What Impacts Health Outcomes in Older Women?

Structural Macrosocial Factors: The Health Outcomes of Older Women

Vulnerable older adults are commonly faced with social isolation, poverty, mobility, cognitive, and functional impairments, with multiple comorbidities and medications, that greatly impact their health outcomes and quality of life. This is the population that I work closely with in cancer care. Attempting to understanding the social epidemiology that influences the health of older adults with cancer is an overwhelming task, so to start I will try to articulate the some of the broad macro level social factors that influence the health of women 65 years and older.

The conceptual model presented in Kaplan’s (2004) article displayed below, illustrates the various social structural influences on an individual’s health from a ground-up approach.

I will attempt to use this conceptual model above to illustrate the structural macrosocial factors that influence the health of older women, which closely pertains to my work.

Background

Older adults in Western culture are commonly faced with social isolation, and many of them are women. In Canada, 9% of older adults who are 65 years or older are women, compared to 7.5% who are male (Statistics Canada, 2015). Women live longer, and therefore have more comorbidities, yet they receive less medical interventions that older men (Clarke, Bennett, and Korotchenko, 2014). Due to longevity of older woman, they require more health care visits, have higher rates of social isolation, decrease social and financial supports (Clarke et al., 2014).

History

Throughout history, societal attitudes, practices, and policies that positioned older women as invisible and isolated in their homes, Today, women older than sixty-five years of age, were raised in a time in history that was paternalistic and offered little choice, power, and privilege to women, and were expected to care for their children and aging parents without pay or subsidy from the government. Historically, sexist and paternalistic societies have perpetuated this caregiving role of women, which resulted in limited work opportunities, which has been shown to contribute to poorer health in older age (Davidson, DiGiacomo, & McGrath, 2011).

The needs of older women are often advocated by and addressed by nongovernment organizations, rather than essential government bodies, and “as a consequence the unique needs of women are less visible in population planning and policy” (Davidson et al., 2011, p. 1032).

Authors Davidson et al. (2011) uncover the need for policymakers to employ a gendered approach to health policy, research, and health delivery, to generate the‘feminization of aging’ discourse; which is understood by women living alone longer, having more comorbidities that leaves them more vulnerable to social isolation, poverty, elder abuse, and decreased access to care.

Culture

Ageism

Ageism is the discrimination of a person because of their age and social discourse marginalizes older people (Neysmith, 2018). Societal marginalization of older adults is a result of the prejudice attitudes and actions, steaming from ageism which is defined as “the stereotyping and discrimination of older people because of age” (Phelan, 2008, p. 322). Dominant social and medical discourse contributes to the notion that the maintenance of health is a private matter that is the responsibility of the individual, failure to maintain is one’s own fault, perpetuating societies views of dependence of elders as burdensome (Neysmith, 2018). Older persons generally have lower sociodemographic status, health literacy, and access to health care, which are predictors of mortality (Burhenn et al., 2016).

Dominant social discourse values youth and vitality in society, reducing the opportunity for older adults to participate in social or economic realms and therefore diminishes their representation in policy and professional practice (Phelan, 2008). Societal views commonly portray older adults as dependent, burdensome, unemployable, asexual, mentally incapable, and senile (Phelan, 2008) (Azulai, 2014). This devaluing and poor representation of this population contributes to apathy towards mistreatment of seniors and breeds tolerance of oppressive societal actions which would be considered deplorable for other age groups (Phelan, 2008). Ageist discourse results in both physicians and patients believing their deteriorating health is a natural part of aging, reducing the initiation of medical interventions that would normally be prescribed to alleviate the symptom (Clarke, Bennett, & Korotchenko, 2014).

Sexism

Sexism oppresses women in society, impacting one’s sense of control and “how they enact health seeking behaviors” (Davidson et al., 2011). The current older generation, socialized before the social revolution which emancipated oppressed woman and other minority groups, are more comfortable maintaining traditional gender-roles and often have traditional paternalistic interactions with their physician; therefore, taking a backseat approach to their health care (Clarke et al., 2014). Sexist discourse in our society cause paternalistic practices within the predominantly male biomedical health care system, maintain the invisibility of older woman and their health care needs. Male physicians have been reported to “infantilize their older patients”, speaking to them in a less egalitarian way, assume negative and demeaning stereotypes of elderly women (Clarke et al., 2014, p. 28). This sexism leaves older women powerless and intimidated by their doctors; struggling to articulate themselves during medical visits, and therefore do not advocate to have their health needs addressed (Clarke et al., 2014). In addition, woman may also view their caregiver role in the home as more important than their health, preventing them from accessing health services (Clarke et al., 2014).

Institutions

The dominant bio-medical model in Canadian health care, which assumes the physician is at the top of the hierarchy, defining the parameters of health, and assuming individuals have the capacity to access health care freely and independently (Gephart, 2007). The narrow norms and standards of the bio-medical model discourse creates ageism in our health systems causing inadequate delivery of services to older woman who have more complexity, comorbidity, vulnerability, longevity, and invisibility due to their primary caregiver’s status to their aging spouse (Davidson et al., 2011)

Historically, empirical discourse from research has contributed to the assumption that woman have the same health outcomes related to medical interventions as men, even though woman were not equally represented in the research, if at all (Rolls & Young, 2012). In cardiovascular disease research, women have more associated risk factors than men, but are less studied, receive fewer interventions, have poor health outcomes, and are measured to the male normative frame of reference (Rolls & Young, 2012).

Geriatric medicine is subject to inconstant funding and have low prestige in the medical world, resulting in limited training of clinicians which perpetuates a poor understanding of how care should be delivered to older adults (Azulai, 2014).

Impact on Older Women’s Health

Older people in general subjectively view themselves as dependent and of less value than younger age groups (Phelan, 2008). This phenomenon is reinforced in the research by Tan & Kraus (2015) on self-reported health amongst the social classes, illustrating how dominant discourse can greatly impact one’s personal views of their quality of health and can potentially shape long-term trajectories of health and negatively affect marginalized individuals (Tan & Kraus, 2015).

Davidson et al. (2011) exposes the discourse on widowhood and the adverse effects it can have on an older women’s health outcomes; which is further impacted by a plethora of social, economic, cultural, and political factors, as widows are often face with “decreased financial status due to loss of spousal income and medical and caregiving costs at end of life if their spouse was ill” furthering the vulnerability of this group (Davidson et al., 2011, p. 1036).

Examining structural macrosocial factors has exposed multiple levels of influence from society on a women's position within invisible hierarchies which have a lasting impact on the health outcomes of women as they get older due to lack of power and advantage throughout their life.

References

Azulai, A. (2014). Ageism and future cohorts of elderly: Implications for social work. Journal of Social Work Values & Ethics, 11(2), 2-12. https://www.researchgate.net/profile/Anna_Azulai/publication/263846803_Ageism_and_future_cohorts_of_elderly_Implications_for_social_work/links/54662a840cf25b85d17f5a5e.pdf

Burhenn, P. S., McCarthy, A. L., Begue, A., Nightingale, G., Cheng, K., & Kenis, C. (2016). Geriatric assessment in daily oncology practice for nurses and allied health care professionals: Opinion paper of the Nursing and Allied Health Interest Group of the International Society of Geriatric Oncology (SIOG). Journal of Geriatric Oncology, 7(5), 315-324. doi: https://doi.org/10.1016/j.jgo.2016.02.006

Clarke, L. H., Bennett, E. V., & Korotchenko, A. (2014). Negotiating vulnerabilities: How older adults with multiple chronic conditions interact with physicians. Canadian Journal on Aging, 33(1), 26-37. doi:10.1017/S0714980813000597

Davidson, P. M., DiGiacomo, M., & McGrath, S. J. (2011). The feminization of aging: Howwill this impact on health outcomes and services?. Health Care for Women International,32(12), 1031-1045. doi:10.1080/07399332.2011.610539

Gephart, R. (1999). Paradigms and research methods. Research Methods Forum, 4.

Neysmith, S. M. (2018). Using Ageism as a Lens for Challenging Inequities in Home Care. Social Work and Policy Studies: Social Justice, Practice and Theory, 1(001).

Kaplan, G. A. (2004). What’s wrong with social epidemiology, and how can we make it better?. Epidemiologic Reviews, 26(1), 124-135.https://www.ncbi.nlm.nih.gov/pubmed/15234953

Phelan, A. (2008). Elder abuse, ageism, human rights and citizenship: Implications for nursing discourse. Nursing Inquiry, 15(4), 320-329. doi:10.1111/j.1440-1800.2008.00423.x

Rolls, T. P., & Young, L. E. (2012). Disrupting the biomedical discourse: Older women's lived experiences with heart failure: A feminist review of the literature. Canadian Journal of Cardiovascular Nursing, 22(1), 18-25.

Statistics Canada (2015). Summary Table: Population by sex and age group, by province and territory (Proportion of, both sexes). Government of Canada. Retrieved from: http://www.statcan.gc.ca/tables-tableaux/sum-som/l01/cst01/demo31d-eng.htm

Tan, J.J.X & Kraus, M.W. (2015). Lay theories about social class buffer lower-class individuals against poor self-rated health and negative affect. Personality and Social Psychology Bulletin, 41(3), 446-461. DOI: 10.1177/0146167215569705