Why are older women special?

No, this is not what you think. It has nothing to do with sex but rather with the difference between the sexes.

But first about Wadjda. This week I saw the first feature film ever shot in Saudi Arabia. And perhaps even more significantly, it is the first feature written and directed by a Saudi Arabian woman, the talented Haifaa Al Mansour. Her tale is about a 12-year-old girl, Wadjda, who wants to buy a bike. In the setting of Riyadh this is very special, throwing open closed doors on women’s lives.

Much of the action takes place in Wadjda’s all-girl school, run by a wicked witch, Ms. Hussa (Ahd), who singles the girl out as a troublemaker. But then Wadjda’s suddenly converts to religion in an attempt to win the school’s annual Qu’ran contest so she can buy the bike she wants. She wins the contest, but the school gives the money to Palestine instead of a bike. The story is funny and interesting, but most of all the movie is about women in Saudi society.

The role of women in society is also something we will look at separately when considering support for older people. My colleague is writing an interesting short background paper on this topic for our meeting later this month. It includes many reasons why it is important to pay special attention to women when discussing the care for older people. Let me share a few observations that opened my eyes.

There are more older women than older men

This is something that most people already know. In most countries, women outlive men and therefore women represent a growing proportion of all older people: 53% of the “young-old” (till 75), 58% of the “old” (75-85), and 66% of the “oldest old” (over 85). These are worldwide figures and also in low and middle income countries populations are ageing (often at a more rapid rate than in high income countries). Hence, also in poor countries there are already many older women.

Women tend to be on their own at the end of their lives

Not only do women outlive men, but due to social and cultural norms in many countries, women partner with older men. This means that many women spend many years caregiving for older spouses and other relatives. This decreases the chances for women of getting caregiving support by their partners. Women who lose a partner are also less likely to repartner than men, further decreasing the chances of support. So women are often on their own, without company and without support.

Women face special health issues later in life

Although the health status of older women does not differ significantly from older men, there are some differences. Because women get older than men, they probably have more and more complex chronic diseases and end up in institutions more often. The four biggest causes of disability in older women are vision and hearing impairment, dementia and osteoarthritis. Every year, more than 2.5 million older women lose their independence through visual impairment. Dementia is another cause of disability that disproportionately impacts women.

But women have less access to care

Much of this burden could be avoided if women had access to the necessary care, particularly surgery for cataracts. Especially in lower income countries, women are sometimes simply denied access to health care, let alone long term care.

Older women also have lower financial security than older men. Although women’s educational attainments and labor force participation have increased, older women are more likely to be poor than older men. Moreover, women are less financially prepared for older age than men, are more likely to have worked part-time and spent fewer years in the workforce. These factors contribute to lower probability of coverage of long-term care in later life, especially in countries that do have employment-based insurance schemes.

Women provide most of long term care

Informal caregiving responsibilities fall more heavily on women, many of whom are older with health problems of their own. Caregiving responsibilities also come with economic costs, as caregivers often reduce or adjust their working hours to accommodate these responsibilities. The paid long-term care workforce is overwhelmingly female. Almost all nurses and home care aides in both institutional, home and community-based settings are women.

All these factors justify that we pay a bit of special attention to older women. Or in WHO terms, to give a gender perspective to care and include equity considerations.

Now going back again to the Saudi film. This movie is rather about young than old women. Still it shows that many women have to struggle hard in life, are often on their own and have to care for even young and healthy men. Not being allowed to drive a car alone, it makes sense to find a bike to escape from the other sex.