F R O M T H E E D I T O R

Aging and Gender Issues

G ender is fundamental to per- sonal identity and is the pri-

mary way in which experience is organized. Gender is different from sex. Sex refers to the biologic di- morphic division of human beings; gender refers to the personal and cultural meanings of the biologic differences.

There is much to say about gender issues, but if one is not cau-

tious, it begins to sound like whining. Being female, if one is intent on a mate in late life, puts one at a disad- vantage in a basically monogamous society because there are several available women for every unattached man, and the older one gets, the more pronounced is the im- balance. Men have other concerns. Conditioned through- out life to be strong, controlled, and oftentimes controlling, the loss of strength and influence in aging can be devastating to self-concept. Note the vulnerability to suicide of the aged white man. It is believed that the cumulative costs of male gender expectations and lifestyle often result in poorer health and a shorter life span than in women.

It is believed that the cumulative

costs of male gender expectations

and lifestyle often result in poorer

health and a shorter life span than

in women.

Hardiness vastly favors women; life spans are 6 years longer in the United States and 8 years longer in Japan. Some believe a major factor is that women generally

Geriatr Nurs 1996;17:149-50. Copyright �9 1996 by Mosby-Year Book, Inc. 0197-4572/96/$5.00 + 0 34/1/74751

drink and smoke less, particularly the present cohort of old women. However, the gender gap is now closing slightly.

Women are in the majority in most countries of the world; if all were democracies women could hold signif- icantly more power. Whether they would or not is a moot point. We need only look back three generations in our history to see how many women fought against the fran- chise for women.

One of the major gender issues in

late life is that of caretaking.

One of the major gender issues in late life is that of caretaking. Numerous studies have shown caretaking as primarily a woman's role. Many frail old ladies take care of a frail old spouse to the detriment of their own health. And, after years of subverting their own needs, they be- come so intermingled with those of the spouse that on the death of the spouse, they are at a loss for filling the empty time and heart. Interestingly, a recent study done by Kaye and Applegate 1 provided strong support for the unwaver- ing devotion and direct caregiving capacity of old men, most often caring for a spouse with a disabling chronic illness. Because of our gender stereotypes, we may not have looked closely enough at the actual caregiving situ- ation with old couples.

Another gender statistic that has been widely accepted must be examined, that is that a significantly greater number of old women are afflicted with Alzheimer's dis- ease. The incidence of Alzheimer's disease increases ex- ponentially with age so that the extended survival of women skews the statistics. Age-adjusted statistics show that men have Alzheimer's disease more frequently than women. 2

When I was in high school, gender intelligence crossover was an assumed fact, fairly frequently brought to our attention; boys were much slower in school in the primary grades, but somewhere in the period when the es- trogens and testosterones started flowing, they rapidly became smarter than girls. Now some of the most recent research on Alzheimer's disease seems to support the ac- tion of estrogen in preserving cognition. 2

GERIATRIC NURSING Volume 17, Number 4 Ebersole 1 4 9

Women are not given as intense or immedia te cardiac care as men. Older women with a heart d isorder can ex- pec t to be t reated less energet ica l ly than men. More women than men die o f heart at tacks each year. There are several poss ib le reasons: hormonal protec t ion before menopause may give a false sense o f securi ty to women, as wel l as their phys ic ians ; hear t drugs have not as ye t been tested on old women, so the normal react ions and side effects are unknown. The r isk of death for women who have coronary ar tery angioplas ty is five t imes that o f men o f the same age with s imilar medica l histories , and they are two to three t imes less l ike ly to survive coronary ar tery bypass . 3 However , throughout adul t l ife before age 65, men are much more at r isk for hear t disorders.

We often hear about the unequal dis t r ibut ion of eco- nomic resources be tween men and women. Yet there are numbers of old women who inheri t vast estates on the death o f their husbands. I suspect that the maldis t r ibut ion o f resources within the gender is a cr i t ical p rob lem that gets l i t t le attention. However, it is c lear that very old women who have not worked outs ide the home and d i d not have weal thy husbands are l ike ly to be pover ty str icken i f they survive to outl ive their l imited savings.

Why, i f o ld women have all these disadvantages , do they survive longer and seemingly mainta in morale in spite of being old, poor, and alone? Was Mother Nature so addled that she forgot to protect her own sex? Was Father Time so confused that he shortened the span for his own kind? Wi thout being facet ious we must real ize how li t t le we know. A n era or two ago we thought men d ied sooner because o f confront ing the stresses of dai ly l iving in the compet i t ive working world. Now many women do that, as wel l as raise famil ies . Many men a r e househusbands . We have yet to see how this wil l effect the great baby boomer body of the soon- to-be elder pop- ulat ion.

We nurses have often seen the ma le -domina ted med- ical profess ion as a bas t ion of patriarchy. But today women compr ise 40% of students in medica l school, and it appears that the gender imbalance is changing rather rapidly. How wil l that change the pract ice of medic ine?

These quest ions and many others should be gett ing se- r ious cons idera t ion for ourselves, as wel l as our clients. Let us continue to search for answers and avoid the pi t fal l o f superf ic ial gender s tereotypica l thinking. •

REFERENCES

1. Kaye LW, Applegate J. Men's style of nurturing elders. In: Sabo D, Gordon D, editors. Men's health and illness. Thousand Oaks, Calif." Sage Publications, 1995:205-21.

2. National Institute of Aging. Progress report on Alzheimer's disease: 1995. U.S. Department of Health & Human Services, Public Health Service, National Institutes of Health, NIH Publication No. 95-3994.

3. FDA Consumer 1996;29(9):4.

GENDER SIGNATURE STATISTICS (NOT INCLUDING ETHNIC VARIATIONS)

At age 65 and over Male Female

Population 13.5 mil l ion 19.7 million

Life expectancy at birth 73.2 years 79.8 years

Life expectancy at 65 14 years 18 years

Married 77% 43%

Widowed 13% 47%

Live in family 81% 58%

Live alone 16% 40%

Median income 515,250 $8950

Below poverty level 7% 15%

Employed 17% 9%

Need Help wi th ADLs 18% 26%

Need Help with IADLs 19% 3 5 %

Annual days of restricted 30 36 activity

Su ic ide /100 ,000 152.6 19.2

Alzheimer 's deaths per 30.8 28.1 100,000 (age adjusted)

Heart d isease- re la ted 271,214 324,1 O0 deaths per 100,000

ADL, Activities of daily living; IADL, instrumental activities of daily living. U.S. Bureau of the Census. Statistical Abstract of the United States: 1995

(11Sth edition) Washington, OC: US Government Printing Offices, 1995. AARP. A profile of older Americans: 1995. Free copies may be obtained by writ-

ing AARP Fulfillment, 602 E Street, N.W., Washington, D.C. 20049.

150 Ebersole July/August 1996 GERIATRIC NURSING