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 Disord 13 (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
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 Online 12 (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 Care 48 (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 Proceedings 40 (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.
The concept of ?active ageing? has received much attention through strategic policy frameworks such as that initiated by the World Health Organisation, and through government and non-governmental organisation initiatives. The primary goal of these initiatives is to encourage older people to be active and productive, and to enhance quality of life, health and wellbeing. It is well known that with increasing age, night-time sleep deteriorates, which has implications for how older people maintain activity levels, and leads to an increased propensity for day-time sleep. Using data from 62 interviews with people aged 65?95 years living in their own homes who reported poor sleep, this paper explores the meanings of day-time sleep, and how the attitudes and practices of ?active ageing? are intricately linked to the management of day-time sleep and bodily changes that arise from the ageing process. The desire to be active in later life led to primarily dichotomous attitudes to day-time sleep; older people either chose to accept sleeping in the day, or resisted it. Those who accepted day-time sleep did so because of recognition of decreasing energy in later life, and an acknowledgement that napping is beneficial in helping to maintain active lives. Those who resisted day-time sleep did so because time spent napping was regarded as being both unproductive and as a negative marker of the ageing process.
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 Health 8 (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 SOCIETY 73 (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 Aging 5 pp. 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 REVIEWS 36 (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 & SOCIETY 26 pp. 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 RESEARCH 19 (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 Ageing pp. 113-154 Policy Press
Allum N, Arber S (2008) Secondary analysis of survey data, In: Gilbert GN (eds.), Researching Social Life pp. 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 Making 29 (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
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, Mortality 13 (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 Gerontology 30 pp. 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 Series 1
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 Disorders 11 pp. 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 Policy 39 (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 Thinking 9780203943434 pp. 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 Steps 7 pp. 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 HEALTH 16 pp. 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
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 International 35 (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 Health pp. 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.