“Now there's a good woman”: how rural life course events shape the response to cognitive decline in older women

Abstract

Aims: This dissertation aimed to: (1) analyze the life-course experiences of rural, older women and the impact of those experiences on their values, health-illness behaviors and decision-making, particularly surrounding cognitive decline; (2) compare and contrast the values, health-illness behaviors and decision-making of the older women with those of three younger generations of rural women; and (3) examine findings with the local community to explore ways of working with the formal health care system to identify culturally acceptable ways to deal with cognitive decline. Background: Cognitive decline is a continuum that includes levels of memory problems, poor judgment, confusion, personality change, and difficulty with planning and social functioning. In a pilot study, rural, older women identified cognitive decline, or “losing one's mind,” as the most significant fear and concern for which they desired interventions. The isolation of the rural lifestyle has made these women value independence and self-reliance as essential characteristics for survival. Chronic illnesses, such as progressive types of cognitive decline, significantly threaten the functional and cognitive independence, safety, and quality of life of this population. Method: An ethnographic design utilized in-depth life history interviews with four key informants across one year, focus groups with cross-generational cohorts (n=20), participant observation, and review of cultural artifacts. Interviews were transcribed verbatim and thematically analyzed. Findings: Findings include: (1) historical knowledge indicates belonging, (2) drifting about but not out, (3) gender roles- men protect from outside, women protect from inside, (4) neighbors as a network, (5) trust as an exchangeable commodity, (6) the new outsiders: health service insensitivity reinforces distrust, (7) then and now: loss of social capital, (8) come and eat, (9) there's no place like home, (10) self-determination, (11) all natural please, (12) suffering continuum, (13) stoicism begets emotional disconnect with the health-illness experience, (14) I need help but it is a private matter, and (15) protective silence-avoidance. Conclusion: The findings provide a greater understanding of rural culture, help to personalize health care through sensitivity to culture and generation, decrease disparities in access to care related to rural isolation and improve health outcomes for rural women facing cognitive decline.