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.     

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.     

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.     

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.     

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.     

The older female patient with a complex chronic dissociative disorder

Dissociative disorders are rarely considered in the diagnostic assessment of older women, despite the fact that the existence, appearance and characteristics of certain dissociative disorders in older populations has been known and described since the 1980s. This communication reviews the core phenomena of Dissociative Identity Disorder and related forms of Dissociative Disorder Not Otherwise Specified, the natural history of their phenomena from youth to old age, and describes common presentations of Dissociative Disorders in older women. It also reviews the treatment of complex chronic dissociative disorders and discusses alternative approaches to their psychotherapy in the older female patient. It is crucial to recognize and respect the importance of appreciating individual differences among older dissociative patients and to individualize their treatments accordingly.     

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.     

Self-management of a chronic illness: An exploratory study on the role of spirituality among older African American women

Living with a chronic illness is an experience characterized by changes in self-management behavior. Few studies have addressed the role of spirituality in the self-management of a chronic illness among older African American women. The purpose of this exploratory study was to understand the role of spirituality in the self-management of chronic illness. Data from a sample of 10 African American women were collected from semi-structured interviews and analyzed for common themes through narrative analysis. Four themes emerge from the linkage of spirituality and self-management. Understanding this experience will assist public health providers in creating culturally appropriate health education interventions.     

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.     

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.     

Self-Management of a Chronic Illness: An Exploratory Study on the Role of Spirituality Among Older African American Women

ABSTRACT

Living with a chronic illness is an experience characterized by changes in self-management behavior. Few studies have addressed the role of spirituality in the self-management of a chronic illness among older African American women. The purpose of this exploratory study was to understand the role of spirituality in the self-management of chronic illness. Data from a sample of 10 African American women were collected from semi-structured interviews and analyzed for common themes through narrative analysis. Four themes emerge from the linkage of spirituality and self-management. Understanding this experience will assist public health providers in creating culturally appropriate health education interventions.     

The importance of fairness and equity for the marital satisfaction of older women

In all societies, people are concerned with social justice. "It's just not right" is a fairly common lament. In these two studies, we interviewed 240 older women, who ranged in age from 50 to 82. We found that most older women (85%) considered their marriages to be fair and equitable. Older women were less concerned about existing inequities than their younger peers. Nonetheless, they were somewhat concerned with how rewarding and how fair and equitable their relationships were perceived to be. Those who felt over-benefited, for example, felt more guilty than did their less advantaged peers; those who felt under-benefited felt far more angry than did their privileged peers. Stressful life events--such as the arrival of children, retirement, serious illness, or the awareness impending death--often brought to awareness long simmering resentments over issues of fairness.     

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.     

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 Importance of Fairness and Equity for the Marital Satisfaction of Older Women

ABSTRACT

In all societies, people are concerned with social justice. “It's just not right” is a fairly common lament. In these two studies, we interviewed 240 older women, who ranged in age from 50 to 82. We found that most older women (85%) considered their marriages to be fair and equitable. Older women were less concerned about existing inequities than their younger peers. Nonetheless, they were somewhat concerned with how rewarding and how fair and equitable their relationships were perceived to be. Those who felt over-benefited, for example, felt more guilty than did their less advantaged peers; those who felt under-benefited felt far more angry than did their privileged peers. Stressful life events—such as the arrival of children, retirement, serious illness, or the awareness impending death—often brought to awareness long simmering resentments over issues of fairness.     

Women, aging, and schizophrenia

Schizophrenia is a psychiatric disorder of unknown etiology that typically has an onset in early adulthood and persists for the remainder of the lifespan. For most affected individuals, the illness is recurrent with psychotic symptoms that tend to be episodic in nature. The illness has pervasive and disruptive effects on many life domains; for example, women with schizophrenia are less likely to marry, bear children, and raise their own children than are women in the general population. The age of onset of schizophrenia is later on average in women then men, and women are over-represented among those who develop the illness after the age of 45. Among younger patients with schizophrenia, women tend to have less severe symptoms than men and better outcomes; however, there are fewer gender differences among older patients with schizophrenia. Older women with schizophrenia are vulnerable to problems of both schizophrenia and aging. Schizophrenia symptoms typically continue in later years and include ongoing psychotic symptoms. Problems of aging such as cognitive decline and chronic medical conditions may be exacerbated by schizophrenia and the disorder is associated with premature mortality. Older women with schizophrenia are at risk for neglect of psychiatric and other health needs that are further compounded by limited social support and low socioeconomic status. More research and clinical attention is needed to the problems of older women with schizophrenia.     

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.     

Experiences of Sleep and Benzodiazepine Use among Older Women

Sleep disturbances are common among older women; however, little is known about sleep experiences among chronic benzodiazepine users. The experience of sleep, sleep troubles, and management of sleep problems were explored through semistructured interviews with 12 women aged 65–92 who had used a benzodiazepine for three months or longer to treat a sleep disturbance. Themes that emerged from an interpretive phenomenological analysis included multiple reasons for sleep disruptions (health problems, mental disturbances, and sleeping arrangements), opposing effects of benzodiazepines on sleep (helps or does not work), and several supplemental sleep strategies (modification of the environment, distraction, and consumption).     

Functional consequences of work-related spinal musculoskeletal symptoms in a cohort of Australian midwives

BackgroundEarly evidence suggests spinal musculoskeletal symptoms are as prevalent in Australian midwives as in samples of nurses. Functional consequences of these symptoms include sick leave and functional incapacity, which are costly at both individual and workplace levels. To date there have been no studies of these consequences in midwives.QuestionWhat risk factors are associated with sick leave and functional incapacity among midwives with spinal musculoskeletal symptoms?MethodsWe undertook a cross-sectional study of qualified Australian midwives who completed the baseline survey of the Nurses and Midwives e-Cohort Study. A comprehensive set of independent variables were examined for bivariate associations with the main outcomes of sick leave and functional incapacity due to work-related musculoskeletal symptoms in the neck, upper or lower back. Associations that achieved a p value < .1 were entered into multiple logistic regression models.Findings729 midwives with a mean age of 46 years were eligible for inclusion. Functional incapacity was more than twice as common as sick leave. Severity of worst pain was the explanatory variable most strongly associated with each main outcome and the only one significant for both. Psychological job demands showed a significant association with sick leave, while several individual factors were associated with both outcomes. Only the association of poorer general health with functional incapacity remained significant in all three spinal regions.ConclusionOur sample reported considerable work-related musculoskeletal pain and functional incapacity. Factors associated with sick leave and functional incapacity in midwives should be confirmed by longitudinal studies with the aim of developing tertiary prevention strategies.     

How Does the Age Gap Between Partners Affect Their Survival?

I use hazard regression methods to examine how the age difference between spouses affects their survival. In many countries, the age difference between spouses at marriage has remained relatively stable for several decades. In Denmark, men are, on average, about three years older than the women they marry. Previous studies of the age gap between spouses with respect to mortality found that having a younger spouse is beneficial, while having an older spouse is detrimental for one’s own survival. Most of the observed effects could not be explained satisfactorily until now, mainly because of methodological drawbacks and insufficiency of the data. The most common explanations refer to selection effects, caregiving in later life, and some positive psychological and sociological effects of having a younger spouse. The present study extends earlier work by using longitudinal Danish register data that include the entire history of key demographic events of the whole population from 1990 onward. Controlling for confounding factors such as education and wealth, results suggest that having a younger spouse is beneficial for men but detrimental for women, while having an older spouse is detrimental for both sexes.