Sara's research focuses on gender and class inequalities in health, ageing and later life and on sociology of sleep. She was PI on SomnIA, Sleep in Ageing, a multi-disciplinary New Dynamics of Ageing collaborative research programme (2006-2011), and joint PI (with Debra Skene, FHMS) on an EU funded Marie Curie Research Training Network to train European doctoral and post-doctoral researchers in the Sociology of Sleep (2005-2009).
Sara has completed research for the ESRC on 'Negotiating Sleep among Couples' and on 'Older Men'; for the Nuffield Foundation on late life decision-making about life prolongation techniques; for the Health Development Agency on social support, social capital and health, and on older people and falls; for the US National Institute of Aging on a comparative US/UK study of clinical decision-making for older patients; for the EU on a comparative study of 'Sleep in Ageing Women' and a cross-national study of 'Gender, food and later life'; and for Anchor Homes to evaluate their refurbishment and rebuild programme in residential homes. She has recently co-edited Contemporary Grandparenting: Changing Family Relationships in Global Contexts (Policy Press, 2012).
Much of Sara's research uses secondary analysis of large-scale datasets. She has conducted comparative research on inequalities in health, comparing Britain with Scandinavia in collaboration with Professor Eero Lahelma from Helsinki. She edited a special issue of Social Science and Medicine on 'Social and economic patterning of women's health in a changing world' (2002, vol. 4, no. 5) with Myriam Khlat, INID, Paris, a Monograph of Current Sociology on 'Gender, Ageing and Power: Changing Dynamics across Western Societies' (2007, vol.55, no.2), and a special issue of Sociological Research Online (12,5) on 'Sleep Across the Lifecourse' (2007).
Professor Arber is frequently invited to speak at international meetings, including Canada, Chile, USA, Latvia, Australia, New Zealand, Switzerland, Austria, Ireland, Finland, Germany, Italy, Norway, Czech Republic, Brazil and Belgium since 2005. Her book Connecting Gender and Ageing (co-authored with Jay Ginn) won the 1996 Age Concern prize for the best book on ageing.
Sara's recent teaching has been in the area of gender and ageing, and on survey research methodology to undergraduates and M.Sc in Social Research Methods students. She previously taught final year options in Gender and Society and in Sociology of Health and Illness. Sara supervises 8 doctoral students in the fields of health, ageing, gender and sociology of sleep, including some students conducting secondary analysis of national datasets. She has supervised 46 students to successful completion of their PhD.
Sara Arber was President of the British Sociological Association (1999-2001), Treasurer (1988-1990) and is currently a Vice President. She was President of the International Sociological Association Research Committee on Sociology of Aging (RC-11) (2006-2010) and organiser of the ISA RC-11 Inter-Congress Conference on 'Ageing Societies and Ageing Sociology', 7-9 September 2004. She was Vice President of the European Sociological Association (2005-2007) and played a key role in organising the ESA conference in Glasgow, 3-6 September 2007. Sara is an elected Academician of the Social Sciences, and a Fellow of the British Academy. Sara received the BSG (British Society of Gerontology) Outstanding Achievement Award 2011 for her contribution to the field of ageing. Sara was a consultant on the ONS/ESRC Review of Social Classifications and sits on various advisory committees. She chaired the Sociology Editorial Board (1992-95) and was Treasurer of the British Sociological Association (1988-90). She was a member of the ESRC Grants Assessment Panel (2008-12-) and is currently a member of the British Academy Research Awards Board (2012- ). She was a member of the ESRC Social Affairs Committee (1984-87), and the S.W. Surrey District Health Authority (1981-90). Sara is currently a member of 7 Editorial Boards, including Journal of Aging Studies, Research on Aging, and International Journal of Social Research Methodology, and is an Associate Editor for Social Science and Medicine. Sara is a member of the 2014 REF (Research Excellence Framework) Panel for Sociology.
Aims To understand sleep as part of the 24 hour provision of resident care by viewing it in the wider social context within the care home, exploring both the subjective experience of residents and the perceptions of staff. Methods Qualitative research in four care homes for older people consisting of semi-structured interviews and ethnographic observations. Interviews were conducted with 38 residents and 39 staff, and were analysed using a grounded theory approach. Findings The findings have highlighted some challenges and opportunities for developing practice in care homes to improve residents' sleep. In addition to pain and physical disabilities, both the physical environment and practices in care homes can affect residents’ sleep and night-time experience. Conclusion Improving our understanding of residents’ and staff experiences at night in care homes can inform the development of good practice in night-time care and contribute to a positive culture of person-centred care.
In this paper we seek to understand the influence of gender on the different approaches to managing poor sleep by older men and women through the conceptual framework of existing theoretical debates on medicalization, healthicization and 'personalization'. In-depth interviews undertaken between January and July 2008 with 62 people aged 65-95 who were experiencing poor sleep, revealed that the majority of older men and women resisted the medicalization of poor sleep, as they perceived sleep problems in later life were an inevitable consequence of ageing. However, older men and women engaged differently with the healthicization of poor sleep, with women far more likely than men to explore a range of alternative sleep remedies, such as herbal supplements, and were also much more likely than men to engage in behavioural practices to promote good sleep, and to avoid practices which prevented sleep. Women situated 'sleep' alongside more abstract discussions of 'diet' and health behaviours and drew on the discourses of the media, friends, family and their own experiences to create 'personalized' strategies, drawn from a paradigm of healthicization. Men, however, solely relied on the 'body' to indicate when sleep was needed and gauged their sleep needs largely by how they felt, and were able to function the following day. © 2012 Elsevier Ltd.
Poor sleep is known to impact on health and wellbeing in later life and has implications for the ability of older people to remain active during the day. Medical treatments for chronic poor sleep have primarily included the regular, long-term prescribing of hypnotics, which are known to impact on older people's health, cognitive function and quality of life. Therefore, recent policy and practice has focused on reducing such prescribing, on encouraging older people to stop taking long-term hypnotics and on finding alternative, non-pharmacological ways to manage poor sleep. However, little research has been undertaken to understand the perspectives of older people who choose not to seek professional help for their poor sleep, despite the potential impact of poor sleep on their health and ability to remain active. Through in-depth interviews with 62 older men and women living in their own homes in England, this article explores the factors that deter older people from seeking professional help for their poor sleep. We argue that these are located in their perceptions of the normativity of poor sleep in later life, their beliefs about prescription sleeping medications and their desire to maintain control and autonomy over their everyday and night lives. © 2012 The Authors. Sociology of Health & Illness © 2012 Foundation for the Sociology of Health & Illness/Blackwell Publishing Ltd.
Free time, that is, the time that remains at one's own discretion after conducting daily work and personal care activities, has been previously recognized as a ‘primary good’ and an important welfare resource that provides opportunities for participation in social life and leisure. However, recent years have witnessed an increasing preoccupation with the phenomenon of time poverty, drawing attention to the distribution of free time and its relationship to structural and family circumstances. In this article we propose a novel approach to the measurement of time poverty and document its occurrence amongst British workers. In line with previous literature, a conceptualization of time poverty as a relative lack of free time resources vis-à-vis other members of the community is adopted. However, unlike previous empirical studies, we investigate the differential configuration of time poverty on weekdays and weekend days, alongside indicators of the quality of free time, taking into account insights from theoretical and empirical work within the field of the sociology of time. Our analysis of the 2000 UK Time Use Survey highlights class and gender inequalities that have been missed by previous measurement approaches and demonstrates that, overall, working women experience multiple and more severe free time constraints, which may constitute an additional barrier for their leisure and social participation.
In divergent ways, both government policy and care home practices influence the everyday life of older people living in English care homes. The rhetoric of choice for care home residents may be in conflict with the reality of government policy-driven service delivery. The aim of the article is to examine the role of organised activities in facilitating choice and active ageing among care home residents. Findings from a study of ten care homes in South East England exemplify the conflict between government policy rhetoric and the reality of care home life. The indication is that the formality of the "activities of daily living" support procedures restricts residents' involvement in the organised social activities.Within the general provision of services, the organised "social activities" offered failed to meet the interest, cognitive and physical abilities of residents. The reality of "choice" is therefore questionable. Policy needs to support a transformation in the delivery of care to ensure it addresses the actual needs and expectations of older people experiencing care home life. © The Author.
Work and family are two key domains of life among working populations. Conflicts between paid work and family life can be detrimental to sleep and other health-related outcomes. This study examined longitudinally the influence of work–family conflicts on subsequent sleep medication. Questionnaire data were derived from the Helsinki Health Study mail surveys in 2001–2002 (2929 women, 793 men) of employees aged 40–60 years. Data concerning sleep medication were derived from the Finnish Social Insurance Institution’s registers covering all prescribed medication from 1995 to 2007. Four items measured whether job responsibilities interfered with family life (work to family conflicts), and four items measured whether family responsibilities interfered with work (family to work conflicts). Cox proportional hazard models were fitted, adjusting for age, sleep medication five years before baseline, as well as various family- and work-related covariates. During a five-year follow-up, 17% of women and 10% of men had at least one purchase of prescribed sleep medication. Among women, family to work conflicts were associated with sleep medication over the following 5 years after adjustment for age and prior medication. The association remained largely unaffected after adjusting for family-related and work-related covariates. Work to family conflicts were also associated with subsequent sleep medication after adjustment for age and prior medication. The association attenuated after adjustment for work-related factors. No associations could be confirmed among men. Thus reasons for men’s sleep medication likely emerge outside their work and family lives. Concerning individual items, strain-based ones showed stronger associations with sleep medication than more concrete time-based items. In conclusion, in particular family to work conflicts, but also work to family conflicts, are clear determinants of women’s sleep medication.
This article presents the key findings from an extensive research project aiming to identify the determinants of poor sleep in care homes. A mixed methods study was conducted in 10 care homes in South East England. This included 2-week daily diaries completed by 145 older residents and interviews with 50 care-home staff. This research demonstrated that the regular surveillance by qualified nurses and care assistants at night seriously impedes the quality of sleep experienced by older people living in care homes. However, nurses and social care workers have a duty of care, which would not be fulfilled if regular checks were not undertaken at night. There is a need for care-home staff to strike a balance between enabling older people living in care homes to have a good night's sleep and adhering to their own professional duty of care.
Sleep, which is vital for health and wellbeing, is influenced by a complex array of (neuro)biological and social factors. Previous research has suggested that these factors vary across the life course, as well as being affected by transitions, such as parenthood, care-giving and widowhood. This research has also suggested that many of these transitions have a greater affect on women’s sleep. Yet much of this research has focused on women and one-sided reports of partner behaviours. This paper draws on data from Wave 1 of the Understanding Society Survey to examine gender differences in sleep maintenance within younger and older heterosexual couples. Data were collected in 2009 from a representative sample of households in Britain with a response rate of 59%. Sleep maintenance, namely waking on 3 or more nights per week, was included in a self-completion module. A series of logistic regression models are run using sleep maintenance as a dependent variable; i) a two level model for couples where the male is aged 50 or less (n=2452 couples); ii) a two level model for older couples where the male is aged above 50 (n=1972 couples); iii) bivariate models which allow for odds to be calculated separately for male and female partners. Results from the couple level models illustrate how both younger and older women have increased odds of difficulties with sleep maintenance (as compared to their male partners). Poor sleep maintenance is also associated with poor health, own unemployment, dissatisfaction with income, having had a previous cohabiting relationship and having younger children for both men and women. Reports by the husband of frequency of coughing/snoring at night is significantly associated with their wives’ sleep maintenance among younger couples and vice versa; but among older couples there is only a significant association of husband’s snoring on wife’s sleep. Whilst the current analysis is cross-sectional, further understanding of the dynamic relationships of sleep will be revealed through longitudinal analysis as Understanding Society moves through future waves.
This paper examines the amount of time that care-home residents spend in bed at night, focusing on how residents' bedtimes and getting-up times are managed. Using a mixed-methods approach, diary data were collected over 14 days from 125 residents in ten care homes in South East England. The findings indicate that residents spent, on average, nearly 11 hours in bed at night, significantly more time than was spent sleeping. There was greater variance in the amount of time residents who needed assistance spent in bed than there was for independent residents. Detailed investigation of six care homes, each with 8 pm to 8 am night shifts, showed that bedtimes and getting-up times for dependent residents were influenced by the staff's shift patterns. Analysis of qualitative interviews with 38 residents highlighted a lack of resident choice about bedtimes and many compromises by the residents to fit in with the care-home shift and staffing patterns. The social norm of early bedtimes in care homes also influenced the independent residents. It is argued that the current system in care homes of approximately 12-hour night shifts, during which staff ratios are far lower than in the daytime, promotes an overly long ‘night-time’ and curbs residents' choices about the times at which they go to bed and get up, particularly for the most dependent residents.
Objective: International differences in disease prevalence rates are often reported and thought to reflect different lifestyles, genetics, or cultural differences in care-seeking behavior. However, they may also be produced by differences among health care systems. We sought to investigate variation in the diagnosis and management of a "patient" with exactly the same symptoms indicative of depression in 3 different health care systems (Germany, the United Kingdom, and the United States).Method: A factorial experiment was conducted between 2001 and 2006 in which 384 randomly selected primary care physicians viewed a video vignette of a patient presenting with symptoms suggestive of depression. Under the supervision of experienced clinicians, professional actors were trained to realistically portray patients who presented with 7 symptoms of depression: sleep disturbance, decreased interest, guilt, diminished energy, impaired concentration, poor appetite, and psychomotor agitation or retardation.Results: Most physicians listed depression as one of their diagnoses (89.6%), but German physicians were more likely to diagnose depression in women, while British and American physicians were more likely to diagnose depression in men (P = .0251). American physicians were almost twice as likely to prescribe an antidepressant as British physicians (P = .0241). German physicians were significantly more likely to refer the patient to a mental health professional than British or American physicians (P < .0001). German physicians wanted to see the patient in follow-up sooner than British or American physicians (P < .0001).Conclusions: Primary care physicians in different countries diagnose the exact same symptoms of depression differently depending on the patient's gender. There are also significant differences between countries in the management of a patient with symptoms suggestive of depression. International differences in prevalence rates for depression, and perhaps other diseases, may in part result from differences among health care systems in different countries.
Caregiving research has rarely examined the nature and impact of care provision at night. This paper analyses indepth interviews with 24 older people in England whose sleep had been adversely affected by providing care at night. A framework is proposed that illustrates how six aspects of caregiving can disrupt carers' sleep quality: first, attending to the night-time physical needs of the care recipient; second, anticipation of their night-time care needs; third, ‘monitoring’ their relative at night; fourth, disruption from relatives who are awake for long periods at night, wandering or shouting; fifth, undertaking emotional support, and worries or anxieties related to their relative; and finally, the legacy of caregiving may continue to disrupt sleep after caring ceases, because of painful images of their relative's suffering or feelings of guilt. Adverse effects on carers' sleep are greatest for co-resident carers, especially when caring for a spouse or relative with a life-limiting illness or dementia.
Despite the recent theoretical focus on the emergence of the Third Age as a period of fulfilment and an ongoing engagement with an active leisure lifestyle, there is a dearth of quantitative studies on how older people spend their time. Few studies of later life capitalise on time-use surveys, which constitute the most widely employed and accurate methodology for collecting data on everyday life. This article analyses data from the 2000 UK Time Use Survey in order to operationalise the concept of the Third Age and test theoretical propositions regarding the irrelevance of social divisions in the formation of an active leisure lifestyle after retirement. The analysis focuses on a subsample of 1615 people over the age of 64. An index of active leisure activities is constructed in order to estimate the proportion of third agers amongst British retirees. Logistic regression models are specified to examine the relative influence of socio-demographic characteristics on the probability of a person being a third ager. Strong effects of structural factors and health are found, which do not support arguments suggesting a minor influence of social context in lifestyle choices after retirement. 'Active' ageing appears to be the province of those who are culturally and materially advantaged, and it is the healthy, educated, upper-class and middle-class men that are more likely to engage in a Third Age leisure lifestyle.
This article illustrates the ways that sociological research can inform an understanding of sleep. We emphasise the value of qualitative studies of sleep, by reviewing recent research on the ways that gender and co-sleeping influence sleep, and the influence of caregiving at night on sleep. We then consider large-scale quantitative studies of sleep, drawing on data from the UK Understanding Society 2009 survey (n=14,746). We show how providing care to an elderly or disabled relative in the home is linked to reported sleep problems which is only marginally attenuated following adjustment for disadvantaged socio-economic characteristics and poor health.
The concept of ‘active ageing’ has received much attention through strategic policy frameworks such as that initiated by the World Health Organisation, and through government and non-governmental organisation initiatives. The primary goal of these initiatives is to encourage older people to be active and productive, and to enhance quality of life, health and wellbeing. It is well known that with increasing age, night-time sleep deteriorates, which has implications for how older people maintain activity levels, and leads to an increased propensity for day-time sleep. Using data from 62 interviews with people aged 65–95 years living in their own homes who reported poor sleep, this paper explores the meanings of day-time sleep, and how the attitudes and practices of ‘active ageing’ are intricately linked to the management of day-time sleep and bodily changes that arise from the ageing process. The desire to be active in later life led to primarily dichotomous attitudes to day-time sleep; older people either chose to accept sleeping in the day, or resisted it. Those who accepted day-time sleep did so because of recognition of decreasing energy in later life, and an acknowledgement that napping is beneficial in helping to maintain active lives. Those who resisted day-time sleep did so because time spent napping was regarded as being both unproductive and as a negative marker of the ageing process.
Background Studies using conventional socioeconomic indicators have reported inconsistent evidence on socioeconomic differences in complaints of insomnia. We lack studies using a comprehensive socioeconomic framework over the life course ranging from childhood to adulthood. This study therefore aimed to examine the associations of both past and present socioeconomic circumstances with complaints of insomnia. Methods Data were derived from cross-sectional postal surveys (2000–2002) representative of the staff of the City of Helsinki, Finland (n = 8960, aged 40–60 years). Socioeconomic circumstances were measured by parental education, childhood economic difficulties, own education, occupational class, household income, housing tenure, and current economic difficulties. Complaints of insomnia during the previous month were measured by difficulties initiating and maintaining sleep and non-restorative sleep. Logistic regression analysis was used, adjusting for age and marital status. Results Complaints of insomnia at least once a week were reported by 25% of women and 21% of men. Childhood economic difficulties showed associations with complaints of insomnia among both women (OR 1.52; 95% CI 1.31–1.76) and men (OR 2.25; 95% CI 1.67–3.02) even after full adjustments. Also current economic difficulties remained associated with complaints of insomnia, but only among women (OR 1.65; 95% CI 1.41–1.93). However, education, occupational class, and income showed only limited age-adjusted associations with complaints of insomnia and these associations disappeared after full adjustments. Discussion Past and present economic difficulties were strongly associated with current complaints of insomnia. Supporting both families with children and adults to cope with their economic difficulties might reduce complaints of insomnia in adulthood.
Differences in daily light exposure profiles have been reported, with younger M-types shown to spend more time in bright light, especially in the morning, compared with E-types. This study aimed to investigate how patterns of daily light exposure in older non-resident M-types and E-types compare. Sleep diaries were kept during actigraphic measurement of activity and light using the Actiwatch-L for 14 days in 12 M-types [eight females, mean ± standard deviation (SD) Horne–Östberg Morning–Eveningness Questionnaire (HÖ MEQ) score 75.2 ± 1.6] and 11 E-types (seven females, HÖ MEQ 41.5 ± 4.8), over 60 years old, living in their own homes. Light data were log-transformed, averaged over each hour, and group × time analysis of covariance (ancova) performed with age as a covariate. M-types had significantly earlier bed and wake time than E-types, but there was no significant difference in sleep duration, sleep efficiency or time spent in bed between groups. Daily exposure to light intensity greater than 1000 lux was compared between the two groups, with no significant difference in the duration of exposure to >1000 lux between M-types and E-types. Twenty-four-hour patterns of light exposure show that M-types were exposed to higher light intensity at 06:00 h than E-types. Conversely, E-types were exposed to higher light intensity between 22:00 and 23:00 h than M-types. These findings show that differences in daily light exposure patterns found previously in younger M-types and E-types are also found in older M-types and E-types, but at an earlier clock-time, confirming the tendency to advance with ageing.
The authors examined physician diagnostic certainty as one reason for cross-national medical practice variation. Data are from a factorial experiment conducted in the United States, the United Kingdom, and Germany, estimating 384 generalist physicians’ diagnostic and treatment decisions for videotaped vignettes of actor patients depicting a presentation consistent with coronary heart disease (CHD). Despite identical vignette presentations, the authors observed significant differences across health care systems, with US physicians being the most certain and German physicians the least certain (P < 0.0001). Physicians were least certain of a CHD diagnoses when patients were younger and female (P < 0.0086), and there was additional variation by health care system (as represented by country) depending on patient age (P < 0.0100) and race (P < 0.0021). Certainty was positively correlated with several clinical actions, including test ordering, prescriptions, referrals to specialists, and time to follow-up.
Sleep is functional for individual and societal well-being, with partial sleep deprivation associated with adverse health and safety consequences. Surprisingly, sleep is absent from work—life balance debates and has remained largely under-researched by sociologists. This article examines the relationship of insufficient sleep duration with occupational circumstances and family responsibilities, providing a contribution to the examination of the health consequences of working patterns in the UK. We analyse time use data from 2000, focusing on a sub-sample of workers aged 20—60 years (n = 2882). Nested logistic regression modelling is used to identify the segments of the working population getting a short sleep duration that if sustained may have negative health outcomes. An inverse relationship between working hours and sleep duration is found, which is stronger for men than women. Shift work and social class are also significant predictors of short sleep for men.
Sleep is fundamental to health and well-being, yet relatively little research attention has been paid to sleep quality. This paper addresses how socio-economic circumstances and gender are associated with sleep problems. We examine (i) socio-economic status (SES) patterning of reported sleep problems, (ii) whether SES differences in sleep problems can be explained by socio-demographic characteristics, smoking, worries, health and depression, and (iii) gender differences in sleep problems, addressing the relative contribution of SES, smoking, worries, health and depression in explaining these differences. Logistic regression is used to analyse the British Psychiatric Morbidity Survey 2000, which interviewed 8578 men and women aged 16–74. Strong independent associations are found between sleep problems and four measures of SES: household income, educational qualifications, living in rented housing and not being in paid employment. Income differences in sleep problems were no longer significant when health and other characteristics were adjusted. The higher odds of sleep problems among the unemployed and adults with low education remained significant following adjustment. Women reported significantly more sleep problems than men, as did the divorced and widowed compared with married respondents. Gender differences in sleep problems were halved following adjustment for socio-economic characteristics, suggesting that SES inequalities play a major part in accounting for gender differences in sleep problems. Our study casts doubt on the primacy of physiological explanations underlying these gender differences. Since disadvantaged socio-economic characteristics are strongly associated with sleep problems, we conclude that disrupted sleep may be a mechanism through which low SES is linked to poor health.
The power of medical technologies to extend the final stages of life has heightened the need to understand what factors influence older people's wish to use such medical technologies. We analyse gender differences in such views, based on audio-recorded interviews with 33 men and 36 women (aged 65–93) in south-east England. Older women were twice as likely as men to oppose using medical technologies to extend life. More older women voiced ‘other-oriented’ reasons for their opposition, particularly not wanting to be a burden on others. Older men's attitudes were primarily ‘self-oriented’, reflecting a concern to stay alive for as long as possible, with fewer expressing concern about consequences for others. Women's greater life course involvement in caring and empathising with the wishes and concerns of others underlay these gender differences. Thus, women were ‘performing gender’ by putting others before themselves, even at this critical juncture in their lives.
Recent literature has highlighted the sociological significance of sleep and has suggested that sleep offers a ‘window’ onto the gendered nature of our lives. Yet within this body of work men's sleep has been largely ignored. This paper seeks to rectify this omission and situates itself at the intersection between literature on the sociological aspects of sleep and social-constructionist-orientated writings on men's health. It draws upon qualitative data from 40 men to investigate male understandings of, and attitudes towards, sleep. At first glance, it could be suggested that men have little regard for sleep, and are prone to taking risks with their dormancy. Viewed in this way sleep becomes an instrument used in the negotiation of status and power and intrinsically bound up with the demonstration of masculinities. Yet, men's relationship with sleep is more complex than this. Amongst other things, the men within the present study were embroiled in a function/non-function dichotomy. Sleep was seen as needed for the praxis of ‘father’, ‘worker’, ‘husband’ and ‘mate’ but was also considered as something which should not get in the way of performing these roles.
Using novel methods, this paper explores sources of uncertainty and gender bias in primary care doctors’ diagnostic decision-making about coronary heart disease (CHD). Claims about gendered consultation styles and quality of care are re-examined, along with the adequacy of CHD models for women. Randomly selected doctors in the UK and the US (n = 112, 56 per country, stratified by gender) were shown standardised videotaped vignettes of actors portraying patients with CHD. Patients’ age, gender, ethnicity and social class were varied systematically. During interviews, doctors gave free-recall accounts of their decision-making, which were analysed to determine patient and doctor gender effects. We found differences in male and female doctors’ responses to different types of patient information. Female doctors recall more patient cues overall, particularly about history presentation, and particularly amongst women. Male doctors appear less affected by patient gender but both male and especially female doctors take more account of male patients’ age, and consider more age-related disease possibilities for men than women. Findings highlight the need for better integration of knowledge about female presentations within accepted CHD risk models, and do not support the contention that women receive better-quality care from female doctors.
Background Nonmedical determinants of medical decision making were investigated in an international research project in the United States, the United Kingdom, and Germany. The key question in this paper is whether and to what extent doctors' diagnostic and therapeutic decisions in coronary heart disease (CHD) are influenced by patient gender. Methods A factorial experiment with a videotaped patient consultation was conducted. Professional actors played the role of patients with symptoms of CHD. Several alternative versions were taped featuring the same script with patient-actors of different gender, age, race, and socioeconomic status. The videotapes were presented to a randomly selected sample of 128 primary care physicians in each country. Using an interview with standardized and open-ended questions, physicians were asked how they would diagnose and treat such a patient after they had seen the video. Results Results show gender differences in the diagnostic strategies of the doctors. Women were asked different questions, CHD was mentioned more often as a possible diagnosis for men than for women, and physicians were less certain about their diagnosis with female patients. Gender differences in management decisions (therapy and lifestyle advice) are less pronounced and less consistent than in diagnostic decisions. Magnitude of gender effect on doctors' decisions varies between countries with smaller influences in the United States. Conclusion Although patients with identical symptoms were presented, primary care doctors' behavior differed by patients' gender in all 3 countries under study. These gender differences suggest that women may be less likely to receive an accurate diagnosis and appropriate treatment than men.
The study of sleep has been neglected within sociology, yet may provide insights into fundamental aspects of the nature of gender inequalities. This article examines how, for couples with children, sleep is influenced by the gendered nature of caring. A key concern is not only who gets up to care for children's physical needs at night, but whether this changes with women's increased role in the labour market. Of concern also is how changes in the nature of caring for older children, as opposed to young children, may impact on parents’ sleep. This article analyses qualitative data from an ESRC funded multi-disciplinary project on couples’ sleep based on in-depth audio-tape recorded interviews with 26 couples (aged 20–59) with younger and older children. Additionally, one week's audio sleep diaries were completed and follow up in-depth interviews were undertaken with each partner on an individual basis. Physical and emotional care for young children at night was largely provided by women, with a lack of explicit negotiation between partners about who provides this care, even when women return to employment. Thus, considerably more women than men continued their daytime and evening shifts, as well as undertaking an ongoing third shift of sentient activity for their family, into the night. This resulted in a fourth night-time shift where physical caring, and sentient activities continued. As a consequence, women were more likely to subjugate their own sleep needs to those of their family. Fathers did not, in general, undertake this fourth night-time shift. Those that did were more likely to be the fathers of young adult children who were staying out late at night, with the focus of their concerns being the safety of their children.
Objective. To determine the relative contributions of: (1) patient attributes; (2) provider characteristics; and (3) health care systems to health care disparities in the management of coronary heart disease (CHD) and depression. Data Sources/Study Setting. Primary experimental data were collected in 2001–2 from 256 randomly sampled primary care providers in the U.S. (Massachusetts) and the U.K. (Surrey, Southeast London, and the West Midlands). Study Design. Two factorial experiments were conducted in which physicians were shown, in random order, two clinically authentic videotapes of “patients” presenting with symptoms strongly suggestive of CHD and depression. “Patient” characteristics (age, gender, race, and socioeconomic status [SES]) were systematically varied, permitting estimation of unconfounded main effects and the interaction of patient, provider, and system-level influences. Data Collection/Data Extraction Methods. Analysis of variance was used to measure provider decision-making outcomes, including diagnosis, information seeking, test ordering, prescribing behavior, lifestyle recommendations, and referrals/follow-ups. Principal Findings. There is a high level of consistency in decision making for CHD and depression between the U.S. and the U.K. Most physicians in both countries correctly identified conditions depicted in the vignettes, although U.S. doctors engage in more information seeking, are more likely to prescribe medications, and are more certain of their diagnoses than their U.K. counterparts. The absence of any national differences in test ordering is consistent for both of the medical conditions depicted. U.K. physicians, however, were more likely than U.S. physicians to make lifestyle recommendations for CHD and to refer those patients to other providers. Conclusions. Substantively, these findings point to the importance of patient and provider characteristics in understanding between-country differences in clinical decision making. Methodologically, our use of a factorial experiment highlights the potential of these methods for health services research—especially the estimation of the influence of patient attributes, provider characteristics, and between-country differences in the quality of medical care.
Cardiopulmonary resuscitation (CPR) may be used by default on patients suffering a cardiac arrest in hospital in the UK unless there is an order that specifies otherwise in the patient's notes. Guidelines recommend that the decision involves competent and willing patients or, in the case of incapacitation, their families. In practice, patient autonomy is often compromised. Ideally, discussion of preferences for end-of-life care should take place prior to hospitalisation. The majority of research on this topic has been conducted on hospitalised patients, so little is known about the views of older, but healthy, people about resuscitation decision-making. The present study was designed to address this gap. A series of eight focus groups involving a total of 48 participants over the age of 65 was conducted to explore people's views about the factors guiding resuscitation decision-making. A qualitative analysis, which emphasised the dilemmatic nature of resuscitation decision-making, identified two broad thematic dilemmas that subsumed six specific themes which contribute to resolving the dilemmas: quality of life (medical condition, mental versus physical incapacity, age and ageing, and burden), and the involvement of others (doctors and families) versus loss of autonomy. The dilemma underlying quality of life is that an acceptable quality of life after CPR cannot be assured. The dilemma underlying the involvement of others is that individual autonomy may be lost. The themes and subthemes provide the basis for guiding these difficult discussions in advance of serious illness.
Many clinical trials recruit fewer participants than the original recruitment target and so interest in patient’s perspectives on trial recruitment is increasing as efforts to improve trial participation continue. Studies looking at factors that can influence cancer trial participation have raised several key issues including patient’s views about the trial interventions, the extra time required to attend additional trial appointments, and fears of randomisation. However many of these used quantitative survey methods developed from health professionals’ perspective with little sociological research addressing the patient’s perspective. Qualitative interviews with 9 women, 3 included their husband in the interview, were carried out, in order to discover what key factors influenced their decision. All interviews were transcribed and analysed using a grounded theory approach. By exploring women’s reasons for participating or not in a breast cancer trial, this study gives some insight into the importance of the family members to the women when making what becomes a shared decision about trial participation. The results show that the most important factor that influenced a woman’s decision about trial participation was her family members’ views and opinions. For some women their relatives’ view of whether or not they should participate in the trial was more important than their own. Even if the view was the opposite of their own they would still accept the choice that their family member opted for. Key motivations for trial participation were altruistic and there was a belief that taking part would help future treatments, although this was balanced by the need to avoid personal harm when taking part. There was a lack of understanding relating to the trial process and participation which underpinned some of the women’s decisions. This study shows that a major factor unexposed before is the influence of family, and raises the issue of the importance of the family members in cancer trial decision-making and the need to explore this further to meet patients’ needs. It seems that this has either not been prompted in the structured surveys or not raised. Indeed all the recommendations from the studies looking at barriers to participation (McDaid et al 2006) recommend more information is given to the patients, and yet information does not seem to be the requirement of the patients, but, the need to involve key people in the family in the information giving process may
The worldwide trend towards ageing of societies is well documented with extensive discussions of support and care needs for frail older people. There is less discussion of the implications of gender differences in later life for access to support in the event of frailty or disability. Although, marital status is fundamental to well-being in later life (Arber and Ginn, 1991, 1995; Gaymu et al., 2008), there has been less appreciation of the scale of gender difference in marital status in later life, variations between societies, and their implications. It is important to consider the interaction between gender and marital status and the ways this may change over time (Arber, 2004a; Arber, 2004b; Manning and Brown, 2011). The focus of this chapter is to examine the intersection of gender and marital status in later life across societies, how this links to inter-generational relations, and how global changes make it increasingly important to consider the implications of the gender and marital status interaction when studying access to caregivers and social support in later life.
This chapter demonstrates how sleep is inextricably linked to ‘society’. Part 1 illustrates how sleep and its disorders are historically and culturally divergent and that ‘where’, ‘why’ and ‘how’ we sleep differ depending on the society in which we live. Part 2 focuses in more detail on the ‘private’ nature of Western sleep. Sleep is affected by the social context where it occurs, and is thus influenced by household composition, power, gender, social roles and life course position. Finally, we examine sleep in care-giving and institutional contexts, where sleep is not only ‘observed’, but may be disturbed by those undertaking care or surveillance at night. Sleep is also socially patterned with the socially disadvantaged most likely to report sleep problems.
Over the last 30 years, the field of aging has been the site of an exceptional growth of research interest, yet it is only really within more recent social gerontology that the many varied experiences of older people are being acknowledged and explored through the intersection of race, ethnicity, sexuality, class, and, as many have argued, most importantly, gender. This chapter will show the importance of recognizing the gender dimension within the study of aging by exploring how using a “gendered eye”, or adopting a “gender lens” (Calasanti & Slevin, 2001) not only reveals neglected issues for older people, but is also fundamentally important in thinking about the study of old age at a time when the growth in the aging population is unprecedented. The chapter commences by stepping back 30 years to reflect on theoretical approaches to the study of aging and approaches that initially neglected gender. We then move on to demonstrate how the contribution of feminist scholarship raised awareness of the need to identify and address the neglected are of older women’s issues, and at the same time, neglecting older men’s issues (Thompson, 1994). Next, we consider how this approach ultimately evolved to take account of the interlinkages between age and gender relations in recognition of the need to examine men’s and women’s experiences relationally. Emerging issues within this new era of age and gender relations are introduced in the form of the changing nature of roles, relationships, and older people’s identity. The following section focuses on the aging, gendered body through discussion of the tension between aging identities and narratives of bodily decline as experienced differently by men and women (Gullete, 1997). Finally, the chapter concludes by highlighting challenges for the future of aging for men and women, such as the growing numbers of the oldest old, who are predominantly widowed women, implications for unmarried or childless older men and women, and the policy implications of such challenges.
Sleep, until recently, has been a neglected topic or issue within sociology and the social sciences and humanities in general. At first glance this may seem unsurprising given the predominant waking assumptions, concerns or preoccupations of these disciplines. Further reflection, however, reveals the shortcomings of any such neglect or dismissal of sleep as a topic worthy of sociological attention. Sleep is a socially, culturally and historically variable phenomenon. How we sleep, when we sleep, where we sleep, what meaning and value we accord sleep, let alone with whom we sleep, are all important topics of sociological investigation which do not simply vary around the world, both past and present, but within different segments of society and within and between cultures. The nature, quantity and quality of sleep, moreover, is clearly important both for the individual and society in terms of health and safety, productivity and performance, quality of life and well-being. In part a response to this past neglect, and in part a response to broader social trends and transformations regarding sleep, sociologists and others in the social sciences and humanities are now turning their attention to what might broadly be termed the ‘sleep and society’ agenda (Williams 2005; Williams 2008). Sleep, in this respect, is not simply a rich and fascinating sociological topic in its own right, but a valuable new window or way of approaching a range of existing sociological research agendas on issues as diverse as work, health, gender, ageing and family life. This work in turn opens up significant new opportunities to explore the dynamic interrelations between social and biological factors regarding sleep and sleep disruption across the life course. In these and many other ways then, a sociological approach to sleep is not simply long overdue, but a timely and valuable complement to work in related fields of inquiry such as sleep epidemiology and public health which, in similar fashion, take us far beyond the sleep laboratory or sleep clinic to broader issues concerning sleep, health and society. It is therefore to a further consideration and elaboration of this newly emerging sleep and society agenda within sociology that we now turn in this chapter. We outline several strands of recent sociological work - starting with some preliminary points regarding the very conceptualisation and measurement of ‘sleep’ as a methodological backdrop to the sociological themes and issu
Whilst most academic literature on food is written from a nutritional perspective, over the last three decades there has been increasing sociological interest in the meaning of food from a social interactionist approach. This interest was stimulated by the burgeoning feminist examination of the gendered domestic division of labour within households (for example Arber, 1993; Oakley, 1975). Cooking and its allied tasks: menu choice, shopping, preparation and clearing up afterwards, continues to be carried out mainly by women (DeVault, 1991; Sullivan, 1997). Since the 1980s, there have been changes in the gender dynamics of responsibility for meal preparation associated with age, class, educational level and presence of children within relationship units (Kemmer, 2000; Warde and Hetherington, 1994). The negotiation of food habits and behaviours of heterosexual couples entering into a relationship, whether cohabitation or marriage, has been investigated by Kemmer et al (1998) and Lake (2006), but less attention has been paid how food is linked to older people’s negotiations and adjustments to life events such as widowhood and new partnership formation. This chapter sheds light on the enduring importance of food as ‘social glue’ in old age, and how gendered food practices play a pivotal role in the maintenance of roles and identities in later life. Food practices expose social relations as they reflect, and are used to perform, social roles and identities. Life events such as widowhood in later life impact on the social roles of older people which in turn are reflected in food related behaviour such as the responsibility for food and food preparation. Continuities and discontinuities are experienced differently by older men and women, and the strategies employed to deal with them reflect perceptions of traditional cultural and gender roles. The chapter firstly examines sociological literature around food and the gendered division of labour in the kitchen, and discusses the sparse literature on ageing, social networks and food behaviours. Secondly, it discusses the methodology of our qualitative research project. Thirdly, it analyses our data to examine traditional notions of age related feminine and masculine identities and their impact on food related behaviours despite, and as a result of late life-course transitions.
This chapter examines sleep of women in Northern Italy. In depth qualitative interviews with 40 women aged between 40 and 80 years enabled examination of the intimate aspects of sleep and how these are related to the social and family context of Italian women. The aim of this chapter is to examine the meanings that Italian women attach to sleep, and their perceptions of one of the key factors that influence their sleep. The dominant theme that emerged from the interviews as influencing women’s sleep was their care-giving roles, although the interview guide was not specifically designed to examine care-giving. For this reason, the chapter focuses on how Italian women’s care-giving roles shape their sleep patterns and definitions of their sleep quality. Italy provides an important case study for examining the ways that care-giving roles structure women’s sleep because of the fragmented welfare provision for both childcare and eldercare. The particular intensity of family connections in Italy and close intergenerational exchanges of informal care puts into sharp relief how caring delineates the extent and continuity of women’s sleep, highlighting how family roles and relationships interact and intersect with sleep. The chapter first provides a brief review of research on women’s sleep, which hitherto has primarily focused on sleep in the UK. We then provide a review of care provision, family culture and the Italian welfare state. After outlining our methodological approach, we present data on women’s understandings and meanings of sleep, before examining how Italian women’s care-giving roles impact on their sleep at various stages through their life course.
Debate about elderly people has been dominated by stereotypical images, while profound inequalities in the circumstances of elderly people have been neglected. This paper examines one aspect of inequality, that of personal income, showing that elderly people span the gulf between affluence and poverty, and that ageist representations of pensioners mask structured inequalities which have arisen during the working life. The paper focuses on gender inequality of occupational and private pension income and assesses the effects of the sexual division in the labour market ('the price of being female') and of women's role in the domestic economy ('the cost of caring'). Gender and marital status as well as class are found to be crucial factors in understanding income inequality among elderly people. Occupational and personal pensions are the chief means of perpetuating these divisions into later life. The paper uses data from the 1985 and 1986 General Household Survey, which provides a representative sample of over 7000 people over age 65. Reprint of article first published in The British Journal of Sociology, 1991, 42(3), 369-396. Available at: http://www.jstor.org/stable/591186
Sociology almost entirely neglects later life. This contrasts with social policy where elderly people are largely seen as a burden on society and their carers. The article examines three areas of sociological enquiry and suggests reasons for the omission of elderly people. Parallels are drawn with sociology's earlier neglect of women. The feminist agenda has largely excluded the concerns of elderly women and at times has contributed to the pathological image of elderly people as burdens to be shouldered by their daughters. We argue that sociological theories would be enriched by incorporating the experiences of elderly people within their theoretical net. Reprint of article first published in The Sociological Review, 1991, 39(2), 260-291. DOI: 10.1111/j.1467-954X.1991.tb02981.x
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