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.     

An ecological synthesis of research on older women's experiences of intimate partner violence

In this systematic literature review, we synthesized the current knowledge of intimate partner violence experienced by older women. We identified 32 studies that included data collected from older women and synthesized the findings using the ecological model as an organizing framework. Themes in the microsystem included the immediate context in which the abuse takes place and impacts on older women. The mesosystem included themes on the older woman's relationships with her social network. Themes in the exosystem encompassed community-based services. Finally, themes in the macrosystem encompassed broad ideologies, mores, and influences of the geographic location. We used the ecological model to frame a discussion of implications for future research, policy, and practice.     

The psychosocial meaning of menopause: women's experiences

This paper reports on a qualitative study of womens' experiences with menopause from a psychosocial perspective. Women give voice to the impact of menopause upon their sense of self and significant relationships in their lives. This study raises questions about the meaning of the reluctance of women and others to discuss menopause in a helpful, meaningful way.     

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.     

Qualitative assessment of women's experiences with ECV

For women with unsuccessful ECV, discussions about their mode of delivery should include the benefits and risks of a planned caesarean or vaginal breech birth. However, most obstetric units continue to offer only planned caesarean births when ECVs are unsuccessful despite the proven safety of vaginal breech births in selected patients. Such unit policies can be at variance with a woman's desire and preference for vaginal birth. Thus, a conflict situation arises that could have varying medical, emotional and cultural implications.AimTo provide a consumer perspective on ECV from women who had an unsuccessful procedure.MethodologyA qualitative study involving focus group discussions with women who had unsuccessful ECV at secondary obstetric facility in Melbourne, Australia.ResultsEmergent themes from the focus group discussions were related to emotions associated with the inevitability of a caesarean section for breech, consequences of an unsuccessful ECV and the various activities undertaken by women to induce spontaneous version.ConclusionA medicalized approach to ECV fell short of women's expectations of care. There is a need to develop strategies that will help women deal with any conflicts occasioned by an unsuccessful ECV.     

Older women's experiences with chronic pain: daily challenges and self-care practices

The subjective nature of chronic pain leads to challenges in describing, treating, and accommodating pain. Twenty older women, who engaged in focus groups, and eight of whom also participated in individual interviews, discussed the influence of chronic pain on their perception of self as well as daily functioning. Managing pain forced many of the women to withdraw from social activities that they valued and interfered with sleep patterns, household tasks and recreational activities. Varied acceptance by social network members added to the challenge of adjusting to complications associated with pain. Self-care practices that supported independence contributed to women's perceived success in daily functioning.     

Focus groups identified women's perceptions of dairy foods

Focus groups were conducted with 39 Caucasian women (ages 30-55 years) to gain insight regarding their thoughts and feelings toward dairy foods. Women resided in Virginia; all had at least a high school education. Themes characterizing the group discussions were identified. Women knew that dairy foods were a good source of calcium and discussed it in relation to osteoporosis. Although many knew the risk factors related to osteoporosis, most were confused about measures to prevent it. Many used calcium supplements or vitamin/mineral supplements to help meet calcium requirements. Most thought dairy foods were high in fat. Women also discussed the sensory attributes of dairy foods as well as convenience and cost of dairy foods in relation to their dairy food choices.     

Australian women's experiences of living with gestational diabetes

PurposeThe purpose of this study was to describe Australian women's reflections on the experience of having a pregnancy affected by GDM.MethodsParticipants were women aged ≥18 years, diagnosed with GDM ≤3 years previously and registered with the National Diabetes Services Scheme. Data was collected from a cross-sectional written postal survey which included the opportunity for women to document their experiences of living with GDM. Thematic framework analysis was undertaken to determine underlying themes.ResultsOf 4098 invited eligible women, 1372 consented to participate. Of these, 393 provided feedback on their experiences of living with GDM. Eight key themes emerged from the data (1) shock, fear and anxiety (8.9%), (2) uncertainty and scepticism (9.4%), (3) an opportunity to improve one's health (9.6%), (4) adapting to life with GDM (11.6%), (5) the need for support (17.2%), (6) better awareness (3.5%), (7) abandoned (14.9%), (8) staying healthy and preventing diabetes (13.7%). Women taking insulin were more likely to experience shock, fear or anxiety (p = 0.001) and there was a trend towards women who spoke another language also being more likely to report this experience (p = 0.061). Those diagnosed with GDM in a previous pregnancy (p = 0.034) and younger women (p = 0.054) were less likely to view the diagnosis as an opportunity to improve their health.ConclusionsThis study provides an insight into the experience of the pregnant woman diagnosed with GDM. It emphasises the importance of health professional support and provides insight into the challenges and opportunities for future diabetes risk reduction.     

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.     

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.     

Nativity and older women's health: constructed reliance in the health and retirement study

Gender and nativity are known risk factors for physical and economic dependency. Immigrant women are particularly disadvantaged because of their greater lack of social and economic resources. In this study, we investigate how women immigrants coordinate and utilize various support systems as they approach retirement age, as well as how choices and constraints affect their physical wellbeing. Experiences throughout the life course play a role in the maintenance of health, but the pre-retirement years are particularly crucial to the establishment of patterns of reliance to be used in later life. We examine the effects of economic resources, social support, and family ties (as well as several exogenous variables) on women's physical health using data from the Health and Retirement Survey. For the women in this study, demographic characteristics, such as Hispanic ethnicity and low education are strong risk factors for poor health. Findings also indicate that reliance patterns across resource domains do not differ significantly by nativity and that both economic and familial resource access significantly lessens the risk of poor health for both native and foreign born women.     

Qualitative insights into women's personal experiences of perinatal depression and anxiety

Background and aimSymptoms of perinatal depression and anxiety are usually described and understood from a nosological perspective. This research sought to gain insight into women's lived experience of postnatal depression and anxiety, the factors that contribute to these symptoms and the context in which they develop.MethodFace to face and telephone interviews were conducted with 28 women from metropolitan and rural areas across Australia, who had experienced postnatal depression and/or anxiety within the last five years. Analysis was conducted from a grounded theory perspective.FindingsParticular symptoms of anxiety and depression develop in the context of the numerous changes inherent to the transition to motherhood and contribute to a common experience of frustration and loss. Symptoms were also associated with feelings of dissatisfaction with the pregnancy and motherhood experience.ConclusionsThe findings provide useful insights into women's experiences of mental health symptoms during the perinatal period, how these symptoms present and the factors involved in their development and maintenance. The need to consider women's perspectives to develop resources and health promotions strategies, as well as within the context of relationships with health professionals is highlighted. The study emphasizes the need for greater, more accurate information surrounding perinatal depression and the need to increase the profile and awareness of anxiety disorders.     

Japanese women's experiences of pharmacological pain relief in New Zealand

BackgroundIn Japan, most women manage labour pain without pharmacological interventions. However, New Zealand statistics show a high percentage of epidural use amongst Asian women. Entonox (a gas mixture of nitrous oxide and oxygen) and pethidine are also available to women in New Zealand. This article investigates how Japanese women in New Zealand respond to the use of pharmacological pain relief in labour.QuestionsThe study was guided by two research questions: (1) How do Japanese women experience and manage labour pain in New Zealand? (2) How do they feel about the use of pharmacological pain relief?MethodsThirteen Japanese women who had given birth in New Zealand were interviewed individually or in a focus group. The conversations were analysed using thematic analysis.FindingsAlthough in Japan very few women use pain relief, nine women received epidural and/or Entonox out of 11 women who experienced labour pain. The contrast between their Japanese cultural expectations and their birth experiences caused some of the women subsequent personal conflict.ConclusionJapanese women's cultural perspectives and passive attitudes were demonstrated to influence the decision-making process concerning pain relief. It was concluded that understanding Japanese cultural worldviews and approaches to the role of pain in labour would help maternity providers in their provision of appropriate care for Japanese women.     

Heterosexual women's perceptions of their marriages to bisexual or homosexual men

Twenty-one heterosexual women who were or had been married to bisexual or homosexual men and had children by them responded to a 28-page questionnaire that explored their experiences as wives and mothers. All of the married women expected a lasting, monogamous marriage. Only three had partial knowledge of their husband's sexual orientation before marriage. All of them went through a painful grief reaction when they learned that their husbands had emotional or sexual, or both, attachments to other men. The suffering was aggravated by feeling deceived or stupid for not having guessed the truth. What made it difficult for them to seek support from family and friends was the fear of encountering social disapproval or ostracism. They were afraid for themselves, their husbands, and their children. At the time of the study 11 of the 21 women were still married and living with their husbands, but most of them felt unsure that the marriage would last. Ten were in transition, separated, or divorced. Only three of the still married wives had complete confidence in the future stability of their relationships. These marriages were characterized by good communications, husbands who considered themselves bisexual, and an open marriage contract whereby wives could have heterosexual affairs. Findings cannot be generalized from this small convenience sample, but will hopefully encourage further research. The writers are also soliciting more subjects to enlarge the sample.     

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.