Ageing, Chronic Illness and Women’s Stories

Many ageing women with chronic conditions face challenges rooted in past hardships, cultural habits and care burdens. Deeply embedded behaviours, digital exclusion and unaddressed grief hinder health management. Systemic gaps, low patient activation and psychological weight further complicate care. Sustainable solutions require empathy, accessible technology, culturally relevant support and recognition of women as both patients and caregivers.

Key Points

• Lifelong habits and cultural norms hinder effective chronic disease management.
• Digital tools often exclude ageing women due to poor design and low literacy.
• Mental health issues are frequently unspoken or mislabelled.
• Many women are both caregivers and patients, lacking adequate support in either role.
• Sustainable care must prioritise empathy, accessibility and cultural relevance.

“Picture it: Sicily, 1924…”
— The Golden Girls

Blanche, a character from The Golden Girls series, always began telling a story with place and year, then unfolded a woman’s life. Let’s borrow this narrative device: to design care that finally fits ageing women we must first see how yesterday’s realities shape today’s multimorbidity.

Below are four composite stories based on real-world patterns, drawn from Europe, Latin America, the Middle East and beyond. Their names are fictional—but their needs are not. Their paths differ, but their struggles converge. After the stories, we reflect on what this means for care, support and shared responsibility.

Maria — Sicily, 1944

Childhood: Post-war ration cards, olive-oil scarcity, walked barefoot to school until 11.

Adulthood: Married at 18; five pregnancies by 30; double workload—field and household.

Medical timeline: 1972: borderline blood pressure; 1988: “mild sugar” (no follow-up); 2003: type 2 diabetes; 2014: knee arthritis; 2021: depression after husband’s stroke.

Today (80): Recently widowed; must now manage bills and transport her husband once handled. Uses feature phones only; reject continuous glucose monitor (CGM), as its font is too small.

Maria’s challenge is not resistance—it’s unfamiliarity. When she is asked to eat low-carb, the advice clashes with a lifetime of carb-heavy staples. Pasta, bread, potatoes were not indulgence—they were survival. Asking her to unlearn that is not simple; it is a psychological ask, not just nutritional.

Layla — rural Jordan 1951 → Amman 1980

Childhood: Desert village life; early marriage at 16; raised seven children; no formal schooling.

Adulthood: Managed household, cooked for extended family; rarely saw doctors unless pregnancy-related.

Medical timeline: 1996: hypertension; 2003: obesity (BMI 38) noted during check-up for foot pain; 2010: diagnosed with diabetes; 2017: neuropathy; 2022: mobility issues, her weight remains taboo topic.

Today (73): Widowed. Her sons live abroad; her daughters are overloaded. Feels shame about her body and dependence. Refuses glucose tracking, as she cannot read English interface and is ashamed to ask for help.

Layla’s story illustrates how modesty norms, digital illiteracy and silent suffering obstruct effective care. She has internalised her health problems as personal failure, not preventable burden—mirroring millions of women across the Middle East and beyond.

Isabel — rural Galicia 1958 → Madrid 1979

Childhood: Farm chores, winter hunger, one-room school.

Adulthood: Cleaner on rotating shifts; two children; caregiving for a cousin with dementia.

Medical timeline: 2000: her daughter is diagnosed with a gestational diabetes; 2002: her daughter delivers a 4.4 kg baby who dies suddenly weeks later—family never speaks of it; paediatrician tells Isabel to “watch the sugar” but no test is done; 2012: formal type 2 diabetes diagnosis; 2018: diabetic retinopathy; 2022: depression finally diagnosed after years of believing that “all the women in our family are moody.”

Today (66): Retired and widowed within a year, moved into daughter’s flat—lost rural network, gained informal caregiver. Does not count carbs; her eye-strain limits app use; worries about retina surgery being delayed.

Isabel shows us how unspoken grief, gendered mental health stigma and generational norms delay care. Her care journey is deeply shaped by what was never said—and what still feels shameful to name. She's also navigating the downstream health effects of historical knowledge gaps—like the fact that delivering a high-birthweight baby (a known risk factor for Type 2 diabetes) was not widely recognised until well after her daughter’s loss. Those past unknowns still shape today’s chronic realities.

Carmen — La Paz 1946 → Barcelona 1970 (nurse)

Childhood: High-altitude sun, polio scare.
 

Adulthood: 35 years as ward nurse; night shifts; union representative; back injuries; primary carer for mother with heart failure.
 

Medical timeline: 1999: chronic lumbago; 2007: hypertension; 2015: chronic kidney disease (due to nonsteroidal anti-inflammatory drug overuse); 2022: burnout & chronic insomnia—still wakes to phantom call-bells thinking that “someone must need me.”
 

Today (78): Officially retired. Skips nephrology when the ward is short-staffed; guilt lives on both sides of the stethoscope.

Carmen reminds us that many women are both patients and providers—and often under-supported in both roles. The psychological toll of lifelong caregiving becomes a condition itself.

What Shapes Their Care Experience Today

These women live with multimorbidity, yes. But they also carry:

• Psychological weight: Depression dismissed as “moodiness,” internalised fatalism, shame around poor literacy or failed habits.
• Behavioural inertia: Habits from decades past are deeply embedded. Pasta is not “just a carb” — it’s cultural identity, economy and taste. How do you "go low-carb" in places where rice, bread or plantains were the base of every meal?
• Social shifts: Widows with vanished roles, daughters now distant, friends also ageing. Their support network shrinks while needs rise.
• Low patient activation: Not because they do not care—but because they do not know where or how to start. Prioritising themselves was never encouraged.
• Tech mismatches: Vision loss, low digital literacy and confusing user experience keep many tools irrelevant or inaccessible.
• Global variation: These stories may start in Europe, Latin America or the Middle East, but they echo across continents. And the challenges—lifestyle mismatch, digital exclusion, under-recognised mental health—are magnified in regions where care access is even more fragile.

The System Has Changed

Healthcare has evolved from personal to procedural. These women remember when a doctor knew their name, their family and their story—not just their laboratory results. Today, they’re referred across specialties, see different faces at every visit and often hear their names shortened or mispronounced. They leave 10-minute appointments with questions they did not have time to ask, or only think of after the door closes. They are asked to use devices (What’s a CGM? Why there are two blood pressure readings?) or log symptoms in apps that do not accommodate failing eyesight or digital illiteracy. They remember when their doctor looked at them, not a screen. Now, the responsibility to coordinate, track, understand and comply falls heavily on them—when that capacity may be at its lowest.

What Must Change: A Shared Responsibility

Holistic care is not about adding more professionals—it’s about designing around real lives. To make care sustainable, it is necessary to:

1. Reimagine patient journeys with these women at the centre, not on the margins.
2. Train clinicians in health psychology: how to meet resistance with curiosity, not blame.
3. Fund community-based coaching, peer support and caregiver respite.
4. Design tech accessibly, using large fonts, audio navigation and family-linked accounts.
5. Make mental health universal in care pathways, especially for older women.
6. Value the ageing female healthcare workforce with flexibility and recognition.
7. Map global variability in care norms and make behavioural change tools culturally and historically relevant.
8. Update risk frameworks: Many key predictors—like delivering a macrosomic baby—were unknown or ignored when these women gave birth. They should not pay twice for a gap in the system’s memory.
9. Support empathy as a core clinical skill: Healthcare professionals, especially under pressure, are often guided by KPIs but lack insight into what truly matters to the patient. A simple pause in assumption and a trained eye for context can lead to better care and less frustration—for both sides.
10. Ask yourself this: If you are reading this and you are in medtech, pharma or hospital leadership, how will you bring this shared responsibility into your roadmap, strategy or meeting agenda? These women are not edge cases. They are the centre of your care population.

Empathy as Strategy

This is not charity. This is resilience. If we understand the history of these women, we can design the care for their future. If we train healthcare workers not just in protocols but in empathy and health psychology, we can help patients make meaningful changes without moralising or overwhelming them.

Compassion is not soft. It’s smart. And it’s strategic. The key to sustainable secondary prevention lies in knowing which barriers matter—and which levers actually move.

Change the Prompt

Your chronic patient is not average.
She is female, ageing, overloaded and underseen.
She does not want sympathy. She wants dignity, relevance and relief.

Let’s change the prompt. Let’s see her first.

Conflict of Interest

None