Chronic Pain and Older Women:

Drawing upon the available research literature, this article highlights the research and practice issues that must be addressed if we are to be responsive to the chronic health problems, and subsequent pain, that often codront individuals as they age. This list should by no means be 'seen as exhaustive, but rather as a starting point from which to further our understanding of chronic pain in the lives of older women.     

Nonpharrnacologic Interventions for the Management of Chronic Pain in Older Women

Chronic pain can induce tremendous suffering, seriously affect.the quality of life, and impair optimal daily functioning in older adults. Advances in the conceptualization and treatment of pain support the use of a multirnodal approach to pain management incorporating both pharmacologic and nonpharmacologic interventions for the most effective management of chronic pain. Nonpharmacologic interventions, used concomitantly with pharmacologic approaches, typically result in more effective pain control, less reliance on medications, fewer side effects, less clinical impairment and an increased sense of personal control over pain.     

Influence of Chronic Pain on the Family Relations of Older Women

Explorations of family problems in elderly women with problems of chronic pain is an uncharted territory as is the application of family and couple therapy. The interpersonal conflicts encountered by older pain patients are not fundamentally different than their younger counterparts. Several case illustrations are provided to show the impact of chronic pain as it affects older women in their roles as patients and caregivers.     

Spousal Support of Older Women with Osteoporotic Pain: Congruity of Perceptions

ABSTRACT

Thirty-four couples were interviewed to assess the congruity of husbands' and wives' perceptions of the wives' osteoporotic pain and the exchange of instrumental support within the marital relationship. Moderate correlations were found between the husbands' and wives' ratings of two specific dimensions of the wives' pain experience: interference with daily life and pain severity. Wives who perceived their pain as more severe but as having a lesser impact on their personal lives provided the most frequent help to their husbands. The wives' pain perceptions were not predictive of the amount of assistance they perceived receiving from their spouses. Husbands' perceptions of their wives' pain experience were not predictive of the frequency of instrumental support they either received from or gave to their wives.     

Current Concepts and Management of Cancer Pain in Older Women

Pain is the most common symptom associated with cancer. Sixty to eighty-five percent of individuals with advanced cancer have pain either of a severe or a chronic nature. Despite the fact that appropriate pain management exists, cancer pain is often inadequately controlled. Management strategies for older cancer patients must address the physical, psychological, and social concerns of the individual. The special problems of drug management presented by older patients reinforces the importance of implementing nonpharmacologic therapies when possible.     

Group Work with Older Women:

No abstract available for this article.     

Abused Older Women:

Due to the recent "discovery" of elder abuse and the failure of the battered women's movement to reach out to older persons, the physically abused older woman is not necessarily seen as a battered woman. Elder abuse has been viewed as more akin to child abuse, thus leading to a paternalistic approach to the problem. This article contrasts the prevalence, causal models, and effects of physical abuse amon young and older women. Interventions in the case of spouse and elder abuse are also compared. The author concludes by suggesting ways in which helpers might borrow from the battered women's movement in order to better serve older battered women.     

Osteoporosis and Older Women:

Osteoporosis, a metabolic bone disorder, affects four times as many women as men. Each year 1.3 million fractures, primarily of the vertebra, hip, and wrist can be attributed to osteoporosis. Risk factors for the development of this disease include age, sex, body build, family history, race, loss of estrogen, calcium deficiency, sedentary lifestyle, smoking, and the excessive use of alcohol. Three common approaches used in the treatment and prevention of osteoporosis are hormone replacement therapies, nutrition interventions. and exercise programs. These strategies are aimed at maintaining or stabilizing bone mass and preventing further loss. Living with osteoporosis presents older women with a variety of physical, psychological, and social challenges. To maintain a productive and healthy lifestyle, older women must recognize their physical limitations and make adjustments in their daily lives to cope successfully with these changes.     

Quality of Life Among Older Women with Rheumatoid Arthritis

The purpose of this study was twofold: (1) to identify perceptions of quality of life among a sample of 35 older women with rheumatoid arthritis; and, (2) to describe the strategies they employ to improve the quality of their lives. The responses of these women were consistent with other studies examining dimensions of quality of life; however, these participants also revealed specific self-care actions that were planned and deliberate, aimed at making their lives more enjoyable. This study also underscored the impact of chronic illness on the economic well-being of oIder women.     

Heart Disease and Older Women

Heart disease has traditionally been thought of as a man's disease. However, one in three older women develop heart disease, making it the leading cause of death in older women. Current treatment for heart disease is based largely on studies using males as subjects. Doctors are just now beginning to learn about differences in men and women who have heart disease. The focus of this discussion is heart disease as it relates specifically to women. Risk factors considered are smoking, high blood pressure, elevated blood lipids, diabetes mellitus, obesity, stress, family history and physical inactivity. Diagnosis, treatment options and strategies for living productively with heart disease are presented.     

Anxiety Disorders and Older Women

SUMMARY

Anxiety is a problem for millions of Americans. It poses special challenges for women as they grow into advanced age. This paper provides a general overview of anxiety disorders, including panic disorder, agoraphobia, specific phobia, social phobia, obsessive compulsive disorder, and generalized anxiety disorder. Etiology, assessment and treatment strategies are then addressed. Special focus is directed at biological and psychosocial issues as they relate to older women in the development, experience, treatment and prevention of anxiety disorders.     

Alzheimer's Disease and Older Women

The graying of America suggests that dementia will become "the epidemic of the 21st century." First described in 1907, Alzheimer's Disease (AD) accounts for an estimated two-thirds of all dementia. AD currently has no cure, thus causing a major drain on health care and family resources. Compared to men, women are uniquely affected by AD due to their gender-associated increased risk, longer life span, and roles as caregivers within families and institutions. Living successfully with dementia requires medical and behavioral interventions to manage disruptive symptoms, knowledge to optimize environmental conditions, and caregiver support and savvy to avoid burnout. Strategies for maximizing functioning in older women living with AD are provided.     

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.     

Working with Abused Older Women from a Feminist Perspective

SUMMARY

Domestic violence in older families is often referred to not as family violence but as elder abuse. This chapter will begin by discussing how perceptions of this type of violence impact informal and formal interventions. The prevalence and etiology of domestic violence are described, along with how the joint forces of ageism and sexism affect older female victims. National, state, and local efforts to prevent and remediate the abuse of older women are also covered. In conclusion, the author presents implications for working with groups and individual abused older women from a feminist perspective.     

Older Women and Cosmetic Tattooing Experiences

Aging for the older women in the 21st century is more than medical issues. In this study, 62 women (ages 51–81+) obtained a total of 97 permanent makeup procedures. Procurement cues included self-improvement and friend's appearance, consistent with internal, external, and appearance perspectives of body image. Poor eyesight was also of concern (14/23%). Actual benefits included saving makeup time and money (external), while achieving personal goals (internal). This study seems to confirm that for these older women, body image remains important, especially qualities of the face. They did not shed their internal, external, nor appearance concerns associated with body image, as they aged.     

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.     

Chronic Musculoskeletal Pain:

Two diseases, osteoporosis and osteoarthritis, are responsible for a majority of the chronic musculoskeletal pain that older women experience. Osteoporosis is the metabolic bone disease most common in older women and is responsible for fractures, kyphosis, and chronic pain. Osteoarthritis, the most commonly diagnosed musculoskeletal problem in older women, causes degeneration of the weight-bearing joints in the body, resulting in limited function and chronic pain. In this paper, these and other common disorders are briefly described and typical coping strategies used by older women in pain are reviewed. In addition, potential multidisciplinary treatment regimens are discussed.     

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.     

Alternative Therapies and Empowerment of Older Women

SUMMARY

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 outmoded 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.     

Discrimination Against Older Women in Health Care

Growing awareness of apparent gaps in health care received by women and men raises concern over possible discrimination. This literature review examines this issue for elderly women, whose health care is obtained in a system that also may be permeated with age discrimination. Physicians tend to spend more time with women and older patients, suggesting that discrimination may not be an issue in the physician-patient relationship or may work in favor of older women. However, this may simply reflect elderly women's poorer health. Gender and age disparities in medical treatments received provide a more compelling argument that the health care system is a source of discrimination against older women, who are less likely than others to receive available treatments for cardiac, renal, and other conditions. The history of medical treatment of menopause suggests that stereotypes of older women have been advantageous for segments of the health care system. Finally, in addition to discrimination that has its source within the health care system itself, societal-wide inequities, particularly economic, are extremely detrimental to older women's health care. As we respond to the health care crisis, we must be alert to the potential to rectify those structures and tendencies that can lead to discrimination against women and the aged. Health care reform presents a unique opportunity to ensure health care equity.