Dementia and Palliative Care: Sex Differences

Abstract

Patients who need palliative care have complex physical and psychosocial needs during their illness. The results of previous studies show clear sex inequalities in the occurrence of various symptoms and the need for palliative care. Despite the undoubted sex differences in the creation of palliative care, sex is not a key determinant and is regularly neglected. According to the results of previous studies, women live longer than men, but they live more years with dis- abilities, especially with cognitive impairment. They end up in hospices much more often than men and die more often in institutions (21 % vs. 10 %). The biggest sex differences are present in the domain of caregivers. Most caregivers are women and according to the results of studies it is evident that more than 75 % of all caregivers are women and that women spend 50 % more time providing care than men. The time and effort that women put into caregiving is largely unrecognised and assumed to be a ‘natural’ role for women. In contrast, male caregivers are seen as heroes and numerous studies show that male caregivers receive more support than female caregivers. This is thought to be the reason why female carers have more physical and mental health problems, including anxiety and depression. Health professionals also play a role in the creation of this stereotype. A recent study showed that nurses felt that wives and daughters of patients needed less help than husbands and sons. Overall, all studies show that although women provide most of the care during life, they often lack a reciprocal level of care at the end of their lives. The policy of palliative care is focused on the approach that care at the end of life ‘in the community’ is desirable and achievable for everyone. Unfortunately, the fact that in this context care falls disproportionately on one person - who is most likely a woman - is ignored.