Sex differences in the development of mild cognitive impairment and probable Alzheimer’s disease as predicted by hippocampal volume or white matter hyperintensities

This study examined biological sex differences in the development of mild cognitive impairment (MCI) and probable Alzheimer’s disease (AD) development as predicted by changes in the hippocampus or white matter hyperintensities. A secondary data analysis of the National Alzheimer’s Coordinating Center Uniform Data Set was conducted. We selected samples of participants with normal cognition at baseline who progressed to MCI (n = 483) and those who progressed to probable AD (n = 211) to determine if hippocampal volume or white matter hyperintensities (WMH) at baseline predicted progression to probable AD or MCI and whether the rate of progression differed between men and women. The survival analyses indicated that changes in hippocampal volumes affected the progression to probable AD (HR = 0.535, 95% CI [0.300–0.953]) only among women. White men had an increased rate of progression to AD (HR = 4.396, CI [1.012–19.08]; HR = 4.665, 95% CI [1.072–20.29]) compared to men in other race and ethnic groups. Among women, increases in hippocampal volume ratio led to decreased rates of progressing to MCI (HR = 0.386, 95% CI [0.166–0.901]). Increased WMH among men led to faster progression to MCI (HR = 1.048. 95% CI [1.011–1.086]). Women and men who were older at baseline were more likely to progress to MCI. In addition, results from longitudinal analyses showed that women with a higher CDR global score, older age at baseline, or more disinhibition symptoms experienced higher odds of MCI development. Changes in hippocampal volumes affect the progression to or odds of probable AD (and MCI) more so among women than men, while changes in WMH affected the progression to MCI only among men.     

Exploring self-care among dementia caregivers:the role of perceived support in accomplishing exercise goals

Support provided by family and friends may influence the extent to which older women who are primary caregivers for a spouse with dementia adhere to an exercise routine. The current study reports on qualitative interviews with 30 older female caregivers taking part in an exercise intervention regarding the support they received for their exercise goals. Results indicate that nearly all women received some level of verbal encouragement from family and friends, though far fewer had exercise partners or someone to stay with their husbands while they exercised. To reflect the wide variation observed in the amount of exercise support received and needed by caregivers, a typology of support situations was constructed as follows: Self-reliant, Well-supported, Under-supported, and Superfluous support. Implications for future exercise interventions targeting this population are discussed.     

Learning to listen: epistemic injustice and gothic film in dementia care education

Listening is a critical and under-theorized dimension to struggles against injustice and marginalization. In the wake of critiques from the disability movement of the pre-eminence of expert medical voices, educating professionals to listen to health service users has become particularly critical. The utterances of people with dementia have frequently been subject to, in Miranda Fricker’s terms, “testimonial injustice”: that is, seen as irrational, unreliable, and not to be believed. This article will examine the way in which the generic conventions of the gothic, more specifically what Mary Ann Doane has described as “the paranoid women’s film,” are used in a short film, Darkness in the Afternoon, widely screened in dementia care education in the UK and internationally. Drawing on interviews with dementia care trainers, analysis of training materials, and the film itself, this article proposes that gender and genre is used in this film as a strategy to reorient the listening and affective practices and testimonial sensibilities of health and aged care workers.     

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.     

The Psychological and Health Consequences of Caring for a Spouse With Dementia: A Critical Comparison of Husbands and Wives

Caring for someone with dementia can be demanding, particularly for spouses living with the care recipient. The main goal of this study was to clarify differences in the experience of caregivers who were husbands and wives with respect to burden, health, healthy behaviors, presence of difficult care recipient behaviors, social supports, and the quality of the premorbid relationship. The results of this study support research demonstrating a difference between the caregiving experiences of women and men. It is becoming increasingly apparent that female gender is a marker that places them at increased risk of high burden and less support.     

Risk of Developing Dementia at Older Ages in the United States

Dementia is increasingly recognized as a major source of disease burden in the United States, yet little research has evaluated the lifecycle implications of dementia. To address this research gap, this article uses the Aging, Demographics, and Memory Study (ADAMS) to provide the first nationally representative, longitudinal estimates of the probability that a dementia-free person will develop dementia later in life. For the 1920 birth cohort, the average dementia-free 70-year-old male had an estimated 26.9 % (SE = 3.2 %) probability of developing dementia, and the average dementia-free 70-year-old female had an estimated 34.7 % (SE = 3.7 %) probability. These estimates of risk of dementia are higher for younger, lower-mortality cohorts and are substantially higher than those found in local epidemiological studies in the United States, suggesting a widespread need to prepare for a life stage with dementia.     

Gender, resources across the life course, and cognitive functioning in Egypt

In this article, I evaluate the life-course determinants of cognitive functioning among 1,003 women and men aged 50 and older in Ismailia, Egypt. Three questions motivate this analysis: (1) Do older women have poorer cognitive functioning than do older men?; (2) Do cognitive resources accrued in childhood and adulthood have net positive associations with later-life cognitive functioning for women and men?; and (3) To what extent do differences in the amounts and effects of women’s and men’s cognitive resources account for gaps in their cognitive functioning? Compared with men, women have lower Modified-Mini Mental Status Exam (M-MMSE) scores for overall cognitive functioning. Cognitive resources in childhood and adulthood are jointly associated with the M-MMSE score. About 83% of the gender gap in mean M-MMSE scores is attributable to gaps in men’s and women’s attributes across the life course. Gender gaps in childhood cognitive resources—and especially schooling attainment—account for the largest share (18%) of the residual gender gap in cognitive functioning.Preferential investments in the human resources of boys have been common to many resource-poor settings (King and Mason 2001; Lloyd 2005), and the effects of such investments on gender gaps in child health are known (e.g., Hill and Upchurch 1995). Less well known is the extent to which gender gaps in resources that are accrued across the life course account for gender gaps in later-life health, despite known gender differences in the risks of illness, disability, and death. Demographic research on later-life health also has focused on physical conditions, even though dementia and neuropsychiatric disorders account for a large (~3%) and growing share of the disease burden worldwide (World Health Organization [WHO] 2007).This article assesses the determinants of cognitive functioning among older women and men (e.g., those aged 50 and older) in Ismailia, Egypt. It explores whether and to what extent (1) women have poorer cognitive functioning than men, (2) cognitive resources in childhood and adulthood have net positive associations with cognitive functioning for women and men, and (3) differences in the amounts and effects of women’s and men’s cognitive resources account for differences in their cognitive functioning. Egypt is a superb setting in which to conduct this work because of long-standing gender gaps in opportunities across the life course (e.g., Yount 2001; Yount and Sibai forthcoming) and poor knowledge about their potential effects on later-life cognitive functioning.     

Ability drain: size,impact, and comparison with brain drain under alternative immigration policies

Ability drain’s (AD) impact seems economically significant, with 30% of US Nobel laureates since 1906 being immigrants, and immigrants or their children founding 40% of Fortune 500 companies. Nonetheless, while brain drain (BD) and gain (BG) have been studied extensively, AD has not. I examine migration’s impact on ability (a), education (h), and productive human capital or “skill” s =s(a,?h), for source country residents and migrants under (a) the points system (PS) which accounts for h and (b) the “vetting” system (VS) which accounts for s (e.g., US H-1B program). The findings are as follows: (i) Migration reduces (raises) residents’ (migrants’) average ability, with an ambiguous (positive) impact on average education and skill, and net skill drain, SD, likelier than net BD; (ii) these effects increase with ability’s inequality or variance, are greater under VS than PS, and hurt source countries; (iii) the model and two empirical studies suggest average AD?≥?BD for educated US immigrants, with real income about twice the home country income; and (iv) SD holds for any BD and for a very small AD (7.4% of our estimate). Policy implications are provided.     

Physical and Mental Health Correlates of Self-Efficacy in Dementia Family Caregivers

This study examined whether self-efficacy for controlling upsetting caregiving thoughts would longitudinally predict mental and physical health as well as utilization of psychotropic medications in help-seeking dementia family caregivers (N = 53). Positive associations were found between self-efficacy and self-reported mental health and physical health subscales of the Short Form Health Questionnaire-12, and negative correlations were found between self-efficacy for controlling upsetting thoughts about caregiving and the number of psychotropic medications being utilized both cross-sectionally and longitudinally. These results suggest that self-efficacy for controlling upsetting thoughts may be a fruitful target area for further intervention research with dementia family caregivers.     

Religiousness and Fertility among European Muslims

Based on official data on religion, national origin, and other indicators of ethnic origin, Muslim fertility in 13 European countries is higher than that for other women, but in most countries with trend data the differences are diminishing over time. Fertility varies by country of origin of immigrants. Various European survey data show that higher proportions of Muslim women are married and their commitment to traditional family values is greater than among other women. Muslim women are more religious than non‐Muslim women and religiousness is directly associated with fertility. Among Muslim women, religiousness and commitment to family values are equally important for fertility, while for non‐Muslim women religiousness is much less important.     

Women,Aging, and Schizophrenia

SUMMARY

Schizophrenia is a psychiatric disorder of unknown etiology that typically has an onset in early adulthood and persists for the remainder of the life span. 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 than men, and women are overrepresented 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 for the problems of older women with schizophrenia.     

Predictors of perceived benefits and drawbacks of using paid service among daughter and daughter-in-law caregivers of people with dementia

ABSTRACT

This study examines the types of benefits and drawbacks of a sample of daughter and daughter-in-law caregivers (CG) of people with dementia and explores the predictors associated with the identified benefits and drawbacks. The current study used a secondary analysis of a purposive sample of 102 daughters or daughters-in-law living in Northeast Ohio who were required to be using at least 8 hours of paid services per week to help in caring for their care recipient (CR) with Alzheimer’s disease or other memory problems. Logistic regression was used. All respondents answered that there were benefits of having the paid help, but 51% of them reported drawbacks as well. The analyses revealed that predictors of each identified benefit and drawback were different. Information about benefits and drawbacks of paid help is useful for service providers to design better services for CGs of people with dementia.     

Divorce,living arrangements,and material well-being during the transition to adulthood in rural Malawi

In this paper, we use longitudinal data to investigate how parental death and divorce influence young women’s own experience of divorce in Malawi, a setting where women marry relatively early and unions are fragile. We find that maternal death and parental divorce are positively associated with divorce for young women but, after controlling for socio-demographic and marital characteristics, only the association with maternal death remains statistically significant. Maternal and paternal death are both strongly associated with women’s post-divorce living arrangements, which in turn affects their material well-being. This finding suggests that divorcing at a young age shapes the subsequent life chances of women; although some women return to their parental home and may have the opportunity to reset the transition to adulthood, other women begin their 20s as head of their own household and with considerable material disadvantage.     

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.     

Do Health Insurance and Residence Pattern the Likelihood of Tubal Sterilization among American Women?

American women have increasingly opted for tubal sterilization or tubal ligation surgery in recent decades. While research has begun to examine the unequal access to health care in the United States, little research has considered how this may impact whether women opt for a tubal ligation surgery. We first profile women with and without tubal ligations using bivariate analysis of the most recent data available, a nationally representative sample of 7,643 women from the National Survey of Family Growth, Cycle 6 (NSFG, Public use data file, 2002). We then use logistic regression models to examine the relationship between having tubal ligation and two focal variables: (1) type of health insurance (Medicaid compared with private, government or military, and no health insurance), and (2) rural or urban place of residence. We find that women on Medicaid are nearly twice as likely to have had a tubal sterilization compared with women who have private health insurance coverage. Also, women on Medicaid are substantially more likely to have a tubal sterilization than women with government or military insurance and women with no health insurance (26% and 36%, respectively). Further, we find that women living in rural areas are nearly twice as likely to have a tubal sterilization, compared with women in urban or suburban areas, all else being equal.     

Assisting women to make informed choices about screening for Group B Streptococcus in pregnancy: A critical review of the evidence

The approach to the prevention of early onset GBS disease in the newborn varies considerably from country to country. The Centre for Disease Control in the United States advocates universal culture based screening with the administration of intra-partum antibiotics, usually benzylpenicillin or ampicillin, to women who are colonised with GBS. National groups in the UK and New Zealand advocate a risk-based approach where intra-partum antibiotics are given to women with identified risk factors. The Canadian Taskforce on preventive health care has identified a third approach; where intra-partum antibiotics are given to women with a positive GBS culture and an identified risk factor. There are no national guidelines or consensus in Australia.The aim of this paper is to explore the evidence for screening and intrapartum prophylaxis for GBS. The three main methods of detection and management of GBS in pregnancy are described and the implications for women and midwifery practice are addressed. It is hoped that this discussion will provide women, midwives and other clinicians with a summary of the evidence, risks and benefits to enable informed decision making.     

Recruitment strategies for conducting research on women's retirement

Currently, little information is available to inform new or returning researchers about designing and conducting research on the topic of women and retirement. Few published studies describe how to access non-probability samples of retired women, yet preliminary evidence suggests women possess distinctive characteristics that affect their retirement as well as complicate the recruitment process. In this article, certain challenges and benefits of conducting research with women in retirement are presented. Next, important issues to consider prior to sampling retired women are described. Finally, specific strategies for identifying and recruiting community-dwelling retired women are presented and discussed.     

Is Stepfamily Status Associated With Cohabiting and Married Women’s Fertility Behaviors?

Children from prior relationships potentially complicate fertility decision-making in new cohabitations and marriages. On the one hand, the “value of children” perspective suggests that unions with and without stepchildren have similar—and deliberate—reasons for shared childbearing. On the other hand, multipartnered fertility (MPF) research suggests that childbearing across partnerships is often unintended. Using the 2006–2010 National Survey of Family Growth and event-history models, I examine the role of stepfamily status on cohabiting and married women’s fertility and birth intendedness, with attention to union type and stepfamily configuration. Adjusting for covariates, women in stepfamily unions are more likely to have a first shared birth in a union than women in unions in which neither partner has children from past relationships, but stepfamily births are less likely to be intended than unintended. Further, this association varies by union type: married women have similar birth risks across stepfamily status, but births are less likely to be intended in marital stepfamilies. For cohabitors, women in a stepfamily are more likely to have a birth than women in nonstepfamily unions, with no differences in intendedness. Configuration (whose children and how many) also matters; for instance, women with one child from a past relationship are more likely to have a birth and to have an intended than unintended birth than women with other stepfamily configurations. It appears that children from either partner’s prior relationships influences subsequent fertility decision-making, undermining the utility of the “value of children” perspective for explaining childbearing behaviors in complex families.     

Recruitment Strategies for Conducting Research on Women's Retirement

ABSTRACT

Currently, little information is available to inform new or returning researchers about designing and conducting research on the topic of women and retirement. Few published studies describe how to access non-probability samples of retired women, yet preliminary evidence suggests women possess distinctive characteristics that affect their retirement as well as complicate the recruitment process. In this article, certain challenges and benefits of conducting research with women in retirement are presented. Next, important issues to consider prior to sampling retired women are described. Finally, specific strategies for identifying and recruiting community-dwelling retired women are presented and discussed.     

Improving women’s experiences of perineal suturing: A pragmatic qualitative analysis of what is helpful and harmful

BackgroundPerineal trauma requiring suturing is increasing, along with the associated physiological and psychological morbidities for women. Provider training appears to focus more on technical aspects rather than respectful, relational care for women. Studies exploring women’s experiences have identified that how women are cared for can significantly impact upon overall experiences.AimTo identify areas of improvement to the perineal suturing process and provide robust recommendations for urgent change by investigating what aspects are most traumatic to women and which are most supportive.MethodsA pragmatic qualitative analysis of data generated from 15 in-depth interviews with women who were sutured following birth.FindingsRegardless of tear severity, what was identified as helpful included anything that made the process better by increasing feelings of trust and reassurance, and providing women with a sense of being seen and heard. Harmful experiences were identified as those that worsened the experience, by increasing feelings of fear and vulnerability and leaving women with a sense of being disregarded or disrespected.ConclusionThe study confirmed that how the suturing process is conducted can have a significant detrimental impact upon women’s short- and longer-term physical and psychological well-being.Implications for practiceAn improved experience for women is most likely with kind professionals who explain the process as it goes along, check-in regularly and validate how the women feel. Women prefer to be sutured by a known professional, only if this provider is also kind and respectful.