Why Men Fare Worse: A Mixed-Methods Study Examining Gender Differences in Nursing Home Resident Quality of Life

Abstract

Background and objectives: Despite research documenting gender differences in numerous outcomes in later life, we know little about gender differences in quality of life (QoL) for nursing home (NH) residents. This study examines the relationship between gender and residents' QoL, including possible reasons for differences observed.

Research design and methods: We used a mixed-methods design including surveys with a random sample of Minnesota NH residents using a multidimensional measure of QoL (n = 9,852), resident clinical data, facility-level characteristics (n = 364), interviews with residents (n = 64), and participant observations. We used linear mixed models and thematic analysis of resident interviews and observations to examine possible gender-related differences in residents' QoL.

Results: After controlling for individual and facility characteristics, men reported lower overall QoL than women, including significantly lower ratings in several QoL domains. In interviews, men noted being less satisfied with activities than women, having fewer friends, and being less able to rely on family for support. Some women described the NH as a place of respite, but men more often described being dissatisfied with life in the NH and undesirable for long-term living. Our observations were consistent with interview findings but provide additional nuances, such as that some men organized their own social groups.

Discussion and implications: Our findings suggest that men and women experience QoL differently in NHs, with men reporting lower QoL in several domains. Tailoring more activities for men and finding ways to strengthen relationships for men in NHs could help reduce the gender differences in QoL we observed.

Keywords: Long-term care; Person-centered care; Resident experience; Satisfaction.

Figure 1.

Difference between men’s and women’s adjusted quality of life scores. Notes: QoL = quality of life; ADL = activities of daily living; BIPOC = Black, Indigenous, people of color. Quality of life scores have been adjusted for individual characteristics, including age, race, marital status, length of stay, ADL score, behavioral symptoms, mental health diagnoses, cognitive impairment/dementia; and facility characteristics, including profit/nonprofit status, chain/hospital affiliation, size, occupancy rate, % private rooms, % BIPOC residents, rural/urban geography, average resident acuity (per facility), Medicare/Medicaid coverage, staffing levels, staff retention, and quality of care rating. *p < .05, **p < .01, ***p < .001.