Research on Gender & Dementia Dr Simon Evans Association for Dementia Studies University of Worcester The VERDe Network 2 nd June 2016
Acknowledgements Erol, R., Brooker, D. & Peel, E. (2015) Women and dementia: A review of the research literature. London. Alzheimer s Disease International http://www.alz.co.uk/womenand-dementia Alzheimer s Disease International funding and guidance, case reports & photos
Dementia prevalence and gender Overall, dementia incidence was similar for men and women (Netherlands, USA); After 90 years of age the incidence of Alzheimer's disease is higher for women than for men; Incidence of vascular dementia lower in women than in men (related to stroke & heart disease); US study of 1500 people - 72 in every 1,000 men developed mild cognitive impairment compared to 57 per 1,000 women
Gender related risk factors Dementia in women (probably) and in men (possibly) is influenced by obesity in the middle of life. Depression, which is more prevalent in females, is associated with a higher risk of developing dementia (da Silva et al. 2013) Diabetes is increasing in frequency to a greater extent in women than in men, and is associated with a substantial risk for cognitive impairment. (Azad et al, 2007)
Women living with dementia Very few research papers. Protective factors such as physical, mental and social activity, and education levels differ between men & women. The shift from care-giver to cared for is often difficult. Concept of grateful guilt can lead to conflict Family dynamics, interactions and family roles
Gender and the care-giving role Two thirds of people with dementia live in their own homes, supported by family members Between 60-70% of family caregivers are women Social and cultural expectations that women will provide care Complex mix of reasons for providing care: love, gratitude, expectation, obligation, religious factors Difficult transition to carer role, additional tasks and responsibilities, reassessing relationships
The impacts of care-giving Female carers report higher levels of burden, stress and depressive symptoms than men Financial impact is greater for women more likely to stop working or work part time The main challenges the men experienced were to do with diminishing communication, cognitive and behavioural changes and loss of companionship (Pretorius et al., 2009).
Managing and accessing support Male caregivers are more likely to accept formal help and access support services than women Support groups used far less frequently by men (Brown et al., 2007), who saw them as being aimed at more women, and having an emotionally expressive climate Male caregivers depend more on additional support from daughters or other female members of the family, reinforcing traditional female caregiver expectations (Brown et al., 2007), and possibly influencing the lower levels of burden found in men.
Coping Strategies Men focus on problem solving, accomplishing tasks and preferring to make sense of their experiences at a cognitive level, whereas women focus more on the quality of task performance and emotional support (Ducharme et al., 2011). Male caregivers tend to adopt mechanisms that help them to create a psychological distance from the care recipient, focusing on practical tasks, thus reducing the stress of care (Papstavrou et al., 2007).
Caregiver decision making Different approaches to care-related decision making used by male and female caregivers (Boyle 2013) Wife carers were more likely to use facilitative approaches to make decisions whereas husband carers often adopted supervisory or overseeing roles.
Gender and the care workforce Women make up 75% of the healthcare work force; this is higher for dementia care The gender pay gap in the health and social care sector means that women hourly earnings for women is 10% lower. There are therefore expectations that women with little training, lower pay, and little job security will provide care for people with particularly complex needs. Improved skills, education and working conditions would reduce the stress of caring for people with complex needs
Summary More women live with dementia than men. Higher prevalence and more severe symptoms. Around two thirds of primary caregivers are women; proportion much higher in LMIC countries. Impact on health, wellbeing and finances is therefore likely to be greater for women. The formal care workforce is predominantly female, particularly in dementia care
Recommendations Health and social care policies need to be developed based on evidence of need within every country Adequate, accessible support is needed to provide guilt- free support to women Access to prevention, diagnosis, and formal and informal health and social care needs to be targeted in a way that respects gender difference. Improving the skills in dementia care for all health & social care professionals will help women at home and in the work-force Need further research: impact on women in LMICs, longitudinal studies, the experience of women with dementia and gender data collection analysis
Thank you for listening! Simon Evans University of Worcester, UK Association for Dementia Studies simon.evans@worc.ac.uk http://www.worcester.ac.uk/dementia