Dementia Care, Women's Health, and Gender Equity

Abstract

Although encouraging evidence shows a decline in dementia prevalence, 1 the percentage of the US population aged 65 years and older is predicted to rise to 20% by 2030 (from 13% in 2010). Age is the greatest risk factor for dementia, 2 and the number of cases of dementia will continue to rise as a function of an aging population (approximately 8.4 million by 2030). The mainstay of treatment is functional support, and 83% of caregiving comes from unpaid sources: family. The average person with dementia requires 171 hours of care per month, which is more than 100 hours more care per month than those without dementia (mean of 66 hours per month). 2 Women provide nearly two-thirds of all elder care, with wives more likely to care for husbands than vice versa and daughters 28% more likely to care for a parent than sons. 2 The best long-term care insurance in our country is a conscientious daughter. Making up 47% of the workforce in 2015, burgeoning caregiving demands will disproportionately fall on working-age women, as will the associated decreases in selfesteem.While caregiving for loved ones with dementia can certainly be meaningful, dispiriting routine tasks such as toileting, undergarment changing, and bathing are enduring challenges. Lack of daily predictability in dementia-linked symptoms intensifies the burden. Women are disproportionately at risk for lowering or exiting their career trajectory owing to caregiving demands. 3 The combined stresses of caring for family members with dementia and the lack of time to attend to personal needs can erode caregivers' health. 4 For women who remain in the workforce, dementia care responsibilities can increase costs to their employers from absenteeism, productivity loss, stress-related disability claims, and health benefits plan spending. It remains to be seen whether men can be persuaded to assume an equal share of the burden of caregiving. While gender parity in childcare is modestly growing, gender parity in dementia care is unlikely to occur anytime soon. 5 Hard-fought gains toward equality in the workplace for women are at risk (Figure).Delivering and funding caregiving are separate problems, with intertwined solutions. Government-funded expansion for robust community support and in-home caregiving are offered by several Organization for Economic Co-operation and Development nations. The Netherlands's famous "dementia village," Hogeweyk, and Japan'ssupplyofgovernment-paidin-homecaregiversare illustrative. In the United States, the 2016 political ascension of fiscal conservatives makes such a new entitlement unlikely.

Sex-Specific Differences in End-of-Life Burdensome Interventions and Antibiotic Therapy in Nursing Home Residents With Advanced Dementia

“… 52 Second, women are more likely to assume caregiving roles for a spouse with dementia; the stressful and demanding nature of the caregiving relationship may complicate end-of-life decision-making and motivate more intensive care at the very end of life. 53 , 54 , 55 Outside of the caregiving relationship, men may be more likely to have women advocating for their care than vice versa and may therefore receive more aggressive care. Third, gender-based inequities in the receipt of physical and mental health care among persons with dementia have been well described, with men being more likely to receive primary and consultative care.…”

Self-reassurance and self-efficacy for controlling upsetting thoughts predict depression, anxiety, and perceived stress in help-seeking female family caregivers

“…Providing care for an older family member is a common life challenge that can deeply impact caregivers in a wide variety of ways (Crespo et al, 2005). About two-thirds of all caregivers are women (World Health Organization, 2012), creating distinct risks and benefits for women due to caregiving demands (Bott et al, 2017). Given the prevalence of caregiving worldwide and the specific impact it has on women, it is important to understand the various mental health consequences of such a widespread responsibility.…”

Prescribing medications of questionable benefit prior to death: a retrospective study on older nursing home residents with and without dementia in Germany

“…A previous study has pointed toward sexspecific differences in dementia care, with men more commonly receiving burdensome interventions at the end of life [53]. The differences between men and women may be more related to social contexts than biological phenomena, i.e., gender-based differences in the provision of care or different attitudes toward death [53][54][55].…”