Sleep Behaviors in Older African American Females Reporting Nonmalignant Chronic Pain: Understanding the Psychosocial Implications of General Sleep Disturbance

This study examined factors that influence sleep quality in older African American women (N = 181) reporting chronic pain. Participants completed a series of questions assessing demographic and behavioral characteristics, health status, pain intensity, and sleep disturbance. Findings indicated that younger participants and those experiencing poorer physical functioning reported more difficulty sleeping due to pain. Similarly, participants who reported being awakened from sleep due to pain were younger and experienced greater pain intensity. Understanding the relationship between sleep and pain in this group of women may be useful in promoting effective disease management and sleep awareness among patients, caregivers, and healthcare professionals.     

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.     

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.     

The Psychosocial Context of Bereavement for Older Women Who Were Caregivers for a Spouse With Advanced Cancer

The psychosocial context of bereavement for older women who were caregivers for a spouse with advanced cancer was explored qualitatively with 13 older women. Interviews and diaries were analyzed using constant comparison. The psychosocial context emerged as the intrapersonal : exhaustion, loneliness, pain, and recovering physical health; the interpersonal: finding a new way through both supportive and difficult relationships; and the community/societal: a loss of identity, pressure to move on, financial concerns, and relying on formal supports. The psychosocial context of bereavement for older women who were caregivers is uniquely challenging and must be considered when providing care and programs of support.     

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.     

Coping with loneliness among the terminally ill

Loneliness is a universal phenomenon, and its pain is intensified by a diagnosis of a terminal illness. The present study is an investigation of the strategies used by patients with Multiple sclerosis (MS), by individuals diagnosed with cancer, and by the general population to cope with loneliness. Three hundred and twenty nine MS patients, 315 cancer patients, and 391 participants from the general population answered a 34-item questionnaire. Results indicated that with the exception of Reflection and acceptance, Distancing and denial, and Increased activity, the three groups cope with loneliness significantly differently.     

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.     

Quality of life after radiation therapy: A study of 309 cancer survivors

(1) Comparison of patients with a national sample reveals no difference in income (adjusted for inflation), marital status and education level but patients, who are typically older, are more often retired or disabled. (2) Overall, perceived quality of life is nearly the same for patients and national sample; apparent differences can be readily explained by factors other than cancer or its treatment. (3) While some minor differences among patients were found as a function of their site of cancer, treatment modality, or health status, no evidence was found of significant detrimental effects due to radiation therapy or perceived quality of life. (4) Contrary to expectations of deteriorated quality of life, compared to the national baselines the patients are actually more satisfied with their lives as a whole.     

Patterns of pain and well-being in older women: a 10-year longitudinal study

The relationships among pain, health, and psychological well-being were examined in a secondary analysis of a ten-year study of community-dwelling older women. Over time, there was an increase in the percentage of women reporting pain and a significant increase in the mean level of pain, although 24% of the women never reported pain. Subjective health declined as pain increased. Psychological well-being did not differ between women whose pain increased over time compared to women whose pain did not increase. Future research needs to examine how women maintain psychological well-being as they age in spite of increased pain.     

Living Productively with Arthritis

Anhritis is the most commonly experienced chronic disease among older women. As such, it is essential for professionals to understand the disease process, treatment options, physiological and psychosocial implications as well as how to assist older arthrictic women in developing and implementing strategies for productive living. The disease process, treatment options, physiological and psychosocial implications are presented. The importance of patient education is stressed in addition to mechanisms for assisting older women in coping with pain, preventing or combating learned helplessness, minimizing functional limitations, addressing issues of sexual functioning, complying with medical regimen, and enhancing social supports. Managing stress and dealing with feelings are also discussed.     

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.     

Treatment decision-making among older women with breast cancer

This study examined breast cancer treatment decision-making among older adults, including professional and lay involvement. Thirty respondents were interviewed for this study; cancer survivors (70%) and newly diagnosed (30%) women with breast cancer. Respondents reported making treatment decisions in consultation with their oncologists. However, women differed on the extent to which they perceived their participation in the treatment process. Respondents' oncologists appear to be the primary factor associated with older women's breast cancer surveillance decision-making and adherence. The influence of women's support systems on their treatment decisions and surveillance activities appears to be minimal. Informal support systems, however, likely enhance women's ability to be active participants in their care. The growing need for interventions which target older women has been indicated. Interventions, however, cannot be adequately developed without first identifying the physical and psychosocial phenomena which affect decision-making.     

Quality Assessment of the Oncology Health Service in a Public Hospital

Quality assessment is a crucial issue in the strategic management of the public health sector. The objective of this study is to investigate the patients’ perception of the health system quality and explore the relationships between doctors and long-term cancer patients. The data under study have been collected during a survey conducted with long-term cancer patients who follow an oncological therapy in a Public Hospital. In the study, exploratory factorial analysis is developed and two structural equation models are proposed. The first model describes the service quality as perceived by the patients, which is influenced by four important factors, namely tangible aspects, reliability, empathy (doctor–patient human relations) and hospital organization. The second model describes the relationship between doctors and long-term cancer patients, which is influenced by three factors, that is reliability, empathy and hospital organization. The discussion highlights the contribution that the results of the study may make to the investigation of the possible strategies for improving health care service quality.

     

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.     

Assessment of Older Women with Chronic Pain

Females suffer from a larger number of chronic pain syndromes, live longer with chronic pain and disability, and more often live alone than males. Thus, they should be prime candidates for pain treatment. Yet a number of factors inhibit geriatric patients from receiving rehabilitation for their pain. Chronic pain has been determined to be a complex perceptual event that is influenced by psychosocial, behavioral, and biomedical factors. A comprehensive strategy for assessing chronic pain patients is described. Special attention is given to the association between pain and depression and the important medication of perceived interference with life, social support, and functional activities as these variables appear to be particularly relevant to a geriatric pain population.     

Agency and fatalism in older Appalachian women’s information seeking about gynecological cancer

Researchers consider older women in rural Appalachia to have low levels of agency and high levels of fatalism regarding decision making about cancer treatment. Using the life course perspective, we examined older women’s agency with information seeking about gynecological cancer. Semistructured interviews with 20 White women living in central Appalachia revealed four trajectories: Surrendering Control, Accepting Death, Self-Care, and Advocacy, each with its own forms of agency. Some women experienced personal transformation, increased self-efficacy, and a passion for community empowerment. Fatalism was not understood apart from placing trust in medical expertise. We implore researchers to further explore rural expressions of agency.     

Breast Cancer:

Cancer is a major problem for elderly individuals. Overall, it is the second leading cause of death after heart disease and 50% of all documented cases occur in 12% of the population over the age 65. About 50,000 women in the United States age 65 and older are diagnosed annually with breast cancer, making it one of the most serious health oroblems for women in this age ~ O U D I. t is the second leading causk of cancer deaths after lung cancer in women. While breast cancer is not preventable, the survival rate is near 100% if detected earlv. However. late staEe of diamosis remains a concern in this age groip. ~ ~ ~ r o x & n ai0t%e lo~f women with breast cancer present with metastases as the first indication of a malignancy. Early detection and screening offer the only solution to this dreaded situation. Society must find ways to make these practices available to the elderly.     

The impact of early-life economic conditionson cause-specific mortality during adulthood

The aim of this study is to assess the effects of economic conditions in early life on cause-specific mortality during adulthood. The analyses are performed on a unique historical sample of 14,520 Dutch individuals born in 1880–1918, who are followed throughout life. The economic conditions in early life are characterized using cyclical variations in annual real per capital gross domestic product during pregnancy and the first year of life. Exposure to recessions in early life appears to significantly increase cancer mortality risks of older males and females. It also significantly increases other mortality risks especially for older females. The residual life expectancies are up to about 8 and 6 % lower for male and female cancer mortality, respectively, and up to about 5 % lower for female cardiovascular mortality. Our analyses show that cardiovascular and cancer mortality risks are related and that not taking this association into account leads to biased inference.     

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.     

Effects of chronic illness on daily life and barriers to self-care for older women: A mixed-methods exploration

This mixed-methods study examined the subjective experience of living with chronic illness and identified barriers to self-care. Community-dwelling older women with chronic illness completed an initial (N = 138) and follow-up mailed survey 6 months later (N = 130). On average, participants reported four comorbid health conditions and the corresponding physical pain, activities curtailed or relinquished, and time and energy focused on managing health. Only 34% of participants practiced all 10 key self-care behaviors. Reported barriers to self-management included pain, lack of financial resources, and worry. In the regression analysis, having more depressive symptoms was a significant predictor of challenges with self-care behaviors.