Troubled Aging in Place: Women & Chronic Disability

Grandmas are moms with lots of frosting.

~Author Unknown

Working in acute care for over 20 years I’ve been on the care-giving end of many
elderly patients; the majority of them being women who tend to live longest.
For many women longevity can be a mixed blessing; while women do live longer
than men (on average 5 yrs), they are at greater risk of an old age tempered with
disability.

Aging with Chronic Disease

Many of our disease states, especially in the elderly, have gone from acute, such as
pneumonia ( the “old man’s friend”) which killed the patient in 2 weeks—to chronic;
not cured but  managed over long periods of time. We tend to see acute
exacerbations of chronic conditions such as congestive heart failure, diabetes, or
COPD, over and over again.

The diseases that drastically shortened life-spans in the past are now the
cause of multiple hospitalizations and caregiver-burnout. In the parlance of
medical-slang we called them “frequent flyers” and they actually get to be
well known by staff as they come in for periodic “tune-ups.”
In rare but extreme cases this can lead to” Granny Dumping,” the abandonment of an
elder to hospitals on Holidays or Weekends by family who can no longer cope with
the multiple co-morbidities of grandma.

When do Women’s Chronic Conditions Start?

Researchers at Duke University Medical School found that obesity and arthritis
begin for women in the child-bearing and peri-menopausal years caused by weight
gain. In addition the study showed the women were more likely than men to
experience fractures, vision problems and bronchitis.

“Women have a natural tendency to gain more weight than men over the lifespan, but
may be more motivated to maintain a healthy weight if they realize that those extra
pounds make it more likely that they will be disabled in later years - potentially
becoming a burden to their children or requiring a nursing home. This is important
because it suggests that women's tendency to pack on extra pounds in their child-
bearing and peri-menopausal years translates into loss of independence in their
old age.”
                     - Heather Whitson, M.D. (Assistant Professor of Medicine)

Women’s Chronic Diseases Translates to Loss of Independence

Who ends up in skilled care facilities?  According to the U.S. Bureau of the Census,
slightly over 5 percent of the 65+ population are in nursing homes, assisted living,
and congregate housing; and rates increase with age from 1.4% of the youngest-old
to 24.5% of the oldest-old. It’s usually women due to:

1. Longevity: Women invariably represent a high percentage of the oldest old. For
example, in the United States in 2000, some 67% of those above age 80 were
women; among centenarians, women accounted for 87% of the total
2. Spend Down: Life-time savings is used up by caring for husbands in old age
3. Lack of Informal Care: Care provided by non-paid family members
    “Most elderly males have informal care, most elderly females do not.”
   --Cynthia M. Taeuber

I often heard patients express that they don’t want to be a burden to their children. 
An Aging-in-Place in America study found many elders fear nursing homes over
dying; that being the case, making the future a part of one’s current
philosophy is like social self defense for women planning on aging-in-place. The
time to start is now…

See:
The Terrifyingly Beautiful work by Anton Christian: "Granny Dumping"
The positive taillight sign 
Message to Women (video)
Lifestyle-Related Risk Factors and Risk of Future Nursing Home Admission
Nursing home diaries
blue zones
Chromosome Ends and Diseases of Aging: How do we age?
 Loosing Independence

Visit my website, http://www.aginginplace.com.