The Women's Movement and Older Women's Health

Since women are an increasing proportion of the older population, the health issues that affect older Americans must be regarded in large part as women's issues. Women experience aging differently from men. The advantage in life expectancy of. women over men is not always a boon. Older women have substantially lower incomes and higher poverty rates, are more likely to be widowed and living alone, and depend more on entitlement and social service programs. This paper traces the evolution of the women's movement and identifies some of the health care problems of older women in terms of psychological, socio-cultural, and economic factors. The role of the medical establishment and federal regulations that affect older women are examined. The White House Conference on Aging (1981) is seen as a prelude to the current policies of the Administration that affect older women. Necessary policy changes on the Federal and local levels are discussed as well as the need for redirection in the women's health movement.     

Influence of Life Course Socioeconomic Position on Older Women's Health Behaviors: Findings From the British Women's Heart and Health Study

Objectives. We examined the association between health behaviors and socioeconomic status (SES) in childhood and adult life.Methods. Self-reported diet, smoking, and physical activity were determined among 3523 women aged 60 to 79 years recruited from general practices in 23 British towns from 1999 through 2001.Results. The most affluent women reported eating more fruit, vegetables, chicken, and fish and less red or processed meat than did less affluent women. Affluent women were less likely to smoke and more likely to exercise. Life course SES did not influence the types of fat, bread, and milk consumed. Adult SES predicted consumption of all foods considered and predicted smoking and physical activity habits independently of childhood SES. Childhood SES predicted fruit and vegetable consumption independently of adult SES and, to a lesser extent, predicted physical activity. Downward social mobility over the life course was associated with poorer diets and reduced physical activity.Conclusions. Among older women, healthful eating and physical activity were associated with both current and childhood SES. Interventions designed to improve social inequalities in health behaviors should be applied during both childhood and adult life.In 1977, the United Kingdom Department of Health commissioned an inquiry focusing on health inequalities in the country''s population. The resulting report—the Black Report, published in 1980—highlighted the marked association between adult socioeconomic status (SES) and mortality rates.¹ Such socioeconomic gradients in mortality rates persist today, tracking into old age.²Inequalities in health are a result of clearly identifiable social and economic factors that could potentially be modified to improve people''s quality and length of life. Employment, education, housing, transportation, environment, health care, and “lifestyle” (in particular smoking, exercise, and diet) all affect health and tend to be favorably distributed in advantaged groups.In the United Kingdom, the introduction of the National Service Framework for Coronary Heart Disease in 2000 was intended to reduce the prevalence of and social inequalities in coronary risk factors in the country''s population.³ Achieving these aims requires equitable access to and use of preventive care irrespective of SES, age, and gender. Health promotion initiatives such the “5-a-day” fruit and vegetable diet plan,⁴ smoking cessation clinics, and structured exercise plans have all been part of the drive to reduce the prevalence of coronary risk factors.Recent years have seen increased recognition of the potential implications of life course SES and a deeper understanding of the conceptual framework on which it is based.^5,6 There is growing evidence that coronary heart disease (CHD) risk is associated with life course SES,^7–10 with those in the most disadvantaged SES groups throughout life showing nearly 3 times greater risk than those in more advantaged groups.⁸ This raises the question of the extent to which behavioral CHD risk factors are similarly dependent on life course SES. We examined the effects of childhood and adulthood SES on various health behaviors (diet, smoking, and physical activity) of older British women.     

Older Women's Experiences with Multiple Health Conditions: Daily Challenges and Care Practices

Guided by life-course theory and a trajectory model of chronic illness, we examined the health care practices and management strategies used by 17 older women with multiple chronic conditions. Qualitative analyses revealed that the women played an active role in shaping the course of their illness within their everyday lives. Pain and a decline in energy frequently interfered with completion of daily activities. To compensate, many women reduced and slowed down the pace of activities they performed while emphasizing the importance of maintaining independence and autonomy. Appreciative of support from family members, at times the women received more help and advice than they preferred.     

Three Year Health Outcomes Among Older Women at Risk of Elder Abuse: Women's Health Australia

BACKGROUND: Older women are at increasing risk of various forms of familial violence, yet detection is poor and very little is known of the long-term health effects of this psychosocial problem. The effectiveness of the 'Vulnerability to Abuse' Screening Scale (VASS) in predicting three year health outcomes was investigated among women enrolled in the Australian Longitudinal Study on Women's Health, now known as Women's Health Australia. METHODS: The sample comprised a cohort of 10,421 women aged 73-78 who completed the 1996 and 1999 postal surveys (attrition rate 19.5%). The Time 2 sample had a small bias towards lower risk for elder abuse at Time 1 and better health on SF-36 and self-rated health. The VASS is a 12-item self-report measure with 4 factors: vulnerability, coercion, dependence and dejection. RESULTS: Overall, physical health (PCS) declined while mental health (MCS) increased over the three year period. Decline in physical health was predicted by only the dejection factor, but not by factors which seem to more directly measure abuse. The predictive validity of the VASS for three year mental health outcomes was given partial support. Three of the four VASS factors (dejection, vulnerability, and coercion) predicted decline in mental health at the univariate level, however, after adjusting for confounders, only one VASS factor (dejection) independently predicted decline in mental health. CONCLUSIONS: While the VASS shows some promise as a marker of health risk in older women, only the dejection factor proved consistently predictive of declining health status. Further research is needed to determine longer term predictive validity of the scale and to gain a clearer picture of how abusive experiences impact on older women's health.     

Women's Health Issues

To assess the ways in which social work is addressing issues in women's health care, the profession's journals from 1985-1992 were searched, yielding 36 articles. Over half addressed issues of rcproduction and sexuality including prcgnancy, Family nlanninc, abortion, substance abuse in pregnancy, and fetal oroteciion poficies. ~emainin~ articles addr&sea me&cal diagnoies; including AIDS/HIV/STDs, cancer, illnesses associated with aging, PMS, Turner's Syndrome, and chronic fatigue syndrome. Foci, methodologies, and recommendations are discussed and the authors critically analyze the articles' reflections of the status of women's health as a social work concern.     

Mental Health and Older Women

Currently it is estimated that up to 25 percent of the elderly manifest symptoms of mental disorder. The recognition of the seriousness of the problem has lead to a growing body of research in the field of geriatric mental health. This paper presents an overview of early gerontological studies of life satisfaction and morale of older persons and of the two most prevalent mental health problems of the aged, depression and dementia. Mental health service delivery and utilization issues are also considered.     

Women's Health Care Centers

Feminist health and holistic health movements predate and contribute to the currenl changes in women's hcalth care. Recentlv, there has been r rivilalization of women's IiealUi centers reflechg three approaches to women's health: (1) centers with an exclusive focus on one health problem, e.g., breast cancer, chemical dependency (2) centers with a predominantly reproductive focus, and (3) centers with a holistic/feminist health care focus. Based on an exploratory survey of women's centers in a large city, this paper identifies differences among them and discusses the potential for misguidance that may occur with the current increase in women's health centers. It also discusses the implications of this growth for social work education and clinical practice.     

Improvement of Older Women's Sexuality Through Emancipatory Education

The purpose of this action research (AR) was to explore the ways in which sexuality is experienced daily and to improve the expression of older women's sexuality. The pedagogy of autonomy as proposed by the Brazilian educator Paulo Freire theoretically supported this AR, with the participation of six older adult women living in a rural setting in southwest Brazil. The older women's experiences regarding sexuality, their concerns, and their educational demands could be summarized through five phrases: the improvement of self-esteem as a way to promote sexuality; sexuality impaired by loneliness and lack of affection; men's sexual satisfaction seen as a woman's obligation; women's sexuality controlled by the society; and relinquishment of the companion to attend to the expectations of family members. Dialogical and participative educational approaches and continuous observation-participation strategies were performed to support the women's care and educational requirements.