Understanding older women's health care concerns: a qualitative study

‘I've never given it a thought’: older men's experiences with and perceptions of ageism during interactions with physicians

The subjective experience of ageism among older men has received little research attention. This study examines older Canadian men's experiences with and perceptions of ageism during interactions with physicians. In-depth, face-to-face interviews were conducted with 21 men aged 55 years and over. The findings indicate a seeming lack of awareness of ageism among many, and many did not believe ageism was likely to occur during patient–physician interaction. Negative stereotyping of older patients was common. A large majority of the participants reported that they had not personally experienced ageism during a medical encounter, nor were they concerned about it. Numerous rationales were proffered as explanations of why a particular participant had not experienced ageism and who was more likely to be a target.

‘My opinion is that doctors prefer younger people’: older women, physicians and ageism

This study examines older women's views about and subjective experience of ageism during interactions with physicians. Views about and experience of sexism are also examined. Data were obtained from in-depth, face-to-face interviews conducted with 36 Canadian women 55 years and older. The findings indicate that older women believe ageism is likely to occur during medical encounters and are concerned about it. Few, however, claim to have personally experienced it. Contradicting the stereotype of the passive older patient, many participants were employing strategies to avoid becoming targets of ageism. Although there was some concern about sexism during medical encounters, in general, the women appeared to be less conscious of sexism than ageism.

Not Too Old, Not Too Young: Older Women's Perceptions of Physicians

RÉSUMÉ Les femmes plus âgées interagissent avec les médecins plus souvent que les hommes âgés et les personnes plus jeunes; pourtant, la connaissance et la compréhension de leurs expériences avec les médecins sont limitées. Le but de cette étude était d'étudier les perceptions des femmes âgées de leurs interactions avec les médecins et d'identifier ce que les femmes veulent de leurs médecins. Les entrevues en profondeur avec 30 femmes âgées montrent que la majorité veulent être impliquée activement dans leurs propres soins de santé. Dans la relation patient-médecin, les femmes donnent généralement la priorité aux qualités personnelles de médecins et leur comportement à l'égard du patient. Pour de nombreuses femmes, l'âge et le sexe du médecin ont aussi leur importance.

Health Status and Health Determinants of Older Immigrant Women in Canada: A Scoping Review

Increasing international migration in the context of aging populations makes a comprehensive understanding of older immigrant women's health status and determinants of their health particularly urgent. Using Arksey and O'Malley's framework, we conducted a scoping review to examine the available literature on the health of older immigrant women in Canada. We searched CINAHL, PsycINFO, Embase, Medline, and Cochrane databases for the period of 1990 to 2014 for Canadian-based, peer-reviewed studies on the topic. A total of 20 articles met the inclusion criteria. These articles were divided into six areas of focus: physical health; mental health; abuse; health promotion and chronic disease prevention; barriers to healthcare access and utilization; and health beliefs, behaviours, and practices. Our results show that the health of older immigrant women is affected by the interplay of various social determinants of health including the physical and social environment; economic conditions; cultural beliefs; gendered norms; and the healthcare delivery system. Our results also revealed that older immigrant women tend to have more health problems, underutilize preventive services, such as cancer screening, and experience more difficulties in accessing healthcare services.

Negotiating Vulnerabilities: How Older Adults with Multiple Chronic Conditions Interact with Physicians

La littérature concernant les interactions entre les patients et les médecins a largement ignoré les points de vue des personnes âgées souffrant de comorbidités multiples. Cette étude, avec des données recueillies à partir d’entretiens approfondis avec 16 hommes et 19 femmes qui ont eu une moyenne de six affections chroniques, a porté sur la façon dont les participants ont perçus et vécus les soins fournis par leurs médecins de soins primaires. Les participants ont suggéré que les médecins qui soignent les patients atteints de maladies chroniques multiples devraient être minutieux, prête à “gate-keeping,” fiables et ouvert à différents styles de prise de décision. Cependant, nombreux participants à l’étude ont perçu qu’ils recevaient des soins inadéquats en raison de faiblesses personnelles de leurs médecins, les contraintes de consultations médicales, et l’âgisme sociétal. Par conséquent, beaucoup de participants, surtout les femmes, ont utilisé des diverses stratégies pour maximiser les soins reçus et pour gérer les impressions des médecins à leur egard comme dignes patients. Nos résultats suggèrent que les patients âgés atteints de morbidités multiples perçoivent que leur besoins de santé ne sont pas suffisamment satisfaits.

Effect of age, education and health status on community dwelling older men's health concerns

INTRODUCTION

A significant gap in evidence characterizes the process of establishing patient-centered health priorities for older men.

METHODS

A cross-sectional postal survey of 2325 Canadian community dwelling men aged 55-97 years old was conducted in 2008 to gauge older men's level of concern for 24 different health items, to determine the impact of age, education and health status on these perceptions, and to ascertain whether men perceive that their health concerns are being attended to.

RESULTS

Health issues of greatest concern to men were mobility impairment (64% of respondents), memory loss (64%), and medication side effects (63%). Respondents with lower educational attainment expressed greater concern about their health and were almost 2-fold times more likely to report being concerned about stroke, heart disease and prostate disorders in analyses that controlled for age and health status. Physical and mental health were independently associated with various concerns about health, but old age was not a reliable predictor, with only younger men (<75 years old) differentially preoccupied by conditions such as erectile dysfunction. Health items of greatest concern to men tended to be those with the lowest screening or counseling rates: these included incontinence, osteoporosis, mobility impairment, falls, anxiety issues, memory loss and depression.

CONCLUSION

An improved consumer-guided agenda for addressing older men's health in the coming decade is urgently required.

Red, Hot, Healthy Mommas

There are 3.7 million people 65 years of age and older living in poverty in the United States, and over half are women. This article foregrounds such women’s voices about the aging process while simultaneously providing a space to critically examine issues regarding cultural/medical norms, mind/body duality, and healthcare advocacy. The author interviewed six women, ranging in age from 50 to 65, who frequently attended a healthcare program titled “Red, Hot, Healthy Mommas.” Employing narrative analysis, the author explores two types of counterstories they told in order to understand how these women re-identify and resist the aging process. The author suggests a third counterstory called “negotiated” because findings point to elements that both combat oppression while simultaneously reinforcing dominant metanarratives. Despite the edifying potentials of these strategies for women, the findings also indicate that patient autonomy and responsibility for one’s own healthcare is not necessarily the best solution in combatting discrimination that aging women face in today’s society.

Osteoporotic Caucasian and South Asian women: a qualitative study of general practitioners' support

Health professionals face two complicated but contradictory epidemics: obesity and osteoporosis (OP). While obesity is obvious, OP progresses silently affecting one in two UK women. Both South Asian and Caucasian women are at OP risk. This study compared experiences of osteoporotic Caucasian and South Asian women in a purposive sample of 21 volunteers from south east England, aged 43 to 82 years. The women had been diagnosed for eight months to 40 years. Long disease duration was marked by complacent OP dialogue, although OP was objectionable and marked a loss of quality of life. Inductive content analysis of transcripts showed that 'uncertainty'--about one another and about what constituted helpful self-care--affected both GPs and patients. Instead, support groups and the media supported learning about OP care. Beyond providing drug prescriptions, women reported desiring, but rarely feeling, that GPs fully supported their preferences for self-care. Self-care often included specialist exercise classes. Some younger women led their GPs to better understand the range of self-care options. GPs were seen as being unsure about how and when to discuss physical activity (PA). In conclusion, women with OP in this sample are sensitive to their GP's hesitance about offering detailed PA recommendations. Regardless of ethnicity, younger women undertook PA based on personal initiative. Positive PA experiences stimulated an interest in discussing PA with GPs, and these dialogues broke the silence surrounding OP care. By providing important information regarding the OP patient experience, the findings highlight the unmet desire of OP sufferers for better and closer attention from GPs.

Exercise and nutrition in older Canadian women: opportunities for community intervention

BACKGROUND

The objectives of this study were to examine age differences in the extent to which older Canadian women exercise and eat nutritiously, and to identify the interventions they desire to help them adopt and maintain physical and nutritional fitness.

METHODS

A cross-sectional postal survey of 5,000 community-dwelling women aged 55-95 was conducted across Canada in October 2003. The survey queried exercise frequency, nutritional risk, functional status, and factors deemed facilitative to adopting and maintaining a physically fit and nutritiously healthy lifestyle.

RESULTS

Data from 2,484 women were available for analysis; 31% were 75 years and older. Among women aged 55-74 versus those over age 75, 62% compared to 56% reported exercising 3 times/week for 20 minutes or longer (p = 0.003), 33% in both age groups were eating nutritiously, and 24% compared to 21% were both exercising and eating nutritiously. Thirty-five percent of women aged 55-74 who were not exercising or eating nutritiously desired increased availability of low-cost, suitable health promotion programs and additional written materials to improve these health habits, compared to 25% of women in the 75 year and older group (p < 0.001). Improved transportation to programs was the only intervention preferred by women aged 75 years and older (OR 1.66 (1.30-2.11)). Sedentary women and those at higher nutritional risk were two to three times more likely to identify encouragement from health professionals (OR 1.93 (1.48-2.52)), as well as from family and friends (OR 3.03 (1.89-4.85)) as important facilitators.

INTERPRETATION

Women aged 55-74 who do not exercise and eat nutritiously are most receptive to a variety of health-promoting community interventions.

Examining Older Adults’ Perceptions of Health Care Providers: Identifying Important Aspects of Older Adults’ Relationships With Physicians and Nurses

This article describes older adults' conversations about their relationships with health care providers. Focus group participants (N = 23) were from three ethnic groups (Black, White, and Hispanic) and ages 53 to 92. All but three of the participants were women. Content analysis revealed an overarching theme of genuine caring and three sub-themes: interest in patients' well-being, respectful dialogue, and sharing of information. Older adults' perceptions of genuine caring by physicians and nurses did not differ by ethnicity. Older adults want to engage in a caring, respectful, and educational relationship with their health care providers, which is consistent with fundamental professional values.

Using Narrative Research to Understand the Quality of Life of Older Women With Breast Cancer

PURPOSE/OBJECTIVES

To elucidate some of the issues that affect the quality of life of older women (70 years of age and older) diagnosed with breast cancer.

DESIGN

Descriptive design

SETTING

A National Cancer Institute-designated site in the southeastern United States.

SAMPLE

12 women who were at least 70 years of age undergoing treatment (radiation, hormonal, or chemotherapy) for breast cancer.

METHODS

Two to three interview encounters per participant, each lasting approximately one hour.

FINDINGS

Eight major themes emerged: Importance of God, Positive Attitude, No Alteration in Lifestyle, Physician Trust, Caregiver to Others, Importance of Health, Importance of Family, and Alteration in Lifestyle.

CONCLUSIONS

The eight major themes are similar in terminology but varied in individual meanings.

IMPLICATIONS FOR NURSING

Nurses must determine whether older women with a diagnosis of breast cancer are also primary caregivers to other individuals. As the story-gatherers for the healthcare team, nurses can use the data derived from interviews to document patients' health histories and provide a therapeutic process of coping with illness.

Health professionals, their medical interventions and uncertainty: A study focusing on women at midlife

Health professionals face a tension between focusing on the individual and attending to health issues for the population as a whole. This tension is intrinsic to medicine and gives rise to medical uncertainty, which here is explored through accounts of three medical interventions focused on women at midlife: breast screening, hormone replacement therapy and bone densitometry. The accounts come from interviews with UK health professionals using these medical interventions in their daily work. Drawing on the analysis of Fox [(2002). Health and Healing: The public/private divide (pp. 236-253). London: Routledge] we distinguish three aspects of medical uncertainty and explore each one of them in relation to one of the interventions. First is uncertainty about the balance between the individual and distributive ethic of medicine, explored in relation to breast screening. Second is the dilemma faced by health professionals when using medical evidence generated through studies of populations and applying this to individuals. We explore this dilemma for hormone replacement therapy. Thirdly there is uncertainty because of the lack of a conceptual framework for understanding how new micro knowledge, such as human genetic information, can be combined with knowledge of other biological and social dimensions of health. The accounts from the bone denistometry clinic indicate the beginnings of an understanding of the need for such a framework, which would acknowledge complexity, recognising that factors from many different levels of analysis, from heredity through to social factors, interact with each other and influence the individual and their health. However, our analysis suggests biomedicine continues to be dominated by an individualised, context free, concept of health and health risk with individuals alone responsible for their own health and for the health of the population. This may continue to dominate how we perceive responsibilities for health until we establish a conceptual framework that recognises the complex interaction of many factors at macro and micro level affecting health.

Persevering: the experience of well elderly women overcoming the barriers to the U.S. health care system

PURPOSE

To explore the barriers to health care for well older community living women living in a metropolitan area in North Central Texas.

METHODS

Qualitative thematic design. Forty-six women who attended seniors' centers in North Central Texas participated in focus groups. Then three individual and a key informant interviews were completed. Data were analyzed using Lubrosky's thematic analysis.

FINDINGS

The participants described barriers to access associated with provider barriers of devaluing older adults, the complexity and slowness of reimbursement, inadequacy of health insurance plans and physicians opting out of plans. Participants overcame these barriers by persevering.