Picture of the Icelandic explorer Gudrid Thorbjarnardóttir.
Picture taken by Ascensión Doñate in Snæfellsnes (Iceland)
Ascensión Doñate-Martínez, PhD
Polibienestar Research Institute - University of Valencia
Women tend to have more disabling, but non-fatal diseases; whereas men have more life-threatening conditions. These sex differences represent the ‘male-female health survival paradox’ stating women live longer than men, but with poorer health. In this sense, women are frailer and experience more comorbidities than men, and these differences are higher in older ages [1]. In the same way, physical health-related quality of life is worse among females with chronic conditions than in males [2].
This sex gap is also evident at the end-of-life (EoL) process as women suffer higher prevalence and severity of fatigue at home-based palliative care (PC) [3] or lower symptom improvement – such as in vomiting, depression or anxiety – than the corresponding male patients do while in PC units [4].
Despite these worst health outcomes, patients at specialized PC use to be women as they are more often admitted to these services, especially to hospices [5]. This can be explained by traditional sex roles where men are more likely to receive EoL care at home by their female partners. Also in line with this, it is worth to mention that the rate of nursing home deaths is higher among women than in men [6]. An explanatory hypothesis is that older women are more often institutionalized because their husbands die before them and, subsequently, they lack daily support at home when deterioration of their health is more evident.
These sex differences are even more significant taking into consideration that most caregivers – in general pathways and in PC/EoL care – are women, with the subsequent caregiving burden that may mean an impairment of their physical and emotional welfare. Also, many women tend to feel a great responsibility to provide a ‘good death’ at home for their relatives and partners as a success, and not achieving this may result in feeling guilt or failure [7].
We are aware that women provide most of the care throughout a person’s life. They are a valuable asset in our informal care systems, and they deserve their specific needs to be attended. Also, we should not forget what ‘gender equity in health’ means: "Process of being fair to women and men with the objective of reducing unjust and avoidable inequality between women and men in health status, access to health services and their contributions to the health workforce" [8]. On this basis, health and care systems need to perform greater efforts addressing sex differences when implementing clinical practices and performing research; moving beyond knowledge into action.
References:
[1] Ahrenfeldt, L.J., Möller, S., Thinggaard, M. et al. (2019). Sex Differences in Comorbidity and Frailty in Europe. Int J Public Health, 64, 1025–1036.
[2] Yu, T., Enkh-Amgalan, N., Zorigt, G. et al. (2019). Gender differences and burden of chronic conditions: impact on quality of life among the elderly in Taiwan. Aging Clin Exp Res, 31, 1625–1633.
[3] Husain, A.F., Stewart, K., Arseneault, R. et al. (2007). Women experience higher levels of fatigue than men at the end of life: a longitudinal home palliative care study. J Pain Symptom Manage, 33(4), 389-97
[4] Tai, S.Y., Lee, C.Y., Wu, C.Y. et al. (2016). Symptom severity of patients with advanced cancer in palliative care unit: longitudinal assessments of symptoms improvement. BMC Palliat Care, 15, 32.
[5] Adsersen, M., Thygesen, L.C., Jensen, A.B. et al. (2017). Is admittance to specialised palliative care among cancer patients related to sex, age and cancer diagnosis? A nation-wide study from the Danish Palliative Care Database (DPD). BMC Palliat Care, 16, 21.
[6] Kalseth, J. & Theisen, O.M. (2017). Trends in place of death: The role of demographic and epidemiological shifts in end-of-life care policy. Palliative Medicine, 31(10), 964–974.
[7] Gott, M., Morgan, T. & Williams, L. (2020). Gender and palliative care: a call to arms. Palliative Care and Social Practice.
[8] WHO (n.d.). Gender, equity and human rights (accessed 03/03/2021).
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