Care arrangement choices for older widows: decision participants' perspectives

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.     

Women's autonomy,women's status and fertility-related behavior in Zimbabwe

Women's household decision-making autonomy is a potentially important but less studied indicator of women's ability to control their fertility. Using a DHS sample of 3,701 married black African women from Zimbabwe, I look at women who have no say in major purchases, whether they should work outside the home,and the number of children. When men dominated all household decisions, women were less likely to approve of contraceptive use, discuss their desired number of children with their spouse, report ever use of a modern method of contraception, and to intend to use contraception in the future. However, women's decision-making autonomy was not associated with current modern contraceptive use. Women who had no decision-making autonomy had 0.26 more children than women who had some autonomy. These autonomy measures provide additional independent explanatory power of fertility-related behavior net of traditional measures of women's status such as education and labor force participation.     

Taking charge of self: breast health practices of older rural women

The purpose of this grounded theory study was to explore breast health practices of older Vermont women residing in rural communities. Although the three components of breast health-mammography, clinical breast exam, and self-breast exam-are recommended for women 40 years and over, minimal research has empirically analyzed the breast health practices of healthy women to ascertain if, in fact, these procedures are followed, and if so, what the motivation is for doing so. Twelve women, 50-64 years, participated in face-to-face, audiotaped interviews. Data analysis, including line-by-line and constant comparative approaches, occurred concurrently with data collection. Taking Charge of Self, the generated theory, describes participants' engagement in a process of learning how to take charge of their lives. The analysis indicates that health care providers have a powerful role in the lives of women in this age group. With an increasing emphasis on health promotion and disease prevention, health care providers are positioned to cultivate and support women's development of the personal or internal motivation for health and well-being.     

Unanticipated consequences: a comparison of expected and actual retirement timing among older women

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.     

"My mind's made up": assumptions and decision-making in accounts of caregiving women

In this qualitative study, rural women caregivers for elderly relatives or friends were interviewed about their decision-making. Women deliberating decisions differed from women implementing decisions in how they perceived their caregiving tasks and in their experience of stress. The difference in deliberative and implemental accounts suggests that mindset is a mediating factor for the women in the present study. Women in the process of implementing decisions regarding caregiving described their experiences in a more positive light and reported less stress. Deliberating decisions regarding caregiving, however, was likely to color the experience of caregiving, leaving the caregiver feeling vulnerable, doubtful about herself, and more stressed.     

Change comes slowly for women in rural Bangladesh

Survey results from two disparate rural areas of Bangladesh, Sirajgong and Gopalpur subdistricts in the north-central part of the country and Abhoynagar and Fultala subdistricts in the southwest, offer the opportunity to assess the changing status of women in rural Bangladesh. The survey, conducted by the Mother and Child Health/Family Planning Extension Project of the International Center for Diarrheal Disease Control during 1982-89, collected data on 7433 ever-married women 15-56 years old. The analysis focused on two indicators: women's freedom to move outside their homes (mobility) and women's authority in household decision making. Although most respondents moved freely between households, they rarely traveled outside their village alone. In addition, respondents had little input in household decisions regarding health or expenditures. 65% felt they should be able to decide whether to see a doctor when they were ill or to buy medicine for a sick child, but only 7% actually made such decisions on their own. The majority approved of women working outside their homes, but only 11% did so. Both mobility and authority tended to increase with a woman's age. Women who lived in households headed by their in-laws had less mobility and much less authority. Women from poor homes had greater mobility, but wealth had little effect on household decision making. Education tended to increase decision-making authority but decrease mobility. Finally, the greater economic development, ecological stability, cultural diversity, and social progressiveness in the southwestern region tended to increase both mobility and authority.     

Promoting older women's health and well-being through social leisure environments: what we have learned from the Red Hat Society

The purpose of this study was to describe the ways that participation in a leisure organization contributed to the health and wellbeing 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.     

Mental health and breast cancer screening utilization among older Hispanic women

Considerable racial and ethnic differences exist in the way the burden of cancer is experienced in the United States for older Hispanic women. This study utilized data from the 2008 wave of the Health and Retirement Study to investigate the mental health factors associated with older Hispanic women’s participation in breast cancer screening services. Logistic regression models were used. Findings indicated that anxiety and positive affect were associated with a greater likelihood of participating in breast cancer screening. Despite ongoing national conversations, evidence indicates there is agreement that underserved women need to be screened, particularly the older Hispanic population.     

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.     

Decision-Making Patterns and Contraceptive Use: Evidence from Uganda

Literature on the effect of decision-making patterns on contraceptive use often does not (1) distinguish between women participating in decisions and controlling them, and (2) account for effects of common decision-making patterns within the community. In Uganda where high fertility persists, both of these factors may be relevant to adoption of contraception. We used data from the 1995/96 Negotiating Reproductive Outcomes (NRO) Study which surveyed 1,750 women in 78 communities located in two districts in Uganda. We assessed the effects of individual and community factors on the adoption of modern contraceptive methods using multilevel logistic regression. We included measures of decision-making patterns at both the individual and community levels that distinguished husband-dominated, joint, and wife-dominated decision-making patterns. Contraceptive use is 29% more likely in communities where women more commonly have unilateral control over household decisions. This strong effect of normative decision-making patterns within the community is net of individual education and community education, both of which had strong and significant effects. Less traditional gender roles as measured by normative decision-making patterns seem to support more innovative fertility behavior. Community decision-making patterns matter importantly for contraceptive use in this low contraceptive prevalence setting and need to be assessed elsewhere. Further, women’s influence is inadequately measured where joint decision-making and wife-dominated decision-making are considered together.     

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.     

Female genital mutilation: common,controversial, and bad for women's health

Female genital mutilation has grave consequences for women's sexuality, health, and fertility. Studies conducted since 1990 have found that 97% of women in Egypt, 94% in Mali, 72% in Northern Ghana, 43% in the Ivory Coast, and 20% in Senegal have undergone female genital mutilation. The Population Council seeks to discourage the continued practice of this procedure in Africa while at the same time respecting cultural norms regarding women's sexuality. Change will require political support, culturally sensitive education, and community development. Current Population Council research projects in North and West Africa are expanding understanding of the cultural, attitudinal, and behavioral factors that influence decisions about female genital mutilation, while Demographic and Health Surveys will provide baseline data on the current prevalence of this practice. An emphasis on the reproductive health implications of female genital mutilation, backed by the support of the medical profession, may prove to be the most effective strategy. Of the 8% of women in the 1995 Egyptian Demographic and Health Survey who indicated they would not have their daughters' genitalia excised, more than 40% cited medical complications as the reason.     

The impact of men's and women's retirement on marital relations: a comparative analysis

The study examined whether men's and women's retirement have a differential impact on several aspects of marital life: Power relations (as reflected in decision-making), spousal resources, division of household tasks, and quality of marriage. Questionnaires were distributed to a sample of 519 pre-retired and retired Israelis. The findings indicate that in general, both men's and women's retirement have a similar impact on marital relations in all of the areas examined. No appreciable change in spousal resources was found after retirement, but there was evidence of change in decision-making patterns about spending time and carrying out feminine and general tasks. Retired respondents of both sexes reported fewer marital complaints than the pre-retired respondents, but also expressed less marital enjoyment. It was also found that men's retirement has a different impact than women's retirement on decisions about house-hold affairs and performance of feminine tasks. In addition, gender-based differences were found in several areas, irrespective of employment status. The women reported higher quality of marriage than did the men, and more resources for strengthening the family, whereas the men perceived themselves as making more decisions in the important areas of life, as more hardy, and as controlling the family's financial resources.     

Best friends: the role of confidantes in older women's health

This article explores personal, network, and community contexts in older women's friendships and health. Twenty-six older women (mean age, 67; range 55-85 years) in San Francisco were asked to choose the one individual to whom they felt the closest and then discuss how this individual contributed to their health. Their choices were numerous, diverse, contextual, and circumstantial. Other women were chosen most often; however, this belies the complexity of their choices. Confidants were chosen primarily for expressive reasons, but instrumental reasons proved important too, particularly for lower class women. Older women called upon their closest ties with physical, social, and emotional problems; they were less likely to call upon them with mental, financial, or spiritual concerns. Family members were preferred to friends for direct caregiving; however, some older women felt they would call upon their friends as well. Confidants kept older women healthy by offering advice and encouragement about diet and exercise; by providing meals and transportation; by laughing, talking, and joking with them; by keeping them happy and feeling good about themselves; and, on rare occasions, by offering spiritual guidance. Practical and policy considerations of their choices were discussed.     

Cognitive Functioning and Aging in Women

SUMMARY

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.     

Capability and Health Functioning in Ethiopian Households

From a recent Ethiopian representative household survey this paper empirically operationalizes concepts from the capability approach to shed light on the relationship between conversion factors, capability inputs and health functionings. The subjects of the study are women in partnership. The results suggest their health functionings are responsive to specific household bargaining power conversion factors and capability inputs. The paper also tests the extent to which women who take more decisions achieve better health functioning. The model offers evidence that decision-making and health functionings follow a complex pattern as women who took more decisions were not always better off. The conclusion of the paper is that health functioning may be improved by inducing changes to household decision-making patterns.     

Psychosocial maturity and teenage contraceptive use: An investigation of decision-making and communication skills

The developmental factors influencing teenage women's contraceptive decision-making with first sexual partner are investigated. A discriminant function analysis of results of a study of 17- to 19-year-old women shows the following: Pill users are distinguished from women who have not used any method by having had a longer relationship with their partner, having a more negative attitude towards becoming premaritally pregnant themselves, being older at the time of their sexual debut, engaging in more frequent sexual intercourse, being more trusting of their partner, and perceiving the risks of unprotected pregnancy as greater. Women who are protected by the use of condom are distinguished from women not protected by any method by having had more discussions with male friends about a variety of topics, having better role-taking skills, having a less negative attitude about becoming premaritally pregnant, and having discussed their sexual debut with their partner beforehand. Results are consistent with a conceptualization which distinguishes contraceptive methods on the basis of the psychosocial costs their use incurs for young women.Research supported by Grant #HD09813, National Institute of Child Health & Human Development. Thanks are due to Robin Halliday, Allyson Myhre, and Carolyn Scheve for help in conducing this investigation.     

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.     

Dimensions of power: older women's experiences with electroconvulsive therapy (ECT)

Older women are particularly prone to being treated for depression, and, despite the controversy surrounding it, electroconvulsive therapy (ECT) has gained popularity as a treatment with this population. Research has examined the physical and cognitive changes associated with ECT but there is little understanding regarding how older women themselves experience this treatment. In order to gain better understanding into the subjective experience of receiving ECT, this qualitative study explored the experiences of six older women who were treated with ECT for a diagnosis of depression, using in-depth personal interviews. Analysis suggests that this experience for these older women could not be understood in isolation. Rather, their stories highlighted the importance of interpreting the ECT experience within a broader context that included the larger depression experience, the dynamics of helping relationships, and the discourse available to them for sense-making. Specifically, the central theme underpinning all of these women's stories was the shifting of power from themselves to others. This paper examines how this occurred and discusses implications for practice.