The Aging Process: Unique Challenges for Men

Men and women age differently, both in terms of physical health and psychological well-being. In general, men live shorter lives and suffer more from fatal conditions, while women live longer lives and are more likely to be afflicted with debilitating conditions. The losses associated with aging can quickly erode men's sense of well-being and can lead to withdrawal, anger, and depression. The following information outlines the many unique challenges men face with the aging process and provides helpful strategies for enhancing men's sense of self-worth.

Life Expectancy, Health Factors, and Gender

A great difference exists in the life expectancy between males and females. According to 1995 estimates by the U.S. Bureau of the Census, life expectancy at birth for males is estimated at 73.2 years, while for females it is 79.8 years. This gender gap in life expectancy has declined somewhat in the 1980's and it is expected to decline in the future, with more women experiencing the stresses of the workforce.

In general, women live longer than men because they are much less afflicted by the leading causes of death, particularly diseases of the heart. For men between the ages of twenty-five and sixty-five, the death rate from heart disease is about three times that of women in the same age group. As Andrew Kimbrell points out in his book The Masculine Mystique, "Though heart attacks are also the number one killer of women, almost three-quarters of women who die of heart attacks are seventy five years or older. By this time the average man has been dead for almost two years."

Men are also at higher risk for other fatal diseases including lung disease, liver disease, and hypertension. Men are at an increased risk of developing and dying of cancer. Over the last thirty years, the overall cancer death rate for men has increased twenty-one percent, while the rate for women has remained about the same. Each year over 55,000 more men than women develop cancer, and 30,000 more men than women die of cancer.

It is generally accepted that both biological (hormonal or genetic) and psychosocial factors (for example, men's greater smoking, alcohol consumption, and predisposition to risky and violent behavior) are involved in explaining the differentials in life expectancy. While women live longer and suffer less from major fatal conditions, they are more likely to be afflicted with more nonfatal but debilitating conditions such as arthritis. In addition, women appear to suffer more from various minor illnesses and conditions which limit their activities of daily living. As a whole, women live more of their years in a disabled status and have a greater chance of being institutionalized. Proof of this fact is seen in the census of Illinois nursing homes, where the ratio of women to men is approximately ten to one.

A gender statistic that has been widely accepted is that a significantly greater number of old women are afflicted with Alzheimer's disease. The incidence of Alzheimer's disease increases exponentially with age so that the extended survival of women skews the statistics. Recent age-adjusted statistics show that men have Alzheimer's disease more frequently than women.

One of the most frightening statistics involves suicide rates for elderly men. While suicide rates for women have been stable over the last twenty years, among men they have increased rapidly. Overall men commit suicide at four times the rate of women, Approximately twenty-five thousand men take their own lives each year.

Psychosocial Challenges Men Face with the Aging Process

The aging process can be difficult for both men and women, but research has shown that men generally have a harder time in adjusting to the changes. Conditioned throughout their lives to be strong, controlling, and independent, men can be devastated by the losses that are associated with aging. They may feel that they no longer have anything to contribute to society and may find it very difficult to depend on others for everyday tasks.

One of the biggest challenges men face with growing old is no longer being gainfully employed. Work has always been a central concern in the lives of men, symbolizing their identities and sense of self-esteem. Unfortunately, our society views older men as little more than useless when they can no longer fulfill their primary role as productive workers.

No longer employed, many elderly men do not know what to do with their time. They generally had few opportunities for recreation in the past and may now find it difficult to pursue leisure involvement. They may look at recreation activities as a "waste of time" and feel that without a job, their lives lack purpose and meaning.

The male stereotypical role men lived in the past still exists for many. Society taught these men to be strong, not to complain, and not to become upset. The World War II generation values toughness and stoicism, and men were socially discouraged from revealing their feelings. In not being able to disclose emotion, many elderly men are at risk of developing depression, turning to alcohol or drugs, and committing suicide as a means of coping with stress.

Studies of recently widowed adults indicate that men suffer more emotional problems after the loss of a spouse than do women. The reasons for the gender gap remain unclear, but researchers contend that women apparently have more social ties that help is easing the distress. As one recent widower declared, "It's not easy to be a man. If I express my grief I lose, because I violate the male stereotype of the strong man who shows no emotions. However, I know that if I do not express the pain of grief, I will also lose because suppressing my feelings will bring me more problems. I'm in a no-win situation."

Recent studies of friendship show that men become more isolated from friends as they approach their later years. Elderly men may withdraw from others as they face the challenges of growing old and do the work of revising their sense of self internally. This withdrawal of men may either reflect old age or help to stimulate it. Research reveals that men who are involved in friendship groups tend to manifest better psychological health than those without friends.

Meeting the Quality of Life Needs of Elderly Men

In considering the challenges men face with the aging process, nursing home staff can design interventions which will enhance these individuals' feelings of achievement, independence, and well-being. The following are some ideas which have been successfully implemented at Illinois Council facilities:

• Provide men "work" opportunities and responsibilities. Men may enjoy doing tasks around the facility such as leading an activity program, fixing an item, or writing a newspaper column. Be sure to praise the men for a job well done.
• Those men who are more isolated may enjoy doing more individualized or smaller group activities. Examine the activity assessment to identify past interests. For instance, a man with an interest in cars may enjoy reading through car catalogs.
• Intergenerational involvement can do wonders in boosting men's self-esteem. Having the opportunity to share knowledge, skills, and wisdom with a younger person can help men feel important and valued.
• Men respond well to tangible signs of achievement and success. They enjoy having goals and being recognized for accomplishing these goals. For instance, a man may enjoy participating in a fitness program if specific goals are set for him to achieve. A certificate signifying the achievement of his goal can boost his feelings of self-esteem.
• Make every effort to recognize and validate the male resident's history and identity. Encourage family members to display awards, pictures, and diplomas in the resident's room. Discuss these personal items during caregiving interventions. Consider writing a biography of the resident for the facility newsletter.
• Research shows that social contacts play a key role in coping behaviors. Consider pairing up a male resident with another male resident with similar interests. Encourage community members to spend time a resident. Invite a pastoral counselor to encourage the resident to discuss personal concerns.

Men face many challenges with aging, including shorter life expectancy, increased health problems, and eroded self-worth. By developing interventions that recognize the unique needs of elderly men, nursing home staff can make great progress in enhancing these individuals' feelings of strength, independence, and well-being.

STATISTICS ON AGING, HEALTH, AND GENDER

-- Geriatric Nursing, July/August 1996