C H A P T E R 8
Diversity among Older Women 1
Abstract The purpose of Chapter 8 is to examine and apply issues of diversity from a biological, social, gender, cultural, and other factors to the aging experiences of women in the world. If positive aging supports are to be created and implemented in communities and broader societies, it is crucial to be�er understand the many ways women age over time. It would be unethical for a society to treat all older women as a homogeneous group, and it would be equally detrimental to both society and its aging population to transfer this biased a�itude to the creation of “cookie cu�er” policies and programs designed for this growing aging subpopulation.
Keywords Generational experiences; societal status; changing living conditions; sexuality; gender identity; education access
Global Fact: Ageing occupies connecting chambers within the development landscape, interacting with global pa�erns in labour and capital markets, governmental pensions, services, and traditional support systems, all which are further shaped by technological change and cultural transformations.
—Global Aging (2001)
From a positive aging perspective, be�er understanding factors underlying women’s aging perceptions and experiences over time can be used to then create more effective support programs and policies within communities (eg, Reichstadt, Sengupta, Depp, Palinkas, & Jeste, 2010). It is important to understand what positive aging means in today’s world, and how one defines positive aging depends upon many different diversity-related factors (Aldwin & Gilmer, 2013; Butler, Fuji, & Sasaki, 2011).
There are potentially as many definitions of “positive aging” as there are diverse aging women in the world (Bogunovic, 2011; Bu� & Beiser, 1987). The concept of “diversity” itself can be defined in many ways, such as within and across racial/ethnic groups, living environments, cultures, and levels of performance functioning (eg, Ayo�e, Allaire, & Whitfield, 2012). If different societies, and associated cultures, are going to make communities more “age friendly” for women, the understanding of their diversity issues is important to examine from many different perspectives (Bradshaw, 1999; Hrostowski, 2010; Iwamasa & Iwasaki, 2011; Troutman, Nies, & Bentley, 2011). Only through this thoughtful examination can there be “be�er aged” societies across the world (Arai, Ouchi, Yokode, Ito, & Uematsu, et al., 2012). Litwin (2005) emphasizes the importance of understanding factors that are universal in nature that can be generalizable to many different communities and cultures for there to be successful interventions in supporting an aging population. Effective positive aging
interventions should encompass social, physical, and environmental elements within a woman’s living circumstance (Lee, Lan, & Yen, 2011; Pruchno, Hahn, & Wilson-Genderson, 2012).
Nimrod and colleagues (Nimrod, 2011; Nimrod & Kleiber, 2007; Nimrod & Rotom, 2012) purported that it is more important to examine pa�erns of change and continuity within an aging adult’s developmental trajectory to best understand positive aging outcomes (ie, Innovation Theory of Successful Aging). Similarly, Hank (2011) studied the differential factors underlying quality-of-life perceptions among European older adults, and concluded that changing functional capability was a critical factor in determining these feelings.
As lifespan factors predicting an individual’s positive aging change, it is vital to realize that some predictors related to positive aging can shift in importance from cohort to cohort. For example, Piccinin et al. (2013) examined the relationship between an aging adult’s educational a�ainment and the maintenance of cognitive functioning. Interestingly, there was no direct relationship found, and this has important implications toward assumptions about predictive factors which could be much more complex and individualistic in effect than previously assumed.
Potentially, there could be multiple and diverse meanings of positive aging as a function of equally diverse perspectives and cultural contexts. For example, Liang and Luo (2012) proposed the concept of “harmonious” aging as a way to define positive aging from a cross-cultural perspective. Alternately, Baltes and Baltes (1990) examined positive aging in terms of how an aging woman (or man) adopts strategies to maintain functioning in daily activities through a conscious process of identifying activities that the older adult is best at (“selective optimization”) with associated adaptive adjustments (“compensation”).
Phelan, Anderson, LaCroix, and Larson (2004) made the important point that older adults and researchers may have different perspectives regarding the meaning of positive aging. This insight is important to acknowledge, and emphasizes the need to have older women be a part of the consultation process in developing programs, services, or other public policies intended to help support their positive aging needs. Dionigi, Horton, and Bellamy (2011) investigated the meaning of aging among a sample of older women with different physical activity capabilities. Their research suggests that there is a strong need to examine what is important in terms of quality-of-life needs of aging women to then create effective and supportive interventions to optimize their aging outcomes. Both Glover (1998) and Hazzard (2013) emphasized that many “personal” meanings exist regarding what it means to have a good quality of life
for aging adults. Matching one’s aging-related areas of expertise, needs, and preferences to potential environmental resources determines the best options to be chosen to support positive aging (eg, disability-related capabilities; Minkler & Fadem, 2002).
Communities’ programs and services should be sensitive to this concept and allow flexibility of options for older women in order to optimize their feelings of personal control and mastery within a cultural context (Hopman-Rock & Westhoff, 2002). The process of understanding “fit” is both an internal and an external process of information gathering. From a Continuity theory perspective (Atchley, 1989), it is vital that an aging woman participates in a process of self-examination to determine personal goals, motivations, and age-related perceptions in order to best decide on approaches to achieving positive aging outcomes. This examination of “self” is influenced by our immediate social networks of family members, friends, and other “relevant” social contacts (eg, coworkers). Nimrod (2011) researched older adults’ social activities within online communities and other social networks to examine their impact on older adults’ feelings of positive aging and social engagement. This is an interesting idea because it certainly expands the definition of culture as it impacts one’s aging.
Beyond our immediate social network is the influence of the culture in which we live; this may include more than one culture that we identify with and are influenced by. It is important to examine in many different ways how culture influences our perceptions of aging identity, social resources, and other factors which impact the degree to which a woman can successfully age (eg, Cohen et al., 2006).
Public policies and programs offered to support women’s aging are important to scrutinize to avoid potential bias or discrimination that limit opportunities for women across their life spans. For example, the research of both Freedman and Iwata-Weickgennant (2011) focused on cultural influences on older women’s feelings of optimism and happiness. How society defines “appropriate” aging reactions and coping mechanisms for aging women have a significant impact upon their own self-concept and aging-adjustment reactions (Hyde, Nee, Howle�, Butler, & Drennan, 2011; Osorio- Parraguez, 2013; Strauss, 2011).
In response to the complexity of this positive aging focus, there is the need for a comprehensive cross-cultural model that encompasses many different factors related to aging (Eaton et al., 2012), incorporating both “micro” (self) to “macro” (culture, society) perspectives. The following is a proposed model reflecting a more “holistic” perspective on different levels of factors impacting women’s positive aging:
There has been a growing movement to be�er understand important individual differences in the aging experience for women across their life span (eg, McCann Mortimer, Ward, & Winefield, 2008). This understanding can help communities empower middle-aged and older women to optimize their aging over time (eg, social support networks; Saucier, 2004). The role of culture on the aging experience cannot be understated; it impacts the very meaning of aging from an older adult’s perspective (Litwin, 2006; Torres, 2003, 2009).
While aging seems to be a series of losses beyond one’s control, be�er understanding of how older women a�empt to maintain personal identity through behavioral strategies (eg, self-care regimes; Leach & Schoenberg, 2008; coping with partner violence; Stöckl, Wa�s, & Penhale, 2012) can assist in developing effective training programs for/interventions within communities to assist with positive aging outcomes. Baltes and colleagues (eg, Smith & Baltes, 1993) purported the influence of three aging events that can significantly influence aging trajectories: “Normative biological events” relate to the genetic inherited characteristics of one’s family lineage that impacts a woman’s aging as it unfolds, “normative historical events” relate to the Cold War–related generational experiences that shape a woman’s aging path as she gets older, and “nonnormative events” relate to the very unique characteristics that shape the diversity of aging.
Diversity and Quality-of-Life Perceptions Within a broad cultural definition, there are many unique quality-of-life factors derived from one’s beliefs and values (Molzahn, Kalfoss, Schick Makaroff, & Skevington, 2011).
Over a period of 12 years, Roos and Havens (1991) investigated social factors predicting positive aging outcomes for adults living in the Manitoba region. Women and men living in this region of the world have interesting perspectives toward women and diversity issues across different regions of the world. How cultural relevancy, diversity issues, and positive aging for women are assessed is an important factor to consider when investigating different adjustment issues with culturally diverse older women (eg, Iranian immigrants to Sweden; Torres, 2009). Cultural relevance toward aging successfully has direct implications toward the design and implementation of public policies and laws regarding older citizens (Torres-Gil & Rudinica, 2012).
Kleyman (2006) argued that it is important to understand the potentially different aging trajectories of adults living in diverse urban se�ings for tailored community outreach efforts. Further, effective support services and other community resources (eg, educational programs) must be developed with the understanding of what it means to “age” and associated resiliency responses within a specific culture (eg, Middle Eastern culture; Litwin, 2009) (rural Midwest; Stark-Wroblewski, Edelbaum, & Bello, 2008). This logic extends to specific community-based programs developed for diverse groups of aging women. The planning and administration of support services and community-based programs must be grounded in research on diverse aging female populations within different geographical locations of the world (eg, aging in the United States; Myers, 2013) and different life circumstances (eg, elder abuse programs in Israel; Rabi, 2006).
The assessment of positive aging outcomes, such as feelings of positive life satisfaction in later-life, needs to take into account both objective (eg, functional capability) and subjective (eg, self-rated health) assessments of different groups of aging women (Cernin, Lysack, & Lichtenberg, 2011). The importance of this concept of examining both objective and subjective factors cannot be understated in be�er understanding positive outcomes for aging women. Understanding the complexity of aging experiences for diverse women across the world will only help create more effective assessments of diverse aging groups for intervention purposes (Kampfe, 2000).
It is equally important to understand how aging adjustment experiences subsequently affect one’s sense of “self” and ego identity (eg, transition to retirement; Teuscher, 2010). Similarly, the role of productive activities on a frequent basis can play a significant part in shaping women’s positive aging outcomes and should be encouraged. For example, Willcox, Willcox, Sokolowsky, and Sakihara (2007) observed women weavers in North Okinawa and how their role of productivity assisted in their positive aging a�itudes and aging adjustment.
Quo tes f r o m Fam o us , P o s i t ive ly Aging Wo m en 1
No ma�er what age you are, or what your circumstances might be,
you are special, and you still have something unique to offer.
Your life, because of who you are, has meaning.
—Barbara de Angelis, Writer
Age is not measured by years. Nature does not equally distribute energy. Some people are born old and tired while others are going strong at seventy.
—Dorothy Thompson, Journalist
It is time for parents to teach young people early on
that in diversity there is beauty and there is strength.
We all should know that diversity makes for a rich tapestry, and
we must understand that all the threads of that tapestry are
equal in value no ma�er their color.
—Maya Angelou, National Poet Laureate
Women’s Race, Culture, and Ethnicity Factors in Getting Older As women age, their developmental experiences are shaped by their respective race, cultural, and ethnic identities (Twigg & Martin, 2015). How older women are valued and regarded is influenced by society’s reactions to their social status within the community (eg, Thomas, Hardy, Cutcher, & Ainsworth, 2014). Societal promotion of positive aging outcomes is determined by others’ reactions to the older woman’s identity as being “older” in addition to being a “woman” and of a certain race, ethnicity, and culture (Kraini�ki, 2014; Laceulle & Baars, 2014). Communities can become positive and supportive entities for aging women through the eradication of biased a�itudes and practices.
Interestingly, a “similar to me” bias may have a positive influence on how communities share in the support and caregiving of aging women within the community (eg, African-American culture and prevalence of nonbiological family caregivers) (Powers & Whitlatch, 2014) but, increasingly, there is also a need to acknowledge the reality of a growing multiethnic, multiracial aging population (eg, Aleman, Fi�patrick, Tran, & Gonzalez, 2014). Internalized self- identity (eg, cultural identity of aging) can influence how aging women engage in social interactions and/or exhibit societal “self” presentations (eg, Twigg & Majima, 2014). Understanding older women’s internalized and dynamically changing
“aging paradigm” from a diversity (eg, cultural and/or cohort) perspective is an ethical imperative for community outreach programs, educational initiatives, and other services (eg, new a�itude of “senior coolness;” Zimmermann & Grebe, 2014). For example, “cohort” or generational difference between women’s aging experiences across the world is important to analyze.
Generational Experiences Shaping Women’s Aging Baltes and colleagues (eg, Baltes, Cornelius, & Nesselroade, 1979) emphasized the role of cohort as a factor shaping one’s aging outcomes. Historical events guiding and shaping a woman’s development across a life span can have a profound effect on the probability of achieving positive aging. Generational opportunities for educational and career growth also influence how well a woman may age and more recent works of women have certainly improved their projected aging trajectories (eg, degree a�ainment; Isopahkala-Bouret, 2015). Again, communities and broader world societies must acknowledge this influential factor when considering current and future aging trends of women on a national and international level.
What are the examples of generational experiences that have shaped women’s aging in many different cultures? Certainly, changes in public policies for many industrialized countries have helped improve women’s quality of life but there is still room for improvement (eg, women’s health; Borrell et al., 2014). Unfortunately in many different countries across the world, women have not equally experienced the same improvements that have been seen in more industrialized nations (Keck & Sikkink, 2014; Stromquist, 2014). The differential experiences of social status, resources, and protection through community-based public policies have influenced the nature of aging for many women across the world.
Societal Status for Older Women Over history, the role of women and their associated social status has shifted and become potentially more complex as a function of living circumstances and culture (eg, Ka� & Monk, 2014). One might argue, in many different cultures, that the responsibilities of women have multiplied, but there has not been an equivocal gain in terms of social power with the acquisition of multiple roles (Kulik, 2015). The valuation of women in society needs to become more of a priority, especially as these women transition to roles of dependency in later life. There is always
the concern of “double jeopardy” bias in how women are regarded and treated, regarded as less valued (unfairly) because of being both a woman and an older adult. This bias cannot be tolerated. Instead, women across the world need to be valued for exactly those reasons of being an active, contributory member of society as a woman who has lived a long life. For women to value their personal aging journey, it is important for society to communicate that they are valued as they age and that aging is a positive transition in their lives. This does require a cultural “shift” for many different countries that directly or indirectly communicate a message of youth valuation and aging discouragement.
In order to successfully age, societies across the world need to acknowledge the contributions and wisdom of older women. The woman’s typical experience of aging is transitioning from a child being cared for to becoming a primary caregiver of one’s parents. Across many cultures in the world, women are the “default” long-term caregivers within a family system and this role of caregiver can affect a woman’s aging over time (eg, perceived burden among Chinese spousal caregivers; Chan & Chui, 2011). If we think about the many different physical, mental, and social challenges for a woman to be a caregiver over her life span, it certainly becomes apparent that there are many different stresses and strains, as well as growth experiences that occur within a woman’s development over time. The contribution of this caregiver role within the micro family system, as well as the broader macro society cannot be understated and needs to be acknowledged. Further exacerbating the importance of this diversity role within women’s life spans, their caregiving role responsibilities are usually multifaceted, multifocused, and several decades in duration. Through this acknowledgment of older women’s benefit to communities, women can be�er accept and embrace their personal development into later life.
Changing Living Situations with Aging Environmental demands (“environmental press”), accessibility and mobility needs are factors to consider when a�empting to optimize an older woman’s transition from one situation to another (eg, transitioning from independent living to assisted living) and their associated physical performance and/or mental health needs (eg, Lindemann et al., 2014). Environmental factors underlying and influencing older women’s emotional, social, psychological, and physical resiliency reactions are significant influences, and associated interventions should be tailored in response to these dynamic factors impacting their positive aging (eg, tailored exercise program design; Hooker et al., 2005). In addition to more “internal” factors, support programs and other resources should
incorporate aspects of religion, marital status, educational background, social economics, and motivational issues related to older women’s interests and hobbies; community outreach programs need to take all these factors into account to optimize women’s later-life adjustment to eldercare, retirement, health changes, and other later-life transitions (Padilla & Villalobos, 2007).
Sexuality and Gender Identity in Later Life When we think about individual difference factors, one factor rarely addressed or erroneously categorized is the sexuality of aging women (eg, stereotype of an oversexed “cougar;” Montemurro & Sei�en, 2014). An important part of the aging self-concept, one’s sexuality and associated identity shapes feelings about personal aging, feelings of belongingness, and relationship needs (Bu�aro, Koeniger-Donohue, & Hawkins, 2014). Often, sexuality in later life is considered to be a moot issue, but, in fact, that belief is erroneous and potentially damaging to the self-esteem of aging women. How society reacts to aging women and their associated relationship needs and gender identity issues is important to explore because caregivers and other support resources must acknowledge this individual difference factor to be�er understand the holistic process of women aging over time.
Women’s gender identity framed from a positive aging perspective is important to explore with practitioners offering education and/or support services for older women. For example, be�er understanding of the social support needs of aging lesbians and transgender women (Kimmel, 2014; Wi�en, 2015) is an ethical imperative for a caring society faced with aging populations from diverse backgrounds and lifespan experiences (Avere� & Jenkins, 2012).
Education Access Education is the gateway to accessing job opportunities and associated socioeconomic benefits. Education for women should not simply be relegated to the time periods of early childhood to early adulthood, but rather regarded as a lifespan experience to help women positively adjust to later-life transitions (Merriam & Kee, 2014; Stromquist, 2014). From most societies, career training in middle age and later is a necessity as retirement becomes a less realistic option. As women age, their continued involvement in the workforce is a reality that necessitates continued career training (Arizpe & Aranda, 2014). Employers, educators, and
community outreach programs must ethically offer this opportunity to a growing number of women facing the need for skill updating to remain competitive in the workforce environment.
Quality-of-Life Factors Physical and mental health and aging women. Research over the last decade has begun to more closely examine the relationship between physical and mental health and their influence on aging (eg, in Latin America; Palloni & McEniry, 2007) as well as the need to understand gender issues in research on health and aging (Perrig-Chiello & Hutchinson, 2010). There are two main factors predicting positive aging for both men and women: health and wealth. Women and men can exhibit differential pa�erns of nonnormative health pa�erns and associated “end-of-life” transitions that are influenced by cultural norms and a�itudes (eg, Japan; Chan, Zimmer, & Saito, 2011). Disability trend in an aging population is one aspect of this “nonnormative” aging process that increasingly becomes normative in nature as women reach later stages of life and live healthier than ever before (Mendes de Leon, Eschbach, & Markides, 2011). As with aging men, diversity issues within the societal and genetic context can significantly influence older women’s health-related status and associated physical and mental health outcomes in a meaningful manner (Ajrouch & Marshall, 2004; Duda et al., 2011).
Lee and Lee (2011) reported that there are significant gender-related differences among older South Koreans regarding mental health factors that determine quality-of-life outcomes in later-life adjustment. Gender differences in mental health across the life span are vital to understand for social support programs and community education interventions. The cultural context of a woman’s mental health environment is important to acknowledge both within the United States (eg, Arab-American older adults; Ajrouch, 2007) and in other countries (eg, in Malaysia; Momtaz, Ibrahim, Hamid, & Yahaya, 2011; in Japan; Tiedt, 2013; in China; Zhang, Xu, Nie, Zhang, & Wu, 2012). Within cultures, differences in race, ethnicity, and other demographic factors create an even more complex picture related to lifespan issues of depression and other mental health outcomes. Across cultures, a�ention should be given to identify adjustment issues and the associated intervention provided by societies (eg, later-life marital relationship adjustment issues; Laganá, Spellman, Wakefield, & Oliver, 2011). If not addressed, negative mental health conditions can have an adverse impact on an older adult’s daily functioning capability, such as memory functioning, that can impact the ability to live independently and engage in positive, active-life activities (Steffens, Fisher, Langa, Po�er, & Plassman, 2009).
From a positive aging perspective, health education and community programs offering health screenings for aging women are vital to the health and well-being of the growing aging female population in many different countries across the world. The allocation of economic resources for the health of older women is certainly an issue to be scrutinized in countries across the world (eg, Al Hazzouri, Sibai, Chaaya, Mahfoud, & Yount, 2011; Szwarcwald, da Mota, Damarcena, & Pereira, 2011). Whether older women have access to diverse healthy foods, for example, due to economic status and geographical location should be addressed within communities (Hans and Tibetan older adults; Kimura et al., 2009).
An important diversity issue to examine among aging women is lifespan longevity. The social factors unique to women that determine their quality-of-life outcomes and extended physical health over time are important to identify (eg, Ailshire, Beltrán-Sánchez, & Crimmins, 2011). Mobility status is an important factor related to the social “power” of older women in different cultures and should be be�er understood within the social context of society as a quality- of-life outcome (Nilsson, Avlund, & Lund, 2010). Encouraging aging women’s physical activity is an important “proactive” intervention to consider when thinking about ways to improve their positive aging processes and outcomes (Guedas, Hatmann, Martini, Borges, & Bernardelli, 2012). In creating appropriate physical “aerobics” activities for older women, it is an imperative that up-to-date research takes into account current issues of women’s diet, physical role demands, and other health-related concerns (Kaur, Bains, & Kaur, 2012).
Aging women’s financial resources/opportunities. As was discussed in the previous chapter, one of the two main factors predicting life satisfaction, and positive aging for many older adults is the factor of financial security and stability. One might argue that older women of past generations, and even today, are at a disadvantage in preparing for the expenses of healthcare retirement in later life because of unstable or deficient employment work histories and associated accumulated earnings over a lifetime (Teuscher, 2010). The wage gap between men’s and women’s earnings still exists today in many countries across the world and this disparity has serious implications toward older women’s financial security and opportunities for personal growth.
Social support for older women. Across a woman’s life span, it is important for her to depend upon many different sources of social support for both physical and psychosocial adjustment to the many developmental changes she will experience as she ages. Sources of support may range from a media to extended family systems, peers, friends, and the broader community in which she lives (Smith, Tobin, Robertson-Tchabo, & Power, 1995; Thanakwang, Ingersoll- Dayton, & Soonthorndhada, 2012). Emotional, social, psychological, and physical benefits from having such
C heck I t O ut ! Search the Internet to find resources and content related to a discussion of women’s diversity issues into later life. In reviewing these websites, identify cultural and other environmental/lifestyle factors impacting aging women’s life experiences and aging outcomes. As you are examining these factors, think about the following questions:
1. What are some interesting cultural differences among older women across the world? 2. What role does geographical location have on women’s aging outcomes? 3. How do differences in social support resources impact aging women’s positive growth? 4. Are there different family system dynamics regarding aging women’s roles across cultures? 5. Were you surprised about what you learned? Why?
Wo r ds o f Wi sdo m
Francisca is a 65-year-old woman who was born in Guatemala. Her native language is Spanish and she came to the United States over 30 years ago. Throughout this time she has developed a diverse circle of friends. She has friends from different parts of the world such as El Salvador, China, and Ireland. Other than a language barrier, Francisca has not encountered many obstacles with other aging women, she is confident that the li�le English she knows allows her to communicate well with others who do not speak her native language.
Francisca states it is enjoyable to be able to have conversations with others about their culture and share the similarities across them. She finds it amazing that she is able to learn from others as she ages; she especially loves to get advice from diverse older women. Throughout her life she has received advice that she has found helpful, such as learning how to save money, raising her children, and knowing what is right and what is wrong.
Francisca is very thankful to be living in this country because it has given her things that she could not have in her home country. She benefits from living in a diverse environment because she learns something new from everyone she encounters. She advises younger women to appreciate diversity. She also advises younger women to try to get along with others and learn just like she has!
One might argue that women’s positive aging trajectories may have very specific gender issues to be aware of for policy and program development purposes. From a biological perspective, women’s experiences in aging are embedded within cultural contextual factors (Duay & Bryan, 2006
). How a culture responds to a woman’s aging (eg, educational programs) influences how she may perceive and interpret menopausal changes, physical changes (eg, physical appearance), and similar aging-related transitions. The cessation of fertility could be interpreted as a positive transition for aging women if that reflects the positive aging message transmi�ed through many sources of social feedback within the woman’s culture and society at large. Jenkins and Marti (2012) argued that it is important to examine the postfeminist culture within many different societies that can have a significant impact upon how women feel about their fiscal aging and associated loss of youth. With biological changes, there are important social roles that are maintained, transformed, and/or ended for older women within cultures (Dykstra, 2006). The diversity of experiences and needs for aging women is vital to understand from both a community-based (local) and a global perspective (Fiori, Consedine, & Magai, 2009; Guse & Masesar, 1999; Hutchinson & Nimrod, 2012; Kalavar & Jamuna, 2011; Kauffman, 2002).
To assume that all women experience similar aging events would be doing a disservice to an international aging female population and those who care for them. Individual difference factors of culture, genetics, available social resources and opportunities, among other factors significantly impact an older woman’s quality of life and associated adjustment to personal aging (eg, Aranda et al., 2012). Only through this recognition of “fit” can support programs, legislation, and resources be best tailored to meet the needs of older adults and support their positive aging (Charpentier, Quéniart, & Jacques, 2008; Clark & Glicksman, 2012; Cutler, 1998; Davis-Berman, 2011; Kleyman, 2006).
Summary Many different factors related to the diversity of aging experiences for women were examined. It is important to acknowledge that the aging trajectories of women are very complex and are based upon personal, cultural, and geographical location issues. Combinations of factors dynamically interact to impact both the quantity and quality of years of women as they develop into later life. Potential growth experiences and learning opportunities need to be explored for aging women in order to create effective community-based educational and intervention programs to achieve these aims. Churches, institutions of higher education, and senior centers are among the many opportunities for such programs to be offered to women across communities in the world.
Discussion Questions 1. What are the important individual difference factors which meaningfully shape how a woman ages? 2. What role does cultural identity play in the positive aging outcomes of women? 3. How might social support programs address the potentially diverse needs of an aging female population in many
different countries across the world? 4. In today’s society, how have women’s roles changed and does this have implications toward their aging outcomes
from a diversity perspective? 5. In the future, will there be the same or different diversity issues within the aging female population in the world? 6. How much do generational (cohort) experiences impact diverse women’s aging experiences? 7. Taking diversity issues into consideration, how does this topic apply to the design of community outreach support
program designed for aging women across the world? Give examples of factors to be considered. 8. Are there family issues to be understood that further explain how diverse women positively age? If so, what are
they? 9. If women are varied in their backgrounds and interests, is it possible to create educational programs and support
interventions for positive aging outcomes that are “universal” in focus? 10. Think about your own aging female family members and how there are similar and different aging trajectories.
What individual-difference factors influenced their aging adaptation?
Test Yo ur Kno wl edge ! When thinking about the many different diversity issues of women’s aging, it is very important to understand how aging is shown across the world. Take the following quiz about your knowledge regarding population aging: h�p://www.niapublications.org/quiz/index.php
Supplemental Book Readings Over the past decades, there have been many books wri�en on the topic of diversity issues underlying women’s aging experiences. Here are some recommended additional readings: Mehrotra, C. M., Wagner, L. S., Fried, S., & Mehrotra, C. (2008). Aging and diversity: An active learning experience. New
York, NY: Routledge. This text does a thorough job of reviewing the many different diversity factors which may meaningfully influence
the aging trajectory of an aging adult. Gender and other unique environment, cultural, and cohort factors are discussed by the authors as they have implications toward quality-of-aging experiences. Pluralistic societies as a complex cultural context for aging are examined. Aging women from many different cultural and socio- environmental contexts would gain meaningful information from this resource book.
Cruikshank, M. (2013). Learning to be old: Gender, culture, and aging. Lanham, MD: Rowman & Li�lefield Publishers. Learning how to be “old” in society is the primary message of this textbook. The adjustment process within cultural
and societal a�itudes toward aging is discussed. “Schema” development and shift related to how aging is perceived and treated is reflected in the topics discussed. This adaptation process of learning to become “old” in society relates to positive aging but is not a direct message through the book’s content.
McCulloch, B. J. (1998). Old, female, and rural. New York, NY: Routledge. This book examines the meaning of existence and what it is like to age as a woman living in a rural environment.
Issues of having access to dependable healthcare, living independently, having adequate contact with others for social support, and other quality-of-life factors are examined in the lives of these older women.
Gelfand, D. E. (2003). Aging and ethnicity: Knowledge and services (second edition). New York, NY: Springer Publishing Co. Based on information from the US 2000 Census, this book examines a myriad of diversity issues impacting the
quality-of-aging outcomes for diverse individuals. Many different aspects of sex, race, culture, economic status, education level, and lifestyle, among other individual-difference characteristics, are reviewed as significant factors requiring a�ention in the design and implementation of programs and services to support optimal aging. Aging women from diverse backgrounds would benefit from reading the book.
Cheng, S., Chi, I., Li, L. W., Woo, J., & Fung, H. H. (Editors) (2015). Successful aging: Asian perspectives. New York, NY: Springer Publishing Co. This book does an interesting comparison of Eastern versus Western cultures and their differential impact on the
aging of their populations. The chapters in the book examine cultural differences in family system dynamics, social and physical environments, beliefs and values, and lifestyle factors impacting the aging trajectories of women and men. The authors conclude by discussing the quality of aging within these two cultures. Aging women from different cultural backgrounds would benefit from the insights of the book.
Fishman, T. C. (2010). Shock of gray: The aging of the world’s population and how it pits young against old, child against parent, worker against boss, company against rival, and nation against nation. New York, NY: Scribner. The author brings an important point to the reader—the world is changing because the world is aging. This is a
powerful statement that truly needs to be discussed in terms of eradicating ageism to bringing cohorts together under the shared experience of inevitable aging processes. From an international perspective, the author argues that a growing aging population necessitates a paradigm shift in how “old age” is understood as a life stage and its implications toward communities and public policies. Social change is needed on many different levels within many different countries. Intergenerational relationships and the sharing of resources are certainly social priorities which need to be made into a reality. Older women would be empowered by the message conveyed through the book’s chapters.
Magnus, G. M. (2008). The age of aging: How demographics are changing the global economy and our world. Hoboken, NJ: Wiley. The author makes the assertion that it is vital to acknowledge that most countries across the world will be
significantly impacted by an aging population for the coming decades. With this demographic “aging” population shift across many countries will create a significant impact on the world economy. If societies are not in the process of addressing economic and associated social policies (eg, retirement pension systems) in response to this changing support ratio of younger to older generations, there will be a negative effect on their economic viability. This is an important issue for older women in many different countries of the world who will directly experience this effect on their economy.
Supplemental Aging Videos For learning purposes, the use of videos can be very beneficial for both instructors and readers. Here are some recommended supplemental videos: Global aging: h�p://on.aol.com/video/global-aging-demographics-297733172 (Format: Website)
This is a great website that offers a short video on global aging. How to Live Forever (2008) (Format: DVD)
The video examines the factors which may predict the lives of people who live to 100 and beyond.
Additional Information Links The following are some recommended supplemental Internet links: American Federation for Aging Research website: h�p://www.afar.org/infoaging/ NIA Demography Centers website: h�p://agingcenters.org/ Administration on Aging website: h�p://www.aoa.gov/AoARoot/Aging_Statistics/index.aspx World Health Organization website: h�p://www.who.int/ageing/about/facts/en/index.html Centers for Disease Control and Prevention website: h�p://www.cdc.gov/mmwr/preview/mmwrhtml/mm5206a2.htm United Nations website: h�p://www.un.org/esa/population/publications/Worldageing19502050/ U.S. Census Bureau website: h�p://www.census.gov/newsroom/releases/archives/aging_population/cb10-72.html
References 1. Ailshire JA, Beltrán-Sánchez H, Crimmins EM. Social characteristics and health status of exceptionally long-
lived Americans in the health and retirement study. Journal of the American Geriatrics Society. 2011;59(12):2241– 2248 h�p://dx.doi.org/10.1111/j.1532-5415.
2. Ajrouch K. Resources and well-being among Arab-American elders. Journal of Cross-Cultural Gerontology. 2007;22(2):167–182 h�p://dx.doi.org/10.1007/s10823-006-9033-z.
3. Ajrouch K, Marshall V. Aging and global diversity: Implications for health and practice. The Gerontologist. 2004;44(1):245–246.
4. Al Hazzouri A, Sibai A, Chaaya M, Mahfoud Z, Yount KM. Gender differences in physical disability among older adults in underprivileged communities in Lebanon. Journal of Aging & Health. 2011;23(2):367–382 h�p://dx.doi.org/10.1177/0898264310385454.
5. Aldwin CM, Gilmer DF. Health, illness, and optimal aging: Biological and psychosocial perspectives Berlin, Germany: Springer Publishing Company; 2013.
6. Aleman S, Fi�patrick T, Tran TV, Gonzalez E. Therapeutic interventions with ethnic elders: Health and social issues New York, NY: Routledge; 2014.
7. Arai H, Ouchi Y, Yokode M, et al. Toward the realization of a be�er aged society: Messages from gerontology and geriatrics. Geriatrics and Gerontology International. 2012;12:16–22 h�p://dx.doi.org/10.1111/j.447- 0594.2011.00776.x.
8. Aranda MP, Chae DH, Lincoln KD, Taylor R, Woodward A, Cha�ers LM. Demographic correlates of DSM-IV major depressive disorder among older African Americans, Black Caribbeans, and non-Hispanic Whites: Results from the national survey of American life. International Journal of Geriatric Psychiatry. 2012;27(9):940–947 h�p://dx.doi.org/10.1002/gps.2805.
9. Arizpe L, Aranda J. Women workers in the strawberry agribusiness in Mexico. Migration, women and social development Berlin, Germany: Springer International Publishing; 2014;74–95.
10. Atchley RC. A continuity theory of normal aging. The Gerontologist. 1989;29(2):183–190 h�p://dx.doi.org/10.1093/geront/29.2.183.
11. Avere� P, Jenkins C. Review of the literature on older lesbians: Implications for education, practice, and research. Journal of Applied Gerontology. 2012;31(4):537–561 h�p://dx.doi.org/10.1177/0733464810392555.
12. Ayo�e BJ, Allaire JC, Whitfield KE. Understanding within-group variability of everyday cognition in aging Black/African American adults: A mimic (multiple indicators, multiple causes) model approach. Experimental Aging Research. 2012;38(5):488–510 h�p://dx.doi.org/10.1080/0361073X.2012.726022.
13. Baltes PB, Baltes MM. Psychological perspectives on successful aging: The model of selective optimization with compensation. In: Baltes PB, Baltes MM, eds. Successful aging: Perspectives from the behavioral sciences. New York: Cambridge University Press; 1990:1–34.
14. Baltes PB, Cornelius SW, Nesselroade JR. Cohort effects in developmental psychology. In: Nesselroade JR, Baltes PB, eds. Longitudinal research in the study of behavior and development. New York, NY: Academic Press; 1979.
15. Bogunovic O. Women and aging. Harvard Review of Psychiatry. 2011;19(6):321–324 h�p://dx.doi.org/10.3109/10673229.2011.630821.
16. Borrell C, Palència L, Muntaner C, Urquía M, Malmusi D, O’Campo P. Influence of macrosocial policies on women’s health and gender inequalities in health. Epidemiologic Reviews. 2014;36(1):31–48.
17. Bradshaw R. The aging experience: Diversity and commonality across cultures. Journal of Cross-Cultural Psychology. 1999;30(1):131–132.
18. Butler JP, Fujii M, Sasaki H. Balanced aging, or successful aging? Geriatrics & Gerontology International. 2011;11(1):1–2 h�p://dx.doi.org/10.1111/j.14470594.2010.00661.x.
19. Bu� DS, Beiser M. Successful aging: A theme for international psychology. Psychology and Aging. 1987;2:87–94. 20. Bu�aro TM, Koeniger-Donohue R, Hawkins J. Sexuality and quality of life in aging: Implications for practice.
The Journal for Nurse Practitioners. 2014;10(7):480–485. 21. Cernin PA, Lysack C, Lichtenberg PA. A comparison of self-rated and objectively measured successful aging
constructs in an urban sample of African American older adults. Clinical Gerontologist. 2011;34(2):89–102 h�p://dx.doi.org/10.1080/07317115.2011.539525.
22. Chan A, Malhotra C, Malhotra R, Østbye T. Living arrangements, social networks and depressive symptoms among older men and women in Singapore. International Journal of Geriatric Psychiatry. 2011;26(6):630–639 h�p://dx.doi.org/10.1002/gps.2574.
23. Chan A, Zimmer Z, Saito Y. Gender differentials in disability and mortality transitions: The case of older adults in Japan. Journal of Aging & Health. 2011;23(8):1285–1308 h�p://dx.doi.org/10.1177/0898264311408417.
24. Chan CF, Chui ET. Association between cultural factors and the caregiving burden for Chinese spousal caregivers of frail elderly in Hong Kong. Aging & Mental Health. 2011;15(4):500–509 h�p://dx.doi.org/10.1080/13607863.2010.536139.
25. Charpentier M, Quéniart A, Jacques J. Activism among older women in Quebec, Canada: Changing the world after age 65. Journal of Women & Aging. 2008;20(3/4):343–360.
26. Clark K, Glicksman A. Age-friendly Philadelphia: Bringing diverse networks together around aging issues. Journal of Housing for the Elderly. 2012;26(1–3):121–136 h�p://dx.doi.org/10.1080/02763893.2012.655662.
27. Cohen GD, Perlstein S, Chapline J, Kelly J, Firth KM, Simmens S. The impact of professionally conducted cultural programs on the physical health, mental health, and social functioning of older adults. The Gerontologist. 2006;46(6):726–734.
28. Cutler NE. Preparing for their older years: The financial diversity of aging boomers. Generations. 1998;22(1):81– 86.
29. Davis-Berman J. Older women in the homeless shelter: Personal perspectives and practice ideas. Journal of Women & Aging. 2011;23(4):360–374 h�p://dx.doi.org/10.1080/08952841-.2011.611391.
30. Dionigi RA, Horton S, Bellamy J. Meanings of aging among older Canadian women of varying physical activity levels. Leisure Sciences. 2011;33(5):402–419 h�p://dx.doi.org/10.1080/01490400.2011.606779.
31. Duay D, Bryan V. Senior adults’ perceptions of successful aging. Educational Gerontology. 2006;32(6):423–445 h�p://dx.doi.org/10.1080/03601270600685636.
32. Duda RB, Anarfi JK, Adanu RMK, Seffah J, Darko R, Hill AG. The health of the “older women” in Accra, Ghana: Results of the women’s health study of Accra. Journal of Cross-Cultural Gerontology. 2011;26:299–314 h�p://dx.doi.org/10.1007/s10823-011-9148-8.
33. Dykstra PA. Off the beaten track: Childlessness and social integration in late life. Research on Aging. 2006;28(6):749–767.
34. Eaton NR, Krueger RF, South SC, Gruenewald TL, Seeman TE, Roberts BW. Genes, environments, personality, and successful aging: Toward a comprehensive developmental model in later life. Journals of Gerontology Series A: Biological Sciences & Medical Sciences. 2012;67A(5):480–488.
35. Fiori K, Consedine N, Magai C. Late life a�achment in context: Pa�erns of relating among men and women from seven ethnic groups. Journal of Cross-Cultural Gerontology. 2009;24(2):121–141 h�p://dx.doi.org/10.1007/s10823-008-9078-2.
36. Flood M. A mid-range nursing theory of successful aging. Journal of Theory Construction & Testing. 2005;9(2):35– 39.
37. Freedman A, Iwata-Weickgenannt K. Count what you have now Don’t count what you don’t have: The Japanese television drama around 40 and the politics of women’s happiness. Asian Studies Review. 2011;35(3):295–313 h�p://dx.doi.org/10.1080/10357823.2011.602042.
38. Global Aging. (2001). The ageing of the world’s population. Retrieved from: <h�p://www.globalaging.org/waa2/documents/theagingoftheworld.htm>.
39. Glover RJ. Perspectives on aging: Issues affecting the la�er part of the life cycle. Educational Gerontology. 1998;24(4):325–331.
40. Guedes DP, Hatmann AC, Martini FN, Borges MB, Bernardelli R. Quality of life and physical activity in a sample of Brazilian older adults. Journal of Aging & Health. 2012;24(2):212–226 h�p://dx.doi.org/10.1177/0898264311410693.
41. Guse LW, Masesar MA. Quality of life and successful aging in long-term care: Perceptions of residents. Issues in Mental Health Nursing. 1999;20:527–539.
42. Hank K. How “successful” do older Europeans age? Findings from share. Journal of Gerontology: Social Sciences. 2011;66B(2):230–236 h�p://dx.doi.org/10.1093/geronb/gbq089.
43. Hazzard WR. As a gerontologist enters old age. Journal of the American Geriatrics Society. 2013;61(4):639–640 h�p://dx.doi.org/10.1111/jgs.12176.
44. Hooker SP, Seavey W, Weidmer CE, et al. The California active aging community grant program: Translating science into practice to promote physical activity in older adults. Annals of Behavioral Medicine. 2005;29(3):155– 165.
45. Hopman-Rock M, Westhoff MH. Development and evaluation of “aging well and healthily:” A health-education and exercise program for community-living older adults. Journal of Aging and Physical Activity. 2002;10(4):364– 381.
46. Hrostowski S. Diversity in aging America: Making our communities aging friendly. Race, Gender & Class. 2010;17(3):307–313.
47. Hutchinson SL, Nimrod G. Leisure as a resource for successful aging by older adults with chronic health conditions. International Journal of Aging and Human Development. 2012;74(1):41–65.
48. Hyde A, Nee J, Howle� E, Butler M, Drennan J. The ending of menstruation: Perspectives and experiences of lesbian and heterosexual women. Journal of Women & Aging. 2011;23(2):160–176 h�p://dx.doi.org/10.1080/08952841.2011.561145.
49. Isopahkala-Bouret U. Graduation at age 50+: Contested efforts to construct “third age” identities and negotiate cultural age stereotypes. Journal of Aging Studies. 2015;35:1–9.
50. Iwamasa GY, Iwasaki M. A new multidimensional model of successful aging: Perceptions of Japanese American older adults. Journal of Cross-Cultural Gerontology. 2011;26:261–278 h�p://dx.doi.org/10.1007/s10823-011-9147-9.
51. Jenkins KE, Marti G. Warrior chicks: Youthful aging in a postfeminist prosperity discourse. Journal for the Scientific Study of Religion. 2012;51(2):241–256 h�p://dx.doi.org/10.1111/-j.1468-5906.2012.01651.x.
52. Johnell K, Fastbom J. Comparison of prescription drug use between community-dwelling and institutionalized elderly in Sweden. Drugs & Aging. 2012;29(9):751–758 h�p://dx.doi.org/10.1007/s40266-012-0002-7.
53. Kalavar J, Jamuna D. Aging of Indian women in India: The experience of older women in formal care homes. Journal of Women & Aging. 2011;23(3):203–215 h�p://dx.doi.org/10.1080/08952841.2011.587730.
54. Kampfe CM. Characteristics of diversity and aging: Implications for assessment. Journal of Applied Rehabilitation Counseling. 2000;31(1):33–39.
55. Ka� C, Monk J. Full circles: Geographies of women over the life course New York, NY: Routledge; 2014. 56. Kauffman J. Looking at the past and the future of diversity and aging: An interview with E Percil Stanford and
Fernando Torres-Gil. Generations. 2002;26(3):74–78. 57. Kaur G, Bains K, Kaur H. Body composition, dietary intake and physical activity level of sedentary adult Indian
women. Food and Nutrition Sciences. 2012;3:1577–1585 h�p://dx.doi.org/10.4236/fns.2012.311206. 58. Keck ME, Sikkink K. Activists beyond borders: Advocacy networks in international politics Ithaca, NY: Cornell
University Press; 2014. 59. Kimmel D. Lesbian, gay, bisexual, and transgender aging concerns. Clinical Gerontologist. 2014;37(1):49–63. 60. Kimura J, Browne CV. Eldercare in a Filipino community: Older women’s a�itudes toward caregiving and
service use. Journal of Women & Aging. 2009;21(3):229–243 h�p://dx.doi.org/10.1080/08952840903054815. 61. Kimura Y, Okumiya K, Sakamoto R, et al. Comprehensive geriatric assessment of older adults highlanders in
Qinghai, China IV: Comparison of food diversity and its relation to health of Han and Tibetan elderly. Geriatrics & Gerontology International. 2009;9(4):359–365 h�p://dx.doi.org/10.1111/j.1447-0594.2009.00543.x.
62. Kleyman P. Looking ahead: Philadelphia study focuses on diversity in urban aging. Aging Today. 2006;27(6):7–8. 63. Kraini�ki E. Judi Dench’s age-inappropriateness and the role of M: Challenging normative temporality. Journal
of Aging Studies. 2014;29:32–40.
64. Kreager P, Schröder-Bu�erfill E. Gaps in the family networks of older people in three Indonesian communities. Journal of Cross-Cultural Gerontology. 2007;22:1–25 h�p://dx.doi.org/10.1007/s10823-006-9013-3.
65. Kulik L. The impact of multiple roles on the well-being of older women: Strain or enrichment? Women and aging Berlin, Germany: Springer International Publishing; 2015;51–69.
66. Laceulle H, Baars J. Self-realization and cultural narratives about later life. Journal of Aging Studies. 2014;31:34– 44.
67. Laganá L, Spellman T, Wakefield J, Oliver T. Ethnic minority status, depression, and cognitive failures in relation to marital adjustment in ethnically diverse older women. Clinical Gerontologist. 2011;34(3):173–189 h�p://dx.doi.org/10.1080/07317115.2011.554627.
68. Leach CR, Schoenberg NE. Striving for control: Cognitive, self-care, and faith strategies employed by vulnerable Black and White older adults with multiple chronic conditions. Journal of Cross-Cultural Gerontology. 2008;23:377–399 h�p://dx.doi.org/10.1007/s10823-008-9086-2.
69. Lee E, Lee J. Gender differences in predictors of mental health among older adults in South Korea. International Journal of Aging & Human Development. 2011;72(3):207–223 h�p://dx.doi.org/10.2190/AG.72.3.c.
70. Lee P, Lan W, Yen T. Aging successfully: A four-factor model. Educational Gerontology. 2011;37(3):210–227 h�p://dx.doi.org/10.1080/03601277.2010.487759.
71. Liang J, Luo B. Toward a discourse shift in social gerontology: From successful aging to harmonious aging. Journal of Aging Studies. 2012;26(3):327–334.
72. Lindemann U, Oksa J, Skelton DA, et al. Effect of cold indoor environment on physical performance of older women living in the community. Age and Ageing. 2014;43(4):571–575.
73. Litwin H. Correlates of successful aging: Are they universal? International Journal of Aging & Human Development. 2005;61(4):313–333.
74. Litwin H. The path to well-being among elderly Arab Israelis. Journal of Cross-Cultural Gerontology. 2006;21(1/2):25–40 h�p://dx.doi.org/10.1007/s10823-006-9019-x.
75. Litwin H. Understanding aging in a Middle Eastern context: The SHARE-Israel survey of persons aged 50 and older. Journal of Cross-Cultural Gerontology. 2009;24(1):49–62 h�p://dx.doi.org/10.1007/s10823-008-9073-7.
76. McCandless NJ. Strengthening aging families: Diversity in practice and policy. Journal of Comparative Family Studies. 1998;29(3):607–608.
77. McCann Mortimer P, Ward L, Winefield H. Successful ageing by whose definition? Views of older, spiritually affiliated women. Australian Journal on Ageing. 2008;27(4):200–204.
78. McMullin JA. Diversity and the state of sociological aging theory. The Gerontologist. 2000;40(5):517–530. 79. Mendes de Leon CF, Eschbach K, Markides KS. Population trends and late-life disability in Hispanics from the
Midwest. Journal of Aging & Health. 2011;23(7):1166–1188 h�p://dx.doi.org/10.1177/0898264311422100. 80. Merriam SB, Kee Y. Promoting community wellbeing: The case for lifelong learning for older adults. Adult
Education Quarterly. 2014;64(2):128–144. 81. Minkler M, Fadem P. “Successful aging:” A disability perspective. Journal of Disability Policy Studies.
2002;12(4):229–235. 82. Minkler M, Stone R. The feminization of poverty and older women. The Gerontologist. 1985;25(4):351–357
h�p://dx.doi.org/10.1093/geront/25.4.351. 83. Mokuau N, Tomioka M. Caregiving and older Japanese adults: Lessons learned from the periodical literature.
Journal of Gerontological Social Work. 2010;53(2):117–136 h�p://dx.doi.org/10.1080/01634370903202868. 84. Molzahn AE, Kalfoss M, Schick Makaroff K, Skevington SM. Comparing the importance of different aspects of
quality of life to older adults across diverse cultures. Age & Ageing. 2011;40(2):192–199 h�p://dx.doi.org/10.1093/ageing/afq156.
85. Momtaz YA, Ibrahim R, Hamid TA, Yahaya N. Sociodemographic predictors of elderly’s psychological well- being in Malaysia. Aging & Mental Health. 2011;15(4):437–445.
86. Montemurro B, Sie�en JM. Cougars on the prowl? New perceptions of older women’s sexuality. Journal of Aging Studies. 2014;28:35–43.
87. Myers D. Diversity and aging in America. Planning. 2013;79(3):11–15. 88. Nilsson C, Avlund K, Lund R. Social inequality in onset of mobility disability among older Danes: The
mediation effect of social relations. Journal of Aging & Health. 2010;22(4):522–541 h�p://dx.doi.org/10.1177/0898264309359684.
89. Nimrod G. The fun culture in seniors’ online communities. Gerontologist. 2011;51(2):226–237. 90. Nimrod G, Kleiber DA. Reconsidering change and continuity in later life: Toward an innovation theory of
successful aging. International Journal of Aging & Human Development. 2007;65(1):1–22. 91. Nimrod G, Rotem A. An exploration of the innovation theory of successful ageing among older tourists. Ageing &
Society. 2012;32(3):379–404 h�p://dx.doi.org/10.1017/S0144686X 2012; 1100033X.
92. Osorio-Parraguez P. Health and widowhood: Meanings and experience of elderly women in Chile. Health. 2013;5(8):1272–1276 h�p://dx.doi.org/10.4236/health.2013.58173.
93. Padilla YC, Villalobos G. Cultural responses to health among Mexican American women and their families. Family & Community Health. 2007;30:S24–S33.
94. Palloni A, McEniry M. Aging and health status of elderly in Latin America and the Caribbean: Preliminary findings. Journal of Cross-Cultural Gerontology. 2007;22:263–285 h�p://dx.doi.org/10.1007/s10823-006-9001-7.
95. Perrig-Chiello P, Hutchison S. Health and well-being in old age: The pertinence of a gender mainstreaming approach in research. Gerontology. 2010;56(2):208–213 h�p://dx.doi.org/10.1159/-000235813.
96. Phelan EA, Anderson LA, LaCroix AZ, Larson EB. Older adults’ views of “successful aging”- How do they compare with researchers’ definitions? Journal of the American Geriatrics Society. 2004;52(2):211–216 h�p://dx.doi.org/10.1111/j.15325415.2004.52056.x.
97. Piccinin AM, Muniz-Terrera G, Clouston S, et al. Coordinated analysis of age, sex, and education effects on change in MMSE scores. Journals of Gerontology Series B: Psychological Sciences & Social Sciences. 2013;68(3):374– 390.
98. Powers SM, Whitlatch CJ. Measuring cultural justifications for caregiving in African American and White caregivers. Dementia 2014; Online publication. h�p://dx.doi.org/10.1177/-1471301214532112.
99. Pruchno R, Hahn S, Wilson-Genderson M. Cigare�e smokers, never-smokers, and transitions: Implications for successful aging. International Journal of Aging and Human Development. 2012;74(3):193–209.
100. Rabi K. Israeli perspectives on elder abuse. Educational Gerontology. 2006;32(1):49–62 h�p://dx.doi.org/10.1080/03601270500338617.
101. Reichstadt J, Sengupta G, Depp CA, Palinkas LA, Jeste DV. Older adults’ perspectives on successful aging: Qualitative interviews. The American Journal of Geriatric Psychiatry. 2010;18(7):567–575.
102. Roos NP, Havens B. Predictors of successful aging: A twelve-year study of Manitoba elderly. American Journal of Public Health. 1991;81(1):63–68.
103. Ryser L, Halseth G. Informal support networks of low-income senior women living alone: Evidence from Fort St John, BC. Journal of Women & Aging. 2011;23(3):185–202 h�p://dx.doi.org/10.1080/08952841.2011.587734.
104. Saucier MG. Midlife and beyond: Issues for aging women. Journal of Counseling & Development. 2004;82(4):420– 425.
105. Shah A. Does long-term economic adversity affect older adults’ suicide rates? A cross-national comparison. International Psychogeriatrics. 2007;19(4):788–789 h�p://dx.doi.org/10.1017/S1041610207005704.
106. Smith GC, Tobin SS, Robertson-Tchabo EA, Power PW. Strengthening aging families: Diversity in practice and policy Thousand Oaks, CA: Sage; 1995.
107. Smith J, Baltes PB. Differential psychological ageing: Profiles of the old and very old. Ageing and Society. 1993;13(4):551–587.
108. Stark-Wroblewski K, Edelbaum JK, Bello TO. Perceptions of aging among rural, Midwestern senior citizens: Signs of women’s resiliency. Journal of Women & Aging. 2008;20(3–4):361–373 h�p://dx.doi.org/10.1080/08952840801985185.
109. Steffens DC, Fisher GG, Langa KM, Po�er GG, Plassman BL. Prevalence of depression among older Americans: The aging, demographics and memory study. International Psychogeriatrics. 2009;21(5):879–888 h�p://dx.doi.org/10.1017/S1041610209990044.
110. Stöckl H, Wa�s C, Penhale B. Intimate partner violence against older women in Germany: Prevalence and associated factors. Journal of Interpersonal Violence. 2012;27(13):2545–2564 h�p://dx.doi.org/10.1177/0886260512436390.
111. Strauss JR. Contextual influences on women’s health concerns and a�itudes toward menopause. Health & Social Work. 2011;36(2):121–127.
112. Stromquist NP. Women in the third world: An encyclopedia of contemporary issues New York, NY: Routledge; 2014. 113. Szwarcwald C, da Mota J, Damacena G, Pereira T. Health inequalities in Rio de Janeiro, Brazil: Lower healthy
life expectancy in socioeconomically disadvantaged areas. American Journal of Public Health. 2011;101(3):517–523 h�p://dx.doi.org/10.2105/AJPH.2010.195453.
114. Teuscher U. Change and persistence of personal identities after the transition to retirement. International Journal of Aging & Human Development. 2010;70(1):89–106 h�p://dx.doi.org/10.2190/AG.70.1.d.
115. Thanakwang K, Ingersoll-Dayton B, Soonthorndhada K. The relationships among family, friends, and psychological well-being for Thai elderly. Aging & Mental Health. 2012;16(8):993–1003 h�p://dx.doi.org/10.1080/13607863.2012.692762.
116. Thomas R, Hardy C, Cutcher L, Ainsworth S. What’s age got to do with it? On the critical analysis of age and organizations. Organization Studies. 2014;35(11):1569–1584.
117. Thompson WK, Charoa L, Vahia IV, Depp C, Allison M, Jeste DV. Association between higher levels of sexual function, activity, and satisfaction and self-rated successful aging in older postmenopausal women. Journal of Applied Gerontology. 2011;59:1503–1508.
118. Tiedt AD. Cross-national comparisons of gender differences in late-life depressive symptoms in Japan and the United States. Journals of Gerontology Series B: Psychological Sciences & Social Sciences. 2013;68(3):443–454.
119. Torres S. A preliminary empirical test of a culturally-relevant theoretical framework for the study of successful aging. Journal of Cross-Cultural Gerontology. 2003;18(1):79–100.
120. Torres S. Vigne�e methodology and culture-relevance: Lessons learned through a project on successful aging with Iranian immigrants to Sweden. Journal of Cross-Cultural Gerontology. 2009;24:93–114 h�p://dx.doi.org/10.1007/s10823-0099095-9.
121. Torres-Gil F, Rudinica B. The 21st century realities of American politics, aging and diversity. Aging Today. 2012;33(1):9–14.
122. Troutman M, Nies MA, Bentley M. Measuring successful aging in Southern Black older adults. Educational Gerontology. 2011;37:38–50 h�p://dx.doi.org/10.1080/03601277.2010.500587.
123. Twigg J, Majima S. Consumption and the constitution of age: Expenditure pa�erns on clothing, hair and cosmetics among post-war ‘baby boomers’. Journal of Aging Studies. 2014;30:23–32.
124. Twigg J, Martin W, eds. Routledge handbook of cultural gerontology. New York, NY: Routledge; 2015. 125. Willcox DC, Willcox BJ, Sokolovsky J, Sakihara S. The cultural context of “successful aging” among older
women weavers in a northern Okinawan village: The role of productive activity. Journal of Cross-Cultural Gerontology. 2007;22:137–165 h�p://dx.doi.org/10.1007/s10823-006-9032-0.
126. Wi�en TM. Elder transgender lesbians: Exploring the intersection of age, lesbian sexual identity, and transgender identity. Journal of Lesbian Studies. 2015;19(1):73–89.
127. Zhang L, Xu Y, Nie H, Zhang Y, Wu Y. The prevalence of depressive symptoms among the older in China: A meta-analysis. International Journal of Geriatric Psychiatry. 2012;27(9):900–906 h�p://dx.doi.org/10.1002/gps.2821.
128. Zimmermann HP, Grebe H. “Senior coolness:” Living well as an a�itude in later life. Journal of Aging Studies. 2014;28:22–34.