the high frequency of sexual and domestic physical abuse that women experience. Studies on older women and PTSD indicate that older women are underdiagnosed and are more typically perceived as suffering from depression, anxiety or poor physical health. It was found consistently that older women who present with age-related stressors may not be asked about earlier trauma history or it may not be understood within the context of trauma related variables. In several research studies, trauma history was often not identified either as a result of current assessment practice or because women from certain age cohorts did not disclose trauma-related data to health professionals. Key researchers emphasize the necessity of clinicians, staff and medical personnel to attend to the historical variables present in trauma histories of older women. Researchers underscore the importance of understanding the impact of early and repeated trauma, especially interpersonal trauma, on the physical health and social functioning of older women- even though a significant amount of time may have elapsed since exposure. These findings indicate that further study of PTSD in older women is warranted. The paper concludes with a discussion of assessment and treatment options.     

Posttraumatic Stress Disorder and Older Women

SUMMARY

This article examines the literature related to the identification and treatment of posttraumatic stress disorder in older women. From this review, several key findings emerge. Consistent in the research literature is the fact that American women are more at risk for PTSD than are men as a result of the high frequency of sexual and domestic physical abuse that women experience. Studies on older women and PTSD indicate that older women are under-diagnosed and are more typically perceived as suffering from depression, anxiety or poor physical health. It was found consistently that older women who present with age-related stressors may not be asked about earlier trauma history or it may not be understood within the context of trauma-related variables. In several research studies, trauma history was often not identified either as a result of current assessment practice or because women from certain age cohorts did not disclose trauma-related data to health professionals. Key researchers emphasize the necessity of clinicians, staff and medical personnel to attend to the historical variables present in trauma histories of older women. Researchers underscore the importance of understanding the impact of early and repeated trauma, especially interpersonal trauma, on the physical health and social functioning of older women–even though a significant amount of time may have elapsed since exposure. These findings indicate that further study of PTSD in older women is warranted. The paper concludes with a discussion of assessment and treatment options.     

Attitudes and Stereotypes Regarding Older Women and HIV Risk

Persons aged 50 years and over will soon disproportionately represent the future of the HIV/AIDS epidemic. It is estimated that by 2015 older adults will represent 50% of persons living with HIV in the United States. Despite the HIV/AIDS growing population among older adults, attitudes, beliefs, and stereotypes toward older adults that exist in general society have affected HIV prevention, education, and care. Specifically, ageist attitudes about the sexuality of older adults in general and older women in particular, low clinical HIV suspicion among healthcare providers, lack of knowledge about risk among older women, and differentials in power related to negotiating sexual practices all lead to heightened concerns for the prevention, identification, and treatment of HIV disease in mature women. This article examines common attitudes, beliefs, and stereotypes that exist within general society as well as health and social service providers that place older women at a disadvantage when it comes to HIV prevention, education, and treatment.     

Gender and Aging in the Developing World: Where Are the Men?

In recent years, both population aging and gender issues have gained prominence in international forums concerned with population. It is frequently asserted or implied that older women are universally more vulnerable to social, economic, and health disadvantages than older men. The most significant manifestation of this exclusive concern with women when considering gender and aging is the Plan of Action adopted by the Second World Assembly on Aging in 2002. The assumed relative disadvantage of elderly women is commonly attributed to gender differences in earlier life experiences. But are older women truly disadvantaged globally with respect to all or most essential aspects of well‐being? The authors provide empirical evidence that clearly shows that older women are not invariably disadvantaged vis‐à‐vis men. In particular, they call into question the wisdom and equity of a virtually exclusive emphasis on the needs of women when incorporating gender concerns into policies and programs related to aging. A more balanced perspective that recognizes gender as a potential, but not necessarily central, marker of vulnerability for various aspects of well‐being in specific settings and times, and that allows for male as well as female disadvantage, would serve the current and future elderly generations far better.     

Forever young: Visual representations of gender and age in online dating sites for older adults

ABSTRACT

Online dating has become increasingly popular among older adults following broader social media adoption patterns. The current study examined the visual representations of people on 39 dating sites intended for the older population, with a particular focus on the visualization of the intersection between age and gender. All 39 dating sites for older adults were located through the Google search engine. Visual thematic analysis was performed with reference to general, non-age-related signs (e.g., facial expression, skin color), signs of aging (e.g., perceived age, wrinkles), relational features (e.g., proximity between individuals), and additional features such as number of people presented. The visual analysis in the present study revealed a clear intersection between ageism and sexism in the presentation of older adults. The majority of men and women were smiling and had a fair complexion, with light eye color and perceived age of younger than 60. Older women were presented as younger and wore more cosmetics as compared with older men. The present study stresses the social regulation of sexuality, as only heterosexual couples were presented. The narrow representation of older adults and the anti-aging messages portrayed in the pictures convey that love, intimacy, and sexual activity are for older adults who are “forever young.”     

Cognitive functioning and aging in women

Deficits in cognitive function may impact one's ability to attend to stimuli, think clearly, reason, and remember. Impaired cognitive function is a common complaint among older women presenting for treatment in both mental health and medical care settings, and differential diagnosis of type and extent of cognitive impairment is important for appropriate treatment planning and prognosis. Although overall gender differences in prevalence of cognitive dysfunction are minimal, it is important when treating older women to take into account unique challenges they face in the aging process that impact the cause, type and extent of cognitive complaints with which they present in clinical settings. The current paper provides an overview to guide accurate diagnosis, particularly in women, of different types of cognitive impairment under the broad category of dementias, including Alzheimer's, Lewy Body Disease, Vascular Dementia, and due to general medical conditions such as coronary artery bypass surgery, head injury, menopause, hypothyroidism, breast cancer treatment, Fibromyalgia, and chronic fatigue. In addition, emotional factors such as depression in older female patients complicate differential diagnosis of cognitive impairment and must be addressed. Given the multiplicity of causes of cognitive difficulties for women across the life span, careful assessment is crucial; the current paper reviews assessment strategies to prepare an integrated, biopsychosocial strategy for identifying particular cognitive deficits and related psychological and medical problems. In addition, prognostic indicators and treatment planning are discussed to help the practitioner organize an empathic, reasoned and multifaceted treatment approach to maximize recovery, minimize deterioration, and manage symptoms for older women in the context of their social support system and living environment.     

Sexuality in Older Spanish Women: Voices and Reflections

Our research has been aimed at understanding the experience, practice, and sexual life in a group of Spanish women over 50 years of age. We studied a sample of 729 women between 50 and 80 years old. Our results provide qualitative and quantitative information and important insights about the sexual life of Spanish women and identify differences in the experience and reality of sexual life after the age of 70. The status of having or lacking a partner, and a personal interest in emotional relationships and sexual practices, are elements that determine the possibility of enjoying a satisfying postmenopausal sexuality.     

Worry and Bother: Factors in Rural Women’s Health Decision Making

This exploratory study examined older rural women’s health decision making. Thirty-three rural women were recruited to participate in semistructured qualitative interviews. Major themes emerged that focused on rural women’s comments regarding their concerns about not worrying or bothering their children with personal health matters. Themes were discussed in the context of an ethic of care. Results suggest that it is important for mental health professionals, family physicians, social workers, and other practitioners to be aware of the sense of worry and concern for others that older rural women bring to bear in decision making about personal health issues.