Arber S, Hislop J, Bote M, Meadows RAL (2007) Gender roles and women?s sleep in mid and later life: A quantitative approach, Sociological Research Online
Venn S, Arber S (2008) Conflicting sleep demands: Parents and young people in UK households, In: Brunt L, Steger B (eds.), Worlds of Sleep: Investigations into the Dormant Third of our Livespp. 105-130 Frank & Timme
In this chapter we show how the complexity of everyday household living arrangements influences how and when we sleep, and even where we sleep. Sleeping for members of a household containing teenagers and young adults is at best subject to occasional interruptions, and at worst, frequent and chaotic disruptions. However, whilst our focus is on interruptions to the suggested appropriate requirement of seven to eight hours? sleep at night, we also demonstrate that for both parents and young people household noise and activity may sometimes have a positive effect on sleep, by affording a sense of security, comfort and reassurance.
The aims of this chapter therefore are to examine how parents and young people interact with each others? sleeping space and sleep time. First, by exploring the influence on parents? sleep of having teenagers and young adults living in the home. Second, to look at sleep from the perspective of young people, by examining how parents, other household members and technologies, such as mobile phones, influence their sleep. Finally, the positive aspects of sleep interruption expressed by both parents and young people will be examined, as, for example, when entering each others? sleeping space and time provides peace of mind and security, and can, in some instances, facilitate sleep.
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
Arber S, Hislop J, Bote M, Meadows R (2007) Gender roles and women's sleep in mid and later life: A quantitative approach, SOCIOLOGICAL RESEARCH ONLINE12(5) SAGE PUBLICATIONS LTD
Lowson E, Arber S (2014) Preparing, working, recovering: Gendered experiences of night work among women and their families, Gender, Work and Organization21(3)pp. 231-243 John Wiley
The negative physiological consequences of night work are well evidenced, but there has been limited research on the gendered consequences of night work for partnered women with children. This paper examines women?s experiences of night work by drawing on qualitative interview and audio sleep diary data with 20 UK female nurses working non-regular rotating shifts, together with interview and diary data from their male partners and children. The analysis shows how the lived experience of women?s night work is characterised by three phases, which we discuss within a timescape perspective. Alongside changes to paid work and sleep during the period of night shifts, the ?preparation? and ?recovery? phases of women?s night work involve intense periods of considerable additional unpaid and unrecognised work and anxiety. Gendered expectations for household management and family wellbeing mean that women night workers undertake considerable responsibility for complex planning before night shifts begin, and re-enter established domestic routines within hours after night shifts end. Women maintain continuity for their families by actively managing night work?s impacts. This enables the fulfilment and ?display? of successful and normative gendered patterns of domestic responsibility, which appears to be central to women?s own coping with night shifts.
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.
Arber SL, Fenn K, Meadows R (2014) Subjective financial well-being, income and health inequalities in mid and later life in Britain, Social Science and Medicine100pp. 12-20 Elsevier
The relationship between health and income is well established, but the link between subjective financial wellbeing and self-assessed health has been relatively ignored. This study investigates the relationship between health, subjective financial wellbeing and income in mid-life and later life in Britain. Analysis of the General Household Survey for 2006 examined these relationships at ages 45-64 (n=4639) and 65 and over (n=3104). Logistic regression analysis was used to adjust for income and other socioeconomic factors linked to self-assessed health. Both income and subjective financial wellbeing are independently associated with health in mid-life; those with lower incomes and greater subjective financial difficulties had higher risk of reporting ?less than good? health. In contrast in later life, subjective financial wellbeing was associated with health, but the effect of income on health was mediated entirely through subjective financial wellbeing. The poorer health of the divorced/separated was also mediated entirely by differences in subjective financial wellbeing. Research on health inequalities should pay greater attention to the link between subjective financial hardship and ill-health, especially during periods of greater economic difficulties and financial austerity.
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.
Williams S, Meadows R, Arber S (2010) The Sociology of sleep,In: Cappuccio F, Miller M, Lockley S (eds.), Sleep, Health and Society: From Aetiology to Public Health13pp. 275-299
Oxford University Press
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
Arber S, Hislop J, Williams S (2007) Editor's introduction: Gender, sleep and the life course, SOCIOLOGICAL RESEARCH ONLINE12(5) SAGE PUBLICATIONS 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.
Arber S, Andersson L, Hoff A (2007) Changing approaches to gender and ageing - Introduction, CURRENT SOCIOLOGY55(2)pp. 147-153 SAGE PUBLICATIONS LTD
Arber S, Attias-Donfut C (2007) The Myth of Generational Conflict: Family and State in Ageing Societies, Routledge
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.
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.
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.
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.
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.
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.
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.
Arber SL (2014) Sleep, an Overview, In: Michalos AC (eds.), Encyclopedia of Quality of Life and Well-Being Researchpp. 5990-5992 Springer Publishing
Meadows RAL, Arber S (2015) Marital status, relationship distress and self-rated health: what role for ?sleep problems??, Journal of Health and Social Behavior56(3)pp. 341-355
This paper analyzes data from a nationally representative survey of adults in the United Kingdom (Understanding Society, N = 37,253) to explore the marital status/health nexus (using categories that include a measure of relationship distress) and to assess the role that sleep problems play as a potential mediator. Findings indicate how it is not just the "form" marital status takes but also the absence or presence of relationship distress that is essential to self-rated health. We demonstrate two further findings that: (1) sleep problems act as a mediator of the link between marital status/relationship distress and self-rated health, most notably for those in cohabiting relationships with medium/high distress or who have a history of relationship loss, and (2) the mediating role of sleep problems differs for divorced men and women.
Williams SJ, Meadows R, Arber S (2010) The sociology of sleep, In: Cappuccio F, Miller FM, Lockley S (eds.), Sleep epidemiology and public health Oxford University Press
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.
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.
Arber SL (2013) Gender, Health and Aging. Continuity and change after 2 decades., Medical Sociology Online7(3)pp. 28-37 British Sociological Association
After almost two decades, many issues raised in this article on ?Gender, Health and Ageing? still resonate today, but others seem outdated. The following is still largely applicable:
?It is ironic that such a small amount of research by medical sociologists is devoted to older people despite the high proportion of health resources spent on people above retirement age. What research there is tends to focus on sick older people who are already within the health care system. & The challenge is to build on the theoretical insights and methodological imperatives from feminist sociology and work on women?s health and apply them to older people.? (Arber, 1994: 18)
But other issues raised by the article no longer apply. Although, the importance of hearing the voices of older people and letting older people define issues of relevance to them is widely acknowledged, this is not always the reality in much research. Older people are no longer primarily seen as a ?burden?, but the mandate is increasingly for older people to be active and engaged in ?productive ageing? or ?successful ageing?. However, this contemporary mandate for older people to be involved in paid work, voluntary work and unpaid care-giving for grandchildren, partners and others, may eclipse social divisions among older people, including their health and physiological capacity to engage in ?productive/successful ageing?. The great research taboo in terms of hearing the voices of older people increasingly involves those in the Fourth Age.
Gender has infused and become firmly embedded within both the Sociology of Health and the Sociology of Ageing, although these two fields remain two separate disciplines, with the former much stronger than the later (at least in Britain). There are still many research lacunae. For example, we know much less about older men and their health than about older women, and the tendency to treat older women (or older men) as a homogeneous group within research remains widespread. More nuanced research is needed which addresses class, ethnicity, partnership status and sexuality among older people, as well as gender, and fully examines the intersectionality that characterises and differentiates the everyday lives, health and health behaviours of older women and men.
(Originally published in Medical Sociology News, Volume 20, Issue 1, December 1994)
Link CL, Stern TA, Piccolo RS, Marceau LD, Arber S, Adams A, Siegrist J, von dem Knesebeck O, McKinlay JB (2011) Diagnosis and Management of Depression in 3 Countries: Results From a Clinical Vignette Factorial Experiment.,Primary Care Companion CNS Disord13(5)
Physicians Posgraduates Press, Inc.
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.
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.
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.
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 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.
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.
Aim The aim of this study was to undertake a detailed exploration of sleep in the context of 24 hours in a care home environment, exploring the subjective experience of residents and the perceptions of staff. Method 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, the physical environment and practices in care homes can affect residents' sleep and night-time experience. Conclusion Improving our understanding of residents' and staff's 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.© 2013 RCN Publishing Ltd. All rights reserved.
Lewis H, Arber S (2015) The role of the body in end-stage kidney disease in young adults: Gender, peer and intimate relationships., Chronic Illn
To understand how the physical body, and changes in the physical body, influence peer and intimate relationships and parenting in young adults on renal replacement therapies (RRT).
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.
Bianchera E, Arber S (2007) Caring and sleep disruption among women in Italy, Sociological Research Online12(5)
Konrad TR, Link CL, Shackelton RJ, Marceau LD, von Dem Knesebeck O, Siegrist J, Arber S, Adams A, McKinlay JB (2010) It's About Time Physicians' Perceptions of Time Constraints in Primary Care Medical Practice in Three National Healthcare Systems, Medical Care48(2)pp. 95-100 American Public Health Association
Background: As physicians are pressured to deliver an increasing number of preventive services, follow guidelines, engage in evidence-based practice, and deliver patient-centered care in managerially driven organizations, they struggle with how much control they have over their time. Methods: A secondary analysis was conducted with data from 3 parallel studies of clinical decision making in Germany, the United Kingdom, and the United States with 128 physicians per country. Physicians reported how much time they were allocated and how much time they needed for high-quality care for new patient appointments, routine consultations, and complete physicals. They also reported how much control they had over their time in the office and spending adequate time with patients. Results: German, British, and American physicians were allocated (on average) 16/11/32 minutes for a new patient appointment, 6/10/18 minutes for a routine visit, and 12/20/36 minutes for a complete physical, but felt that they needed more time. Over half of German and American physicians felt that they always or usually had control over the hours they were required to be in their office or spending sufficient time with their patients while less than half of British physicians felt this way. Conclusion: German physicians had the least time allocated and needed for most types of appointment. American physicians had the most time allocated and needed for each type of appointment. However, British physicians felt they had the least control over time in their office and spending sufficient time with patients.
Lewis H, Arber S (2014) Impact of age at onset for children with renal failure on education and employment transitions., Health (London)19(1)pp. 67-85
Previous medical research has shown that children with end-stage renal failure experience delay or underachievement of key markers of transition to adulthood. This article analyses 35 qualitative interviews with end-stage renal failure patients, aged 20-30 years, first diagnosed at 0-19 years of age, to explore how far delayed or underachievement in education and employment is related to their age at onset of end-stage renal failure. This study shows how unpredictable failures of renal replacement therapies, comorbidities and/or side effects of treatment in the early life course often coincided with critical moments for education and employment. Entering school, college, work-related training or employment, and disclosing health status or educational underachievement to an employer, were particularly critical, and those who were ill before puberty became progressively more disadvantaged in terms of successful transition into full-time employment, compared with those first diagnosed after puberty.
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
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
Aubrey P, Arber S, Tyler M (2008) The Organ Donor Crisis: The missed organ donor potential from the Accident and Emergency Departments, Transplantation Proceedings40(4)pp. 1008-1011 Elsevier
The critical shortage of cadaveric donor organs for transplant purposes is a worldwide
concern. The disparity between the number of cadaveric organs donated for transplant
purposes and those patients awaiting transplant operations continues to widen. This article
reports on the findings of an audit of deaths undertaken in 10 accident and emergency
(A&E) departments in North Thames region, UK. The audit itself was borne out of informal
anecdotal accounts from colleagues working in the A&E department who suggested that there
was a potential pool of organ and tissue donors that were not being realized. The article
discusses how those audit findings helped shape the current A&E education strategy in the
North Thames region. The result has been that the North Thames region has seen a dramatic
increase in the number of referrals from the A&E departments, resulting in solid organ
transplantation. Although the results are very encouraging, the program is still very much in its
infancy and a long way from the desired 100% referral rate. In order to maximize the number
of organs from the potential donor pool, the transplant community needs to focus more
attention toward donation from the A&E departments.
Arber S (2012) Gender, marital status and sleep problems in Britain, Przeglad Lekarski / Polish Journal of Social Medicine (English supplement)69(2)pp. 54-60 Partswowy Zaklad Wydawnictur Lekarskich
Sleep is fundamental to health and well-being, with women consistently reporting greater sleep problems than men, yet scant sociological research has examined gender differences in sleep quality. This paper analyses (i) gender differences in sleep problems, and (ii) how marital status differences in sleep problems differ for women and men. In both cases, the relative contributions of socio-economic status (SES), smoking, worries, health and depression in explaining these gender and marital status differences are analysed. Logistic regression is used to analyse the British Psychiatric Morbidity Survey 2000, which interviewed 8578 men and women aged 16 to 74. 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. This study casts doubt on the primacy of physiological explanations underlying these gender differences. Marital status differences in sleep are greater among men than women, with previously partnered men reporting particularly poor quality sleep. However, this is largely explained by the more disadvantaged socio-economic circumstances of the previously partnered, especially for men. We conclude that gender and marital status differences are partly due to the lower socio-economic status of women and of the previously partnered.
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.
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.
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.
Arber SL (2009) Review of C.E. Bird and P.P. Rieker (2008) Gender and health: The effects of constrained choices and social policies, International Journal of Men?s Health8(2)pp. 184-186 Men's Studies Press
Darling AL, Hart KH, Skene DJ, Arber S, Lanham-New SA (2014) Vitamin D status, functional ability and muscle strength in older South Asian and Caucasian women in the UK, PROCEEDINGS OF THE NUTRITION SOCIETY73(OCE1)pp. E23-E23 CAMBRIDGE UNIV PRESS
Venn S, Davidson K, Arber S (2011) Gender and Ageing,In: Settersten RA, Angel JL (eds.), Handbook of Sociology of Aging5pp. 71-82
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.
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.
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.
Arber S (2007) Aging, globalization and inequality: The new critical gerontology, CONTEMPORARY SOCIOLOGY-A JOURNAL OF REVIEWS36(2)pp. 186-188 AMER SOCIOLOGICAL ASSOC
Adams A, Buckingham CD, Arber S, McKinlay JB, Marceau L, Link C (2006) The influence of patient's age on clinical decision-making about coronary heart disease in the USA and the UK, AGEING & SOCIETY26pp. 303-321 CAMBRIDGE UNIV PRESS
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.
Lallukka T, Rahkonen O, Lahelma E, Arber S (2010) Sleep complaints in middle-aged women and men: the contribution of working conditions and work-family conflicts, JOURNAL OF SLEEP RESEARCH19(3)pp. 466-477 WILEY-BLACKWELL
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.
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.
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.
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.
Arber SL, Bowling A, Creech A, Duncan M, Goulding A, Gyi D, Hallam S, Haslam C, Kazi A, lloyd L, lord J, MAP2030 team, Murphy M, Newman A, Phillips AC, Twumasi R, Upton J (2014) Maintaining health and wellbeing: Overcoming barriers to healthy ageing?, In: Walker A (eds.), A New Science of Ageingpp. 113-154 Policy Press
Allum N, Arber S (2008) Secondary analysis of survey data, In: Gilbert GN (eds.), Researching Social Lifepp. 372-393 Sage
This chapter discusses the practical issues and considerations that students need to take into account when selecting and analysing data from existing survey datasets. A discussion of what is meant by ?secondary? analysis, and why one might want to undertake such analysis, is followed by a summary of the major types of survey dataset that are available. Differences between panel, cross-sectional and continuous surveys are highlighted and examples of these are discussed. There then follows a discussion of some of the advantages and also pitfalls of using secondary data sources for sociological analysis, followed by a guide to locating and obtaining datasets. The chapter concludes with a brief discussion of methods that can be used for the analysis of survey data and some ideas for student projects.
Government and other large surveys, as well as the increasing number of panel/longitudinal studies, provide very rich sources of data for secondary analysis. Many of these are under-analysed, from both a statistical and a theoretical viewpoint. This chapter argues that secondary analysis requires sociological imagination and that the secondary analysis of large, primarily government, surveys has untapped potential as a source of sociological insights.
Lutfey KE, Link C, Marceau C, Grant RW, Adams A, Arber S, Siegrist J, Bonte. M, von dem Knesebeck O, McKinlay J (2009) Diagnostic Certainty as a Source of Medical Practice Variation in Coronary Heart Disease: Results from a Cross-National Experiment of Clinical Decision Making,Medical Decision Making29(5)pp. 606-618
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.
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.
Lewis H, Arber S (2015) Impact of age at onset for children with renal failure on education and employment transitions, Health (London, England : 1997)19(1)pp. 67-85
© The Author(s) 2014.Previous medical research has shown that children with end-stage renal failure experience delay or underachievement of key markers of transition to adulthood. This article analyses 35 qualitative interviews with end-stage renal failure patients, aged 20-30 years, first diagnosed at 0-19 years of age, to explore how far delayed or underachievement in education and employment is related to their age at onset of end-stage renal failure. This study shows how unpredictable failures of renal replacement therapies, comorbidities and/or side effects of treatment in the early life course often coincided with critical moments for education and employment. Entering school, college, work-related training or employment, and disclosing health status or educational underachievement to an employer, were particularly critical, and those who were ill before puberty became progressively more disadvantaged in terms of successful transition into full-time employment, compared with those first diagnosed after puberty.
Garnett D, Vandrevala T, Hampson SE, Daly T, Arber S (2008) Family members' perspectives on potential discussions about life prolongation for their older relatives, Mortality13(1)pp. 65-81 Taylor & Francis
Family members (or health-care confidants) of incapacitated patients are often consulted by doctors when making life-prolongation decisions. Little research has been conducted on confidants' views on life prolongation and advance care planning. This study investigated the health-care confidant's view on life prolongation and their involvement in being a potential decision-maker for their relatives in the event of incapacitation. Confidants (N = 12) were interviewed and interviews were analysed using Interpretative Phenomenological Analysis. The analysis revealed three themes relating to their perception of being a potential decision-maker for a relative's life prolonging measures: ?good? and ?bad? death based on past experience and perceptions of quality of life, a sense that discussions were inappropriate at present, and strategies which might be used to encourage discussion. The implications of these findings for family involvement in life-prolongation decisions and how to encourage family discussions about life prolongation are discussed.
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.
Arber S, Timonen V (2015) Grandparenting, In: Twigg J, Martin W (eds.), Routledge Handbook of Cultural Gerontology30pp. 234-242 Routledge
Grandparenting is a dynamic family practice that varies over time and between cultural contexts, and is shaped by material and structural factors such as social class, demographic change, and the welfare state context. Gender norms exert a strong influence on grandparenting practices and their negotiation across the dyadic grandparent-grandchild relationship and the triad of grandparent?adult child?grandchild. Cultural norms and expectations associated with grandparenting may be in conflict, and grandparents use agency to negotiate the balance between norms of ?being there? (to assist), ?not interfering?, and drawing boundaries around their involvement in the lives of younger family generations.
Arber S, Ginn J (2008) The invisibility of age,In: McDaniel S (eds.), Ageing, Key Issues for the 21st Century Series1
Sage Publications Ltd
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
Arber S, Meadows R, Venn S (2012) Sleep and Society,In: Morin CM, Espie CA (eds.), The Oxford Handbook of Sleep and Sleep Disorders11pp. 223-247
Oxford University Press
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.
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.
Arber SL (2010) Review of Saraceno, C. (ed.) (2008), Families, Ageing and Social Policy: Intergenerational Solidarity in European Welfare States. Cheltenham: Edward Elgar, Journal of Social Policy39(4)pp. 650-651 Cambridge University Press
Hislop J, Arber S (2006) Sleep, gender, and aging: Temporal perspectives in the mid-to-later life transition, In: Calsanti T, Slevin K (eds.), Age Matters: Realligning Feminist Thinking9780203943434pp. 225-246 Routledge
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.
Grandparenting in the 21st century is at the heart of profound family and societal changes. It is of increasing social and economic significance yet many dimensions of grandparenting are still poorly understood. Contemporary Grandparenting is the first book to take a sociological approach to grandparenting across diverse country contexts and combines new theorising with up-to-date empirical findings to document the changing nature of grandparenting across global contexts. In this highly original book, leading contributors analyse how grandparenting differs according to the nature of the welfare state and the cultural context, how family breakdown influences grandparenting, and explore men's changing roles as grandfathers. Grandparents today face conflicting norms and expectations about their roles, but act with agency to forge new identities within the context of societal and cultural constraints. Contemporary Grandparenting illuminates key issues relevant to students and researchers from sociology and social policy, including in the fields of family, childhood, ageing and gender studies
Chatzitheochari S, Arber S (2011) Time use studies: A method for exploring everyday life in the Third Age., In: Carr D, Komp K (eds.), Gerontology in the Era of the Third Age: Implications and Next Steps7pp. 127-145 Springer Publishing
Activity patterns after retirement have always constituted a theme of central interest for social gerontology. However, despite the recent theoretical focus on the emergence of the Third Age as a period of self-fulfilment and an ongoing engagement with an active leisure lifestyle after retirement, sociology's knowledge regarding everyday life in older ages remains limited as there is a dearth of social surveys on how older people spend their time. Furthermore, the majority of existing studies on the topic rely on data from conventional interviewer-administered questionnaire surveys that do not provide a holistic account of everyday activities and also have certain methodological weaknesses. Few studies capitalize on data from time-use surveys, which currently constitute the most widely employed and accurate methodology for collecting information on daily activities. The aim of this chapter is to introduce time-use methodology to researchers in the field of aging and to discuss the contributions that analyses of time-use data can bring in the field of social gerontology in the era of the Third Age. The first part of the chapter reviews the basic methodological aspects of time-use surveys and provides a discussion of their advantages over alternative methods of data collection on individuals' time allocation. In the second part an example of a time-use analysis is provided: British data from 2000 are analyzed to examine the socio-demographic correlates of participation in ?active? and ?passive? leisure activities for people over the age of 64.
Arber S (2006) Sleep and health: gender, socioeconomic circumstances, and inequalities in sleep, EUROPEAN JOURNAL OF PUBLIC HEALTH16pp. 5-5 OXFORD UNIV PRESS
This study explored the lived experience of middle class retirees in India through 40 qualitative semi-structured interviews. Interviews were conducted with 20 male and 20 female middle class retirees covering 30 married, 4 widowed, 1 divorcee and 5 never-married retirees aged between 58 to 75, who had been retired from formal sector employment (e.g. managers, bankers, professors, doctors, engineers, administrators) for at least a year. The interviews were analyzed thematically using a Grounded Theory approach.
The main findings of this study suggest that middle class retirees in India searched for an alternative structure to frame their time in retirement to gain an identity after loss of their work-related identity. A strong sense of ?retirement pride? influenced their retirement adaptation, which was the aggregate effect of their life?s accomplishments, a successful family life, possession of good health and financial freedom. They enjoyed freedom, but paradoxically longed for a routine in retirement. This thesis argues that routine in retirement was conceived as under the control of the retirees. They enjoyed freedom by structuring their time creatively through meaningful activities, in particularly part-time work, volunteering and leisure activities besides active engagement with family.
Both male and female retirees valued the importance of health for Active Ageing with the twin objectives of maintaining good health and not becoming a burden on their family. They actively pursued diverse social relationships with family and friends to remain in control for physical and emotional health. Both male and female retirees maintained an active lifestyle and found satisfaction through the process of Active and Productive Ageing. An important gender difference in middle class retirement was that women showed greater ability to engage in multiple activities by successfully combining their family role with leisure activities, volunteering, part-time work and care-giving. The findings from this study strongly suggest that for middle class retirees in India, a Third Age can be recognised on the basis of a positive attitude, resilience, acceptance, retirement pride, freedom, mental and physical health, companionate marriage (for those who are married), rewarding social relationships, and participation in meaningful activities with a desire to pursue a goal and Active Ageing.
Negative impacts of night work on employees are well documented, but little is known about immediate consequences for family members. This study examines how night work within a rotating shift pattern affects the sleep, mood and cortisol levels of female nurses, their husbands and children. Participants included twenty nurses (42.7 ± 6.5 years), their husbands and children (n=34, 8-18 years) who completed sleep diaries, rated their sleep quality, alertness and mood daily, and collected saliva samples each morning and evening for 14 days. Comparisons were made between night work and other shifts (Wilcoxon Signed Ranks test); and between periods preceding, during and following night shifts (repeated measures ANOVA with Tukey posthoc tests). Nurses? sleep after the final night shift was significantly shorter (3h 58 mins ± 46 mins) and ended significantly earlier (13:28 ± 0:48h) than after the first night shift (sleep duration 5h 17 mins ± 1h 36 mins; wake time 14:58 ± 1:41h) (p<0.05, n=16). Nurses felt significantly more sleepy with worse mood during night work compared to periods without night work. Bedtime for pre-teenage children (n=15) was significantly later when mothers were working night shifts. Teenage children (n=19) felt significantly calmer when their mothers were working night shifts. This study found significant negative impacts of night shifts on nurses. Despite some changes to children?s sleep and mood, most parameters were unaffected. There was an absence of changes to husbands? sleep and mood. This suggests nurses? night work has minimal impacts on family members participating in our study.
Turrini A, D'Addezio L, Maccati F, Davy B, Arber SL, Davidson K, Grunert K, Schuhmacher B, Pfau C, KozBowska K, SzczeciDska A, de Morais C, Afonso C, Bofill S, Lacasta Y, Nydahl M, Ekblad J, Raats MM, Lumbers M (2010) The Informal Networks in Food Procurement by Older People-A Cross European Comparison,Ageing International35(4)pp. 253-275
Healthy dietary profiles contribute to successful aging, and dietary intake is dependent upon food procurement capabilities. Both formal and informal social networks can contribute to grocery shopping capabilities and methods of food procurement. This investigation explores the role of informal networks in food procurement methods among adults aged 65 years and older, and compares differences across eight European countries. Food shopping ways (FSW), identified by quantitative analysis (cluster analysis and correspondence analysis), guided the content qualitative analysis which was carried out addressing three main research questions addressing food shopping routines, feelings of dependency and needs of informal support for shopping, and differences between past and present food shopping behaviours. Living circumstances influence food shopping habits. Informal networks differed between two groups of individuals: those living alone and those living with others. Gender differences emerged in shopping pleasure. Geographical factors were associated with preference for shopping companions, attitudes toward receiving support, and availability of a car for shopping. The importance of living circumstances (i.e., alone vs. with others) in FSW was revealed. Informal social networks may play an important role in public health and welfare policies, particularly given the increase in this demographic group. Assistance with grocery shopping and the availability of trained personnel could widen informal networks, and effective informal networks may be an important supportive service for older adults. The comparison across countries highlighted relationships between food procurement capabilities and social networks. These findings may be used to develop resources to better meet the nutritional needs of older adults.
This thesis contributes to the internationalisation of criminological knowledge about gender and crime through a cross-national analysis of female ex-offenders' qualitative experiences of crime and criminal justice in two European countries; Sweden and England. Grounded in a feminist methodological framework, the study draws on 24 life-story narrative interviews with 12 repeat female offenders in Sweden and 12 in England, who, at the time of the interview, self-identified as desisters. Three major phases of the female journey through crime and criminal justice are represented in the study, namely; the female pathway into crime, the female experience of criminal justice and lastly, the female route out of crime.
Some cross-national symmetry is detected across the samples, particularly in the areas of female experiences of gendered victimisation and issues around short custodial sentences. Overall; however, the findings demonstrate that diverse macro-processes and models, especially in terms of 'inclusive' versus 'exclusive' penal cultures, effectually 'trickle down' and produce distinctly different female micro-experiences of crime and criminal justice in Sweden and England. Providing new qualitative evidence of the 'Nordic Exceptionalism thesis?, the findings indicate that, comparatively, the Swedish model offers a macro-context, supported and reflected in allied meso-practices, which is more conducive to the formation of lasting female routes out of crime and into active participation in 'mainstream' society.
The principal qualitative mechanisms that underpin this argument, identified as distinctive to the Swedish model through the cross-national thematic analysis, include: (1) a more robust infrastructure supporting individual change, exemplified in high-quality drugs and alcohol provisions; (2) lived experiences of legitimacy and trust in criminal justice interactions, encouraging less conflictual relations between the individual and authorities; (3) the impact of normalisation ideals and practices within criminal justice processes, ultimately enabling a smoother transition out from the system, and lastly; (4) subjective experiences of more accessible and attractive routes into participation and inclusion, including structured and holistic investments in quality employment support.
Children with Cerebral Palsy (CP) account for the largest group of children with a physical disability in the UK. Despite evidence that sleeplessness occurs commonly in children with CP, there is little in-depth research on their sleep. Previous research has relied on the viewpoints of parents, mainly mothers. No research has explored sleep from multiple family members? perspectives within the same family. This study explores the meanings, organisation and practice of sleep for children with CP, their siblings and their parents.
This qualitative study of 10 families involves 10 children with CP (aged 6-13 years), 7 siblings (from 5 families) and 17 parents. Influenced by existing literature on involving disabled children in research, qualitative semi-structured interviews are supplemented by data from children?s self-directed photography and sleep questionnaires, 2 week sleep diaries and actigraphy for all participants.
Findings emphasise the importance of the social and family context of sleep. For children, the bedtime routine was significant with reference to their practice of sleep and differences were highlighted dependent on age and severity of CP. Night-time interactions with parents were important for children with severe CP experiencing sleeplessness. For some children, the use and location of their bedrooms enabled the attainment of privacy and autonomy. However, differences, regarding these factors, were found between children with severe CP and those without. Night-time parental monitoring of children with severe CP was common but methods differed depending on a number of intersecting factors including severity of the child?s CP, location of bedrooms and co-existing health issues. Different methods of monitoring had varying degrees of impact on parents? sleep and on privacy for the child with CP. Co-sleeping was engaged in by a small number of parents with their disabled child at specific times and used as a strategy to protect the sleep of family members.
Changes in the Saudi family structure are having profound effects on the current cohort of older Saudi women. This is reflected in living arrangements whereby family patterns have been transformed from extended to nuclear ones. Previous social research has not examined the current situation of older Saudi women, with little known about their Quality of Life (QoL).
This study explores the QoL of older unmarried Saudi women by analysing their family relationships, social lives and daily activities. It examines how family relationships, social integration, health and financial aspects are influenced by social policies and gender-related issues.
The study is based on in-depth interviews with a purposive sample of 50 widowed, divorced and never-married women aged 60-75 in Jeddah, Saudi Arabia from a range of socio-economic classes; 25 lived alone and 25 lived in inter-generational households.
Gender segregation was a decisive factor that adversely affected the QoL of interviewees. They were dependent on their family or maids socially, instrumentally, and some financially on the ?Goodwill? of their children or relatives. Older divorced women were particularly likely to experience financial and social problems. Lower class and many middle class older women who lived alone were dissatisfied and suffered from depression, isolation and loneliness, whereas higher class women living alone demonstrated greater autonomy, independence and life satisfaction. Most interviewees had poor health and multiple chronic diseases, such as diabetes and high blood pressure, which are linked to their socially and geographically restricted lives. Also, urbanization and associated cultural changes have adversely affected their QoL.
Gender segregation driven by ultra-conservative patriarchy has resulted in the economic and social dependency and restricted lives of older unmarried Saudi women. State intervention is needed to improve the general situation of older women, such as establishing care homes, increasing social insurance income and providing medical insurance.
Meadows Robert, Williams S, Gabe J, Coveney C, Arber Sara (2018) The Sociology of Sleep,In: Cappuccio F, Miller M, Lockley S, Rajaratnam S (eds.), Sleep, Health and Society: From Aetiology to Public Healthpp. 171-178
Oxford University Press
Over the past decade, sociological studies have convincingly demonstrated that 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, vary around the world, both past and present, within and between cultures and within different segments of society. This chapter outlines two interrelated strands of recent sociological work; how (i) sleep is a ?practice?, which is ?done? and ?negotiated? with others; and (ii) the problems and prospects surrounding the medicalisation of sleep. The concluding section summarises the importance of sociological studies of sleep for public health.
Nightshift work is associated with adverse health outcomes, which may be related to eating during the biological night, when circadian rhythms and food intake are misaligned. Nurses often undertake nightshift work, and we aimed to investigate patterns of energy distribution and dietary intake across 14 days in 20 UK National Health Service (NHS) nurses working rotational shifts. We hypothesised that the proportion of daily energy consumed during the nightshift would increase over consecutive nights. Primary and secondary outcome measures included intakes of energy and macronutrients. Our results show that nurses consumed the same total daily energy on nightshifts and non-nightshifts, but redistributed energy to the nightshift period in increasing proportions with a significant difference between Night 1 and 2 in the proportion of total daily energy consumed (26.0 ± 15.7% vs. 33.5 ± 20.2%, mean ± SD; p < 0.01). This finding indicates that, rather than increasing total energy intake, nurses redistribute energy consumed during nightshifts as a behavioural response to consecutive nightshifts. This finding informs our understanding of how the intake of energy during the biological night can influence adverse health outcomes of nightshift work.