Aging, care and dependency in multimorbidity: how do relationships affect older Bangladeshi women's use of homecare and health services?

Gender issues can create major barriers to healthcare utilization for older women with multimorbidity, especially in developing countries like Bangladesh. Elderly rural women in Bangladesh, are the poorest of the poor, and the women with multimorbidity live in a regulated family atmosphere. This study explored the relationship dimensions of older women with multimorbidity in homecare and their utilization of health services. To gain a deeper understanding of these complex issues, a qualitative case study was conducted. Semi-structured, in-depth interviews were conducted with 11 health staff and 22 older women with multimorbidity, living in three residential communities of the Sylhet District, Bangladesh. Our analysis used critical thematic discourse, a technique developed from Axel Honneth's recognition-and-misrecognition theory. Seven relationship dimensions have been identified, and grouped under three major themes: intimate affairs [marital marginalization and parent-children-in law dynamics]; alienation in community relationships [patriarchal sibling relationships, neighborhood challenges, and gender inequality in interactions]; and legal disconnections [ignorance of rights and missed communication]. Our findings revealed a lack of understanding of the women's multimorbid care needs and patriarchal marginalization in family. This lack of understanding together with poor peer-supports in healthcare is perpetuated by misrecognition of needs from service providers, resulting in a lack of quality and poor utilization of homecare and health services. Understanding the high needs of multimorbidity and complexities of older women's relationships can assist in policy decisions. This study deepens our understanding of the ways gender inequality intersects with cultural devaluation to reduce the well-being of older women in developing countries.

Improving Care for Elders Who Prefer Informal Spaces to Age-Separated Institutions and Health Care Settings.

BACKGROUND AND OBJECTIVES: Despite advantages of urban areas (such as walkability, public transportation, nearby shopping, and health care services), challenges remain for elders aging in place to access care. The changing demographics of older adults, with higher rates of divorce, singlehood, and childlessness, often living alone and far from family, necessitate new strategies to support health and well-being. RESEARCH DESIGN AND METHODS: Drawing on 5 years of ethnographic fieldwork and 25 interviews with elders in New York City, this study presents empirical insights into older adults' use of "third places" close to home, in conjunction with more formal settings. RESULTS: This article identifies external and internalized ageism and complicated age-based identity as important reasons why older adults preferred "third places" to age-separated spaces such as senior centers and formal settings such as health care settings. We find that neighborhood "third places" offer important physical venues for older adults to process negative or hurried interactions in other formal and age-separated places. DISCUSSION AND IMPLICATIONS: This article makes policy suggestions for increasing access and usage of essential services, including developing attractive and appealing intergenerational spaces in which older community members can obtain services and dispatching caseworkers to public spaces where elders congregate. Furthermore, this article recommends improving exchanges between health care providers and older adults so that they feel recognized, respected, and cared for, which can improve health care outcomes.

Aging Alone, Gossiping Together: Older Adults' Talk as Social Glue.

OBJECTIVES: While older adults living alone face challenges to maintaining social ties, elders in urban areas also have unique opportunities for daily socializing that can buffer against loneliness. METHOD: Drawing on 5 years of ethnographic fieldwork among elders in New York City, this study presents empirical insights into the development of supplementary neighborhood-based networks of support for older people living alone and vulnerable to isolation. RESULTS: This study finds that elders who lived alone, without close kin, engaged in daily gossip about other older people they encountered as regulars in local eateries. Despite its negative reputation, gossip helped them connect and access less conventional social support close to home. The majority resisted formal organizations, such as churches or senior centers, and thus their interactions in public venues served as an important source of social involvement. In line with Gluckman's argument (1963), gossip betrayed emotional intimacy and caretaking that connected people who could have fallen off the social radar. DISCUSSION: Higher rates of divorce and lifelong singlehood, coupled with increased longevity, will compel greater numbers of older adults to construct alternative support networks. My findings suggest that more will draw these connections from unconventional venues such as neighborhood public places.