Aging is a woman's issue. Older women are more likely to live longer, be widowed, live alone, and live in poverty and in poorer health than men. To top it off, older women often have more family caregiving responsibilities than do older men.
Women's life expectancy is 77 years compared to 73 years for men. If a woman lives to age 65, she is expected to live until the age of 84 (U.S. Department of Health and Human Services, 2002). The longer women live, the more likely they are to have prolonged chronic illness - almost three of four women older than 65 have two or more chronic conditions (Centers for Medicare & Medicaid Services, 1999). With age, the chronic illnesses cause increasing disability.
At any age, women are at greater risk for poverty than men. The disparities are particularly pronounced in old age. Women 65 and older are twice as likely as older men in this age group to be poor, with annual incomes of less than $10,000 (Social Security Administration, 2000). Gender differences in chronic impairment are also linked to parallel differences in income and poverty. Individuals who are poor have poorer health. Throughout the life course, women are poorer than men because they receive lower wages and smaller private and public pensions. Despite some improvements in women's wages, they are still only approximately 70% of those earned by men, and women with private pensions receive approximately 50% of those received by men (Meyer, 2001). Because of poverty and longer life, women use Medicare and Medicaid for lengthier time periods.
Older women's financial difficulties are compounded by their tendency to live alone. Older women are more likely to be single because of widowhood or divorce than men. More than 33% of older women live alone compared with 14% of older men. More than half (53%) of women 85 and older live alone, compared to 25% of men 85 and older who live alone (Gibson & Brangan, 1998). Only 14% of African American women older than 65 live with a spouse (Quadagno, 1999).
Many elderly women who require help with every day activities rely on family and friends. Three of four elderly disabled individuals rely exclusively on informal unpaid caregivers - most of whom are older women (Federal Interagency Forum on Aging-Related Statistics, 2000). One of four women age 65 to 74, and one in 10 older than 75, is a caregiver (National Alliance for Caregiving, 1997).
When combining disability with the fact that most women live alone it is understandable that women are more likely than men to have a longterm care nurse and to use long-term care services. In 1996, 1.5 million elderly women lived in long-term care facilities, comprising 85% of the nursing home population in the United States (Federal Interagency Forum on Aging-Related Statistics, 2000). This happened despite the fact that 95% of the population of nursing home residents did not want to live in a nursing home (National Citizen Coalition for Nursing Home Reform, 1985). Few other options exist for older women with little money, limited social support, and chronic health problems.
The result of these gender differences is that women live more years with limitations and disabilities that interfere with their earnings, their mental and physical health, and their overall quality of life. They are limited in their access to health care by their finances and by the availability of affordable options for assistance and care with chronic illnesses and disabilities.
Nurses must lead the charge to improve the conditions of aging for women. As nurses, we must do this because we are the health care providers who most often care for these women. We must also do it because as a predominately female profession, we are working on our own future. We must do it because it is nursing's professional mandate and we can do it.
What needs to be implemented?
* Policy changes to improve women's wages and pensions as well as programs that will reduce women's unpaid care burden.
* Policy changes to reduce the risk of impoverishment and the costs of caregiving rather than having them assumed disproportionately by women.
* Monitoring Medicare and Medicaid changes to assure the situation for women is not worsened.
* Increased options and alternatives for quality care and living arrangements.
* Increased research in women's physical and mental health issues.
* Increased visibility of adverse situations faced by older women.
This month's Journal of Gerontological Nursing is a start in what needs to be done to increase the visibility of issues for older women. Important topics addressed include interventions for women who are depressed, the emotional distress of incontinence, the role of attentional processes in community dwelling elderly women, and the concept of aloneness and transgenderism in aging. It is hoped the contents will inspire gerontological nurses and others to action.
One action being taken by some nurses is the development of innovative alternatives for care and support for older individuals. However, many of these nursing innovations are not often widely shared or known. To encourage more of these nursing alternatives for older individuals in a less than encouraging environment, more sharing and collective influence are needed. If you are involved in an innovative alternative for care for older individuals, please write and let me know. Two colleagues at the University of Iowa College of Nursing and I are seeking to identify nurses offering alternative models for older individuals. We are preparing a publication on nurse-developed alternatives for older individuals and would like to let others know what is available and what kind of support is needed for change in policy and practice. We would also like to develop a consortium to share best practices and outcomes with each other and policy makers. Nurses are in the position to make these and other changes in the lives of older women, and when that happens, good things will also happen for older men.
- Centers for Medicare & Medicaid Services. (1999). The characteristics and perceptions of the medicare population. Retrieved June 11, 2003, from http://cms.hhs.gov/mcbs/ CMSsrc/1999/Summary2.pdf
- Federal Interagency Forum on Aging-Related Statistics. (2000). Older Americans 2000: Key indicators of well-being. Washington, DC: U.S. Government Printing Office.
- Gibson, M.J., & Brangan, N. (1998). Out-ofpocket spending on health care by women age 65 and over Medicare: 1998 projections. Washington, DC: AARP Public Policy Institute.
- Meyer, M. H. (2001). Gender, generations, and chronic conditions. The Public Policy and Aging Report, 11(2), 7-12.
- National Alliance for Caregiving and AARP. (1997). Family Caregiving in the US. Washington, DC: AARP.
- National Citizen Coalition for Nursing Home Reform. (1985). A consumer perspective on quality of care: The resident's point of view. Washington, D.C: NCCNHR.
- Quadagno, J. (1999). Aging and the life course. New York: McGraw Hill.
- Social Security Administration. (2000). Income of the population 55 or older. 199s: Tables VIIIA and VIILU. Washington DC: U.S. Government Printing Office.
- U.S. Department of Health and Humans Services. (2002, September 12). HHS issues report showing dramatic improvement in American's health over past 50 years. Retrieved June 9, 2003, from http://www.hhs. gov/news/press/2Q02pres/200209 1 2.html