Older women

Although poverty is an enormous issue in the psychosocial
life of any woman, this issue becomes more
important in elderly women. Women older than the
age 65 constitute the fastest growing segment of the
population and comprise the significant majority of
that total population.
By the year 2012, people age 65 and older will
comprise 14% of the total population, twice the
number in 1956.20 Moreover, women comprise an
even higher percentage of the elderly poor (72%),
and twice as many African-American women live in
poverty as Caucasian. Elderly women are half as likely
as men to have pensions and four times more likely to
become indigent and require Medicaid for nursing
home or other care.21
As women age, life-cycle tasks evolve significantly.
There is enormous diversity of life experience, health
status, economic conditions and overall social supports
each individual woman experiences. Many providers
will first come to know women during this
time as the frequency of visits tends to increase with
the development of health problems. Eighty percent
of elderly women older than age 65 have at least one
chronic health condition. Concerns about health may
well dominate over psychosocial concerns as well as
substantially impact quality of life.
Eighty per cent of elderly women older than age 65
have at least one chronic health condition.
Attention to psychosocial health may reap significant
benefits. The aging woman may have more time
for reflection, more knowledge about herself and life,
and be less driven by sociocultural norms of success
and achievement. This age has the potential to be a
time of enormous satisfaction. A lifetime of caretaking
for others may be turned, finally, toward the self.
Women may need permission to do so, and may
benefit from support and encouragement to see the
value in evolving roles.
It can also be deeply unsettling to no longer be
needed in familiar roles. What is perceived as a time
of freedom and independence to some can be a source
of depression and loss for others.
Major financial changes, whether caused by retirement,
death of a supporting partner, or divorce can
dramatically alter the course of an older woman’s life.
Statistically, a woman in America who reaches age 65
can expect to live another 19 years, a lengthy period of
time to finance and survive.
Several psychosocial challenges are likely to present
themselves as women age. Loss of partners, loved
ones, spouses, and siblings may place a woman at risk
of isolation, living alone, and marked diminution of
social supports.
Women who have enjoyed lifelong independence
may find themselves facing gradual dependence secondary
to physical decline. Our profoundly mobile
society may mean that children, grandchildren, and
other potential sources of support may be substantial
distances from each other. Retirement from work
may be associated with pleasure and joy in newfound
freedom or may result in a loss of sense of identity,
value and importance.
In this culture, aging women are not usually
revered and beloved for their wisdom and past work,
though surely, such family systems exist as places of
support for some. An individual’s ethnicity will influence,
to some extent, how older women are valued
within a family and community. Western culture, and
thus providers, tend to focus on loss in the elderly
rather than gain.
As chronic medical conditions mount, numbers of
prescriptions increase, and visits to the office become
regular, the provider and the individual can both lose
sight of the health that does remain. Gains of this
time in a woman’s life should be celebrated. A new
grandchild, volunteer work that is meaningful, travel,
pleasure in time spent with loved ones all contribute
to the health of an aging individual. These should be acknowledged and celebrated in the course of the
care as surely as the blood pressure should be
monitored.
Isolation is one of the greatest psychosocial risk
factors, and can lead to, or be a symptom of, depression.
Recognition by the provider that an aging individual
is becoming isolated can be an important step
in preventive care.
Isolation is one of the greatest psychosocial risk factors,
and can lead to, or be a symptom of, depression.
End of life issues are challenging for all providers,
and perhaps even more so for patients with whom
practitioners have developed strong relationships. Yet
the fruits of long relationship can be realized powerfully
in such times. All wish for a peaceful death. If the
provider genuinely knows the patient, then s/he genuinely
knows their wishes.
Inevitably, except for sudden unexpected deaths,
the process of physical decline, diagnosis, work up,
and treatment often moves women away from the
primary care arena into specialty and intensive care
settings. Primary providers can lose touch with their
patients, yet this is a time when their continued presence
can be quite valuable. Occasionally, the provider
will be the only individual who has had direct and
clear conversation about a woman’s wishes toward the
end of life. A provider’s responsibility clearly extends
through the end of life in such cases.
Confusion and conflict within families, particularly
gatherings of those from distances, may demand
the distinct voice of the provider who has had these
important conversations. It is a component of good
psychosocial care to assist the extended family in such
times, and honors a provider’s relationship with the
individual. Countless patients have experienced a
sense of abandonment by providers as the time for
medical intervention passes and the time arrives for
allowing the inevitable to occur. “A peaceful death can
only be possible if it is understood that the power of
death in the end triumphs over human science and
artifice, and that only a stepping aside to allow it to
happen can be faithful to the force of nature and
the respect owed to patients.”22 Practitioners must
remain present in order to see these relationships
through, to facilitate that stepping aside if need be,
and to continue the process of providing good psychosocial
care to those left behind.

Posted in: Health,Psychosocial health of well women through the life-cycle