Public Policy,Health Care and Older Women

For the first time in history, long life has become a problem. The most serious problem facing the older generation is the availability and affordability of health care. While the life expectancy of both men and women cbntinues to increase, the older population of the U.S. is becoming increasingly feminine. In the last two decades there has been a dramatic fall in poverty among the aged, yet for many elderly persons and especially older women, Social Security benefits barely keep them above the poverty level. Access to medical care has improved with Medicaid and Medicare, but not to the extent the aging population had anticipated. Proposals for universal health care have been put forth by politicians, legislators and professional organizations, some of which acknowledge the unique health problems of aging women while others are discriminatory to the aged in general and women in particular. Many believe women must assert themselves if their health care needs are to be adequately and fairly addressed. To this end, more women than ever are becoming involved in the political process, running for and being elected to local, state and national offices. It is anticipated that these women will be sensitive to the health care needs of older women and put forth efforts to develop and implement policies which address these needs.     

Older Women and the Health Care System: A Time for Change

SUMMARY

In spite of women's active involvement in a woman's health care movement, the mainline health care system continues to hold tight to its androcentric focus. If women are to be subjected to a health care system that employs sexist and ageist practices, the quality of life in their later years will continue to be jeopardized. The purpose of this paper is to first, recognize the existing health care practices which limit the health care opportunities and choices of older women; and secondly, to discuss how such basic feminist principles as education, egalitarianism, empowerment, and inclusion can be used to improve an older woman's experience.     

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.     

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.     

Aging of Indian Women in India: The Experience of Older Women in Formal Care Homes

The feminization of aging is a process that has begun in India but is not occurring uniformly throughout India. Older women are more likely to be widowed, poor, and suffer vulnerability to adverse outcomes like poor health. With the changing social landscape of India, middle-income older women are increasingly opting for ‘pay and stay homes’, an emerging type of old age home in India. Majority of the 97 women residents of ‘pay and stay’ homes reported being widowed (68%), and 25% were childless. Childlessness and widowhood were important considerations in the decision to relocate to an old age home. Older women reported higher degrees of psychological closeness and contact with daughters than sons, and the overall social network size was small. High prevalence of diabetes rates among older women carries implications for potential functional disability. Strong advocacy measures for empowering older women in India should be a priority policy directive.     

Factors Associated with Advance Care Planning Among Older Women in Southwest Florida

ABSTRACT

As the nation's population continues to age, many older women will face care needs that can be anticipated in advance. However, little is known about the advance care plans of older women and the characteristics of those who plan. This study utilized a stratified random sampling design to survey older women (n = 124) in the state of Florida regarding their attitudes toward future care and planning behavior in social-environmental, health, and financial domains. Regression analyses were conducted to determine factors most predictive of attitudes toward future care and planning behavior by domain. Results suggest that advanced age predicts greater planning behavior, while living alone is associated with less advance care planning behavior. Other factors associated with less planning by domains of care needs include income status, chronic health conditions, educational attainment, and religious status. Nonaccepting attitudes toward planning were associated with a decreased likelihood to have advance care planning documents.     

Care Arrangement Decisions for Frail Older Women: Quantitative and Qualitative Perspectives

ABSTRACT

This study uses both quantitative and qualitative methods to investigate how a range of care arrangement decisions for frail older unmarried women are made. Quantitative data from the 1989 National Long-Term Care Survey provides information concerning factors that predict the probability of five categories of care arrangements, including self only care, nursing home care, informal only care, formal only care, and a mix of formal and informal care. Qualitative interview data provides information on what occurs during care arrangement decision-making processes. Results are combined to explain the choice of care arrangements for a small sample of chronically disabled older unmarried women. Results show that need factors, such as age and disability, are strong predictors of the need for assistance. Family members played a central role in determining care arrangements and often helped an older woman to avoid an unwanted care arrangement. The use of a broad measure of impairment resulted in high levels of disability for the sample participants. Both disability status and care arrangements were transitory in nature.     

Health Profiles and Profile-Specific Health Expectancies of Older Women and Men: The Netherlands

SUMMARY

This study focuses on gender differences in health profiles, and examines which health profiles drive gender differences in remaining life expectancy in women and men aged 65 and over in The Netherlands. Data from the first two cycles of the Longitudinal Aging Study Amsterdam (n = 2,141 and 1,659, respectively) were used to calculate health profiles for individuals of 65–85 years. For both women and men, six profiles were found: I. cancer; II. “other” chronic diseases; III. cognitive impairment; IV. frailty or multimorbidity; V. cardiovascular diseases; and VI. good health. The further characterization of these types showed some gender differences. Remaining life expectancy for women was greater than for men in each health profile. A decomposition into health expectancies showed that both women and men could expect to live about 5 years in good health from age 66. The greatest gender differences in years spent with health problems were found for profile IV and for profile III. Their greater number of years spent in these health states have direct consequences for the type and cost of care women need.     

家庭老年照料对女性照料者健康的影响研究

本文基于中国健康与营养调查1991²009年的面板数据,利用面板工具变量估计模型分析从事家庭老年照料对女性健康的影响。研究发现:从事照料活动使女性过去四周患病率显著提高5.51%2009年的面板数据,利用面板工具变量估计模型分析从事家庭老年照料对女性健康的影响。研究发现:从事照料活动使女性过去四周患病率显著提高5.51%¹7.04%,自评健康状况"一般"和"差"的概率分别提高0.24%和0.10%。照料活动对于女性健康的影响存在城乡、家庭结构和居住模式上的差异。城镇地区女性从事照料活动对健康的影响明显高于农村地区;家庭中兄弟姐妹数量少于3人的女性因照料老年人导致过去四周患病率显著增加7.63%;对于与父母(公婆)同住的女性,提供照料使她们过去四周患病率上升6.66%;提供照料帮助还对不与父母(公婆)同住的女性有显著影响,使其自评健康水平下降7.41%。此外,高强度照料活动对健康的负面影响更大。     

Sexual Orientation and Sexual Health Care Needs: A Comparison of Women Beneficiaries in Outpatient Military Health Care Settings

ABSTRACT

The objectives of this study are to compare the sexual concerns, interest and experiences in discussing these concerns with their doctor for women of “Only Men” and “Some to Only Women” sexual orientation. A survey was mailed to women patients from two military outpatient settings, with 1,196 women responding. Of eligible respondents (N = 1,170), 90% reported “Only Men” and 10% reported “Some to Only Women” sexual orientation. Sexual concerns varied by sexual orientation, while interest and experience in discussing sexual concerns and desire for physicians to initiate the topic differed minimally. Women with “Some to Only Women” sexual orientation have both similar and differing sexual concerns compared to “male-only” oriented women. Larger primary care patient-based studies of sexual health care needs of sexual minorities are needed.     

Older Women Living in a Continuing Care Retirement Community: Marital Status and Friendship Formation

SUMMARY

Ethnographic observations and interviews with twenty female residents of a new Continuing Care Retirement Community (CCRC) revealed the patterns of friendship development experienced by older women. Qualitative analyses identified various phases of friendship development and aspects of the social context that facilitated friendship formation in its earliest stages. Marital status was a major factor in the selection of friends within this setting. Friendship styles and strategies for developing friendships varied considerably. Although most women successfully formed new friendships within this setting, certain subgroups seemed at risk for social isolation.     

Taking Charge of Self: Breast Health Practices of Older Rural Women

ABSTRACT

The purpose of this grounded theory study was to explore breast health practices of older Vermont women residing in rural communities. Although the three components of breast health-mammography, clinical breast exam, and self-breast exam-are recommended for women 40 years and over, minimal research has empirically analyzed the breast health practices of healthy women to ascertain if, in fact, these procedures are followed, and if so, what the motivation is for doing so. Twelve women, 50–64 years, participated in face-to-face, audiotaped interviews. Data analysis, including line-by-line and constant comparative approaches, occurred concurrently with data collection. Taking Charge of Self, the generated theory, describes participants' engagement in a process of learning how to take charge of their lives. The analysis indicates that health care providers have a powerful role in the lives of women in this age group. With an increasing emphasis on health promotion and disease prevention, health care providers are positioned to cultivate and support women's development of the personal or internal motivation for health and well-being.     

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.     

The Potential Impact of Discrimination Fears of Older Gays,Lesbians, Bisexuals and Transgender Individuals Living in Small- to Moderate-Sized Cities on Long-Term Health Care

ABSTRACT

As an exploration of the potential impact of fears of discrimination against GLBTs in long-term health care settings, this study compared perceptions of GLBT persons and heterosexuals. A total of 132 GLBT persons and 187 heterosexuals living in Eastern Washington completed a survey that contained demographic questions and perceptions of discrimination in long-term care settings. Most respondents suspected that staff and residents of care facilities discriminate against GLBTs. GLBT respondents who believed that residents of care facilities are victims of discrimination were more likely to believe that they would have to hide their sexual orientation if admitted to a care facility. GLBT respondents were more likely than heterosexual respondents to believe that GLBTs do not have equal access to health care and social services, that GLBTs residents of care facilities are victims of discrimination, that GLBT sensitivity training programs would benefit staff and residents of care facilities, and that GLBT retirement facilities would be a positive development for older GLBTs. This study is offered as a preliminary investigation of concerns about GLBT discrimination in health care settings, how concerns are expressed, and the implications of those concerns for health care needs.     

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.     

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.     

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.