Women and Positive Aging: An International Perspective

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Section I

The Psychology of Women’s Aging

Outline

Section I. The Psychology of Women’s Aging

Chapter 1 Older Women and Their Mental Health Needs

Chapter 2 Women’s Resiliency and Psychological Adaptation to Aging

Chapter 3 Aging Self-Acceptance for Women

Chapter 4 Aging Women and Mental Aerobics

Section I. The Psychology of Women’s Aging

The first section of the book examines issues related to aging women’s health on psychological, physical, cognitive, and social bases. In order to ensure positive aging for women from a societal perspective, it is vital to understand the factors that precipitate and impact a woman’s aging trajectory over time. The purpose of this section of the book is to introduce many foundational research ideas and practical issues related to women’s aging from a diversity perspective. A cross-cultural and individual-differences examination of aging women’s issues is important in order to identify both universal and unique experiences of aging. Across chapters in this section, person-environment fit issues are discussed in different ways as they relate to women’s positively aging over time.

Chapter 1

Older Women and Their Mental Health Needs

Abstract

Chapter 1 examines the ongoing mental health needs of women as they age. It should not be assumed that men and women are exactly the same in terms of factors determining positive mental health. Because of the diverse issues that women may inherently bring or encounter across the life span, the nonnormative aspect of development has meaningful ramifications for women’s resultant positive aging. For example, the role-related experience of being an elder caregiver of a parent or spouse across many decades of a woman’s life can certainly affect her mental, physical, and cognitive health. It is sometimes thought that the role of elder caregiver is solely negative but it can certainly be an equally challenging growth experience for women which stimulates both the mental and physical engagement of their environment on a daily basis. The general aim of this section is to discuss positive aging factors which can then be incorporated into supportive interventions for aging women, assisting in their achievement of positive aging outcomes within the context of their genetic, cultural, and physical environment.

Keywords

Harmonious aging; mental health; later-life role transition; social power and empowerment; mind-body connection; role of culture

Global Fact: Unipolar depression is projected to be the second leading cause of global disability burden by the year 2020, and aging women are twice as likely to report this condition.

—World Health Organization (n.d.)

Across everyone’s life span, people are faced with a variety of life situations which require adaptive coping reactions and a healthy mental attitude. The process of getting older is one of those significant life situations to be positively adapted over an extended time period. An understanding of realistic aging processes is a vital factor underlying effective personal adaptation. Before reading this chapter further, please take the Facts of Aging quiz in Appendix A to assess your knowledge about aging-related facts and associated adjustment issues. What did you learn? Apply what you learned from taking the quiz to the proceeding discussion of aging women’s mental health and psychological adjustment.

What factors underlie positive aging attitudes and adaptation? Myint et al. (2011) suggested that many life events significantly impact an older adult’s ability to successfully adapt and achieve positive quality-of-life outcomes. Being both actively engaged in daily activities and open to new experiences (eg, learning new information or skills) are two examples of conducive events promoting positive and adaptive responses to aging-related changes. Aging can be a challenging experience for most people, especially within certain living circumstances (eg, community-dwelling older adults; Akincigil et al., 2011).

Aging research started to turn its attention to issues of positive aging and adjustment from a woman’s perspective over 30 years ago (eg, Levy, 1981). Whether older women are truly different than their male counterparts in terms of mental health characteristics, as well as predictive factors, needs further examination (eg, Pachana, McLaughlin, Leung, Byrne, & Dobson, 2012). It is interesting to note that although older men and women are very similar in many ways, their patterns of mental health diagnoses show some differences within different cultures (eg, South Korean culture; Lee & Lee, 2011) and life situations (eg, stressful role responsibilities; Darling, Coccia, & Senatore, 2012).

Is it possible that older women are inherently different in aging-related attitudes or coping reactions? Or, is this perception more an outcome of double jeopardy bias regarding stereotyped perceptions of women (eg, emotionality) and their aging (eg, decrement and loss)? This concept of double jeopardy (eg, Hollis-Sawyer & Cuevas, 2013) is important to explore because this stereotype may have a significant influence on women’s positive aging potential. In certain cultures and societies, older women may be at a social disadvantage in terms of financial viability, social power, and associated support resources. Exploring this idea from a positive aging perspective, women who are empowered and supported in their social roles will be better able to cope and proliferate when faced with aging.

Financial resources are important for women’s later-life adaptation and personal growth. The concept of feminization of poverty speaks toward this issue (Minkler & Stone, 1985), emphasizing the need for society to better understand lifespan issues of workforce participation, participation interruptions (eg, caregiving role demands), and an associated gender disparity in earned income (eg, wage gap and pension acquisition) significantly impacting women’s social status and living situations over a life span.

Women and Harmonious Aging

Positive aging as applied to mental health is analogous to Liang and Luo’s (2012) examination of the concept of harmonious aging. Brennan et al. (2012) emphasized the idea that there needs to be an examination of positive mental health perspectives to better understand and identify coping factors that assist in later-life adjustment. Grafova, McGonagle, and Stafford (2006) suggested that there is a very important link between older adults’ feelings of positive well-being and their associated functional status in conducting activities of daily living.

The delicate balance between mental health and functional status is a vital issue to examine with women who are faced with balancing many roles and responsibilities across a life span (Byles, Gallienne, Blyth, & Banks, 2012). The impact of the caregiver role within a woman’s life cannot be understated because of its broad range of role demands and responsibilities within the family system. Further, being a caregiver can have a significant impact upon an aging person’s mental and physical health (Hoffman, Lee, & Mendez-Luck, 2012; Neysmith, & Reitsma-Street, 2009; Nordtug, Krokstad, & Holen, 2011). Financial and other support resources may be depleted over time for older women who have been caregivers over many decades of their lives.

Aging Women’s Resources and Mental Health

Lack of resources and lack of support may lead to older women developing feelings of depression. Not surprisingly, there is a linkage between depression and being admitted to nursing homes (eg, Miller, Pinet-Peralta, & Elder, 2012). To combat this possible aging trajectory for women, it is important for societies to offer substantially more programs and services to support and supplement the caregiving needs of women across a life span. Chu, Huynh, and Areán (2012) purported that therapeutic interventions need to be grounded in an understanding of cultural beliefs and values (eg, older adults in China). Tailoring community programs and mental health services for aging women to be culturally relevant would only assist in their effectiveness and long-term benefits for all involved.

Quotes from Famous, Positively Aging Women

Old age is not a disease – it is strength and survivorship, triumph over all kinds of vicissitudes and disappointments, trials and illnesses.

—Maggie Kuhn, Activist

If we are strong, and have faith in life and its richness of surprises, and hold the rudder steadily in our hands. I am sure we will sail into quiet and pleasant waters for our old age.

—Freya Stark, Writer

Only through these efforts within communities can positive change for women in terms of mental health adjustment be achieved. For communities to change, there must be broader cultural changes. Cultures which may not have conveyed the social value of women and their roles must consciously shift their focus to consciously value and support aging women’s efforts and contributions within family systems in the broader society.

Women’s Later-Life Role Transitions

An important aspect of aging across the life span involves examining role transitions over time. Wink and Jacquelyn (2006) posed the question, is later life the crown of life? This is an important question in terms of the culmination of life experiences as women age. Women have many social roles, some that are maintained over life spans and some that change. Some roles are defined by family system dynamics such as being a daughter, a sister, a mother, and other possible roles. Other social roles are defined by society with different societal valuations associated with them (eg, career status). Life circumstances can directly impact aging women’s health on a daily basis. For example, Jaussent et al. (2011) examined how women experience stressors that cause interruptions in their sleeping behavior. Disrupted sleeping behavior over time can have effects upon both one’s mental and physical health. Stressors that women experience need to be addressed through community-based and aging support services to alleviate such potential negative influences on one’s otherwise normative aging trajectory.

Tips for Women’s Positive Mental Health

1. Be physically active on a daily basis.

2. Eat healthy and take care of yourself.

3. Take a break and enjoy life.

4. Get adequate rest.

5. Write down your accomplishments and make a wish list of plans to do.

How older adults perceive their social status within communities, based on social-economic status or other social standards, has a significant influence on older women’s internalized feelings of social value and relevancy (Kim, Richardson, Park, & Park, 2013; Ladin, Daniels, & Kawachi, 2010; Pudrovska & Anishkin, 2013). Beyond the family system, women may be faced with different role transitions such as retirement. Changes and loss of social roles over time have an impact upon an aging woman’s life and adaptation outcomes. How successfully an older woman adapts to these role-related changes is both a product of her own personal resiliency and coping strategies learned over time and how society supports these role transitions within the aging population.

Cultures and broader societies need to better educate aging women in terms of how to best transition between roles as they move from work to retirement and from caregiver to care recipient (eg, Olesen & Berry, 2011). Certainly there is a cultural valuation of working that translates into cognitive activity and stimulation for aging women; degree to which women can maintain an engaged active role in work can have positive benefits on their later-life adjustment (Van der Elst, Van Boxtel, & Jolles, 2012).

It is important to acknowledge that inequities regarding the social power and resources of women over a life span have implications toward older women’s mental health outcomes. From positive aging perspective, societies need to focus on empowering women to optimize their aging progress and potential. If achieved, possible gender differences in reported depression, anxiety, and other mental conditions may be minimized among the normal aging population. What factors support aging women’s potential for optimal later-life achievements?

Check It Out!

Search the Internet to find different websites regarding cultural ideas of aging women and mental health. As you review this online content about aging women and mental health (eg, coping) issues, think about the following questions:

1. What are the cultural images about older women and mental health?

2. Are there gender differences in older adults’ mental health portrayals? How so?

3. Is the information presented in terms of positive or negative mental health issues for aging women?

4. In your review, what are the issues related to positive mental health for a growing, aging female population?

5. In examining this online content, are there unique mental health issues related to specific generations of women as they age? If so, why?

Social Power, Empowerment, and Coping of Older Women

The psychological need for independence and autonomy for women as they age can be a critical quality of life issue. Analyzing an older woman’s role within a culture helps us better understand both her needed resources and role-related self-esteem needs. Research suggests a possible curvilinear relationship between age and social power (Schwartz & Bilsky, 1987), impacting aging women’s quality of life. If older women experience a declining social status in response to their aging, this certainly can impact their feelings of life satisfaction, self-esteem, and other psychological reactions (Dowd, 1975). Conversely, cultures and communities which value the contributions of older women benefit both society and the mental well-being of older adults in their society. This social valuation may translate into older women’s internalized feelings of personal self-worth and their ability to adapt to life’s many challenges.

Ryff, Friedman, Morozink, and Tsenkova (2012) argued that a key component to positive later-life adjustment is an individualistic trait of psychological resilience. Even though one might think of this as a trait-related issue, it might be argued that this can also be part of training in community programs for older adults. Understanding the influence of culture on aging women is an important factor for support services offered to older women in different cultures. For example, Thorpe et al. (2011) purported that there are interesting cultural differences between how older Caucasian and African-American women mentally adjusted to experiences of disability and loss due to death, with African-American women utilizing more informal social support resources.

Having a positive life perspective (eg, seeing the glass as half full) in later life in response to aging can be a key predictor of positive aging outcomes in different living environments (in rural Alaska; Lewis, 2013). Steptoe, Leigh, and Kumari (2011) found that one’s mood and associated reactions to daily life activities has a significant impact on older adult functioning. Culturally sensitive education within communities may assist in older women developing effective resiliency responses. Lee and Smith (2011) emphasized the need for education as a factor supporting mental well-being among Korean older adults coping with change in life circumstances as they age. Educational interventions can benefit both the body as well as the mind. Health education initiatives within communities are crucial to promote the overall well-being of an aging population (eg, Perrig-Chiello & Hutchison, 2010).

Mind-Body Connection in Aging Women’s Mental Health

There is certainly a mind-body connection (Brower, 2006), when we examine positive aging mental health outcomes for women. One’s mental health and associated health perspectives can have an impact on one’s physical health (Millán-Calenti, Sánchez, Lorenzo, & Maseda, 2012). Fredriksen-Goldsen et al. (2013) investigated the mind-body connection of physical and mental health and associated health risk factors for aging lesbians, among other aging groups. This type of research is an important step in better understanding the many diverse needs of aging women from different perspectives and life trajectories. Too often, interventions and support programs may focus on the external needs of aging adults without paying attention to the very important internal needs. Darling et al. (2012) emphasized the need to acknowledge older women’s experiences of stressors as they relate to the feelings of life satisfaction and health status.

This mind-body balance applies to the examination of factors (eg, body weight, physical strength, and balance) underlying why women might live longer across many different cultures in the world (eg, Carroll, Blanck, Serdula, & Brown, 2010; Lakey et al., 2012). Both normative and nonnormative health issues are important to understand for intervention purposes (eg, aging Greek patients with Parkinson’s disease; Andreadou et al., 2011). Test yourself with the following positivity scale to understand associated factors.

Test Yourself!

Positivity Scale

Source: Caprara, G.V., Alessandri, G., Eisenberg, N., Kupfer, A., & Steca, P. (2012). The positivity scale. Psychological Assessment, 24(3), 701–12.

Instructions: Please respond to the following items using the response scale and fill in the number from the Likert scale:

1. I have great faith in the future. ______

2. I am satisfied with my life. ______

3. Others are generally here for me when I need them. ______

4. I look forward to the future with hope and enthusiasm. ______

5. On the whole, I am satisfied with myself. ______

6. At times, the future seems unclear to me. ______

7. I feel I have many things to be proud of. ______

8. I generally feel confident in myself. ______

Scoring: Reverse score item #6. Add up the scores. The higher the score, the more resilient you are. Read the article by Caprara, Alessandri, Eisenberg, Kupfer, and Steca to gain more understanding of this brief scale and what it measures.

Subjective perceptions are just as important to understand as objective health indices. An aging woman’s self-rated health is shown to be equally important to other factors to adjustment in later life (Hamid, Momtaz, & Rashid, 2010). To have a positive and/or realistic attitude about one’s physical health influence one’s feelings of positive mental health adjustment in later life (Ruthig, Hanson, Pedersen, Weber, & Chipperfield, 2011). There are unique issues related to the experience of women aging which impact their mental health.

Positive mental health is vital to assist in adaptive responses to the many different role transitions as both a woman and older adult in their specific family system, culture, and other social contexts. It is important to acknowledge that there are universal aging adjustment issues for women. These mental health concerns will only be exacerbated as women across the world continue to live longer, living longer even with chronic conditions such as arthritis. Across their life span, women are typically the default caregivers of significant others in their lives. This is vital to understand because it does have implications toward the stressors and potential mental health issues that women accumulate over time. Brody (2004) among other researchers has discussed the concept of women in the middle, highlighting the idea that there are many societal pressures related to the roles of women in society as they attempt to balance their role of caregivers with their other responsibilities (eg, career).

The mind-body connection for aging women should be an integral part of how and why mental health support programs are designed and implemented for this aging subpopulation. It will be discussed throughout this book how women’s roles have an impact upon their aging processes. Conversely, a woman’s aging positively or negatively affects her social roles and associated role transitions over time. Understanding this dynamic process from a cultural perspective is imperative if effective community-based initiatives are to be offered to aging women in many different societies. In this discussion of understanding universal stressors and potential mental health concerns with aging women across the world, it is very important to examine the same issues within a cultural context.

Factors Determining Aging Women’s Mental Health Outcomes

Certainly understanding important individual difference factors of life circumstance and lifestyle is necessary for appropriate interventions to be designed to support aging women’s mental health outcomes. Gerstorf et al. (2009) suggested that there are many individual differences which determine the degree to which older adults achieve feelings of positive well-being. For example, what social activities an older woman engages in on a frequent basis can certainly have a positive impact on her mental health status. Berner, Rennemark, Jogréus, and Berglund (2012) examined mental health outcomes related to individualistic traits and the use of the Internet in social activities among older adults in Sweden. The degree to which older adults utilized social networks on the Internet predicted the degree of overall social connectedness for most individuals.

The use of technology and its accessibility for aging women as a resource of social communication and support needs further attention within communities on a global basis. Texting emails and chat rooms may be a very positive social resource for women as caregivers and other roles when they feel the need to share their thoughts and feelings with those who share similar life experiences. The use of technology is one way where aging women may feel a sense of social belongingness within (and beyond) her community, a concept suggested by Maslow’s hierarchy of needs theory (Maslow, 1999) among other adaptation theories.

The concept of social belongingness may be extended to the role of spirituality in one’s life and how it relates to social support from two perspectives: one’s religious community and one’s supportive relationship with a spiritual being (Vahia et al., 2011). Hill (2010) and McFarland (2010) examined gender differences related to religious involvement and older adults associated feelings of positive mental health and adjustment capabilities. Both research studies emphasized the need for older adults to have some degree of religious involvement as a lifestyle factor to support feelings of social connectedness within one’s community and social belongingness within one’s social support system.

Social belongingness can be associated with older women’s feelings of positive self-determination. Bojorquez-Chapela et al. (2012) studied the impact of older adults’ feelings of personal autonomy and perceived social capital in Mexico, and the degree to which older women and older men reported feeling empowered and having self-determination in their daily activities was related to positive feelings of aging adjustment and acceptance. The degree to which older adults can engage in and have assistance with self-care activities (eg, Meals on Wheels program usage) has a meaningful impact upon their positive mental adjustment in later life (Choi, Teeters, Perez, Farar, & Thompson, 2010; Rodriguez-Blazquez, Forjaz, Prieto-Flores, Rojo-Perez, Fernandez-Mayoralas, & Martinez-Martin, 2012), and may assist in aging women’s aging in place efforts in the home and broader