Gender, Health, and Aging: Too “Manly” to Seek Appropriate Care?

Dr. Warner-Maron has been practicing nursing for 33 years, specializing in the care of geriatric patients. She is an Assistant Professor at St. Joseph’s University in the department of Interdisciplinary Health Services. Dr. Warner-Maron is the president of the Institute for Continuing Education and Research, providing educational programs for individuals seeking licensure in nursing home administration. She is president of Alden Geriatric Consultants, which provides clinical, administrative and medical-legal expertise to nursing homes and assisted living facilities.

My father denied the presence of blood in his stool at the age of 62. It had been occurring with increasing frequency over a year or more, yet he said nothing to his physician. He said nothing to my mother, who did the laundry, noticed the blood, but also said nothing. That year, my father went to his primary care physician for his annual exam, however he never returned the fecal occult blood tests as he was directed and he somehow convinced the physician not to draw his blood on that particular visit.

He viewed his own father’s cardiopulmonary issues, frequent hospitalizations and limitations of function as signs of impaired masculinity. He believed it appropriate that women became ill and sought care, but men needed to avoid both illness and health care providers at all cost.

Shortly after his retirement, he developed crushing chest pain while driving. Rather than pulling over, he opted to drive himself to the hospital where he was taken immediately to the cardiac cath lab and then to the operating room for a quadruple coronary artery bypass grafting (CABG). His acute myocardial infarction was attributed not only to his long-standing, undiagnosed heart disease but his anemia from a growing colon malignancy. After the CABG and a colon resection had been performed, I asked him about his symptoms. Had he had any? Under what circumstances, I asked. He replied “ I got chest pain at work a lot, so I locked the door to my office and lied down on the floor until it went away. One time I was on a cruise with your mother and I got crushing chest pain while playing the slot machine. When I stopped winning, I went to lay down. I didn’t say anything.”

How unusual was my father’s view of gender and health, of linking being masculine to being healthy but then avoiding attempts to maintain health? Was it born from his experiences of watching his own father’s health fail because he smoked too much, ate poorly and developed too many chronic illnesses? Or was it related to my grandfather’s health issues that forced him into an early retirement with a markedly limited income? My father finally retired at 63, having amassed quite a bit more money that his father, thanks to years of overtime and rarely traveling. His goal was to retire to Florida and relax, pursuing interests long deferred. He would take care of his health when he began receiving Medicare, although he had good benefits from his company.

My father died at age 66.

Can we help address this issue in our own patients by encouraging people, regardless of their sex, to seek preventative care, to understand how to control their diseases, and to become an active participant in their care? Can we address head-on the stereotypes that our patients hold, whether it is rooted in gender-specific behaviors of who gets sick, who gets us well, and how much control we have over what happens to each of us?