Gender and Well-Being 1
Running Head: GENDER AND WELL-BEING IN RESIDENTIAL CARE
No country for old men? The role of a ‘Gentlemen’s’ Club’ in promoting social
engagement and psychological well-being in residential care
Ilka H. Gleibs, Catherine Haslam, Janelle M. Jones, S. Alexander Haslam, Jade McNeill
University of Exeter
Address for correspondence:
Ilka H. Gleibs
Department of Psychology, University of Surrey
Guildford, GU2 7XH
**** in press, Ageing and Mental Health****
Gender and Well-Being 2
Objective: Social isolation is a common problem in older people who move into care that
has negative consequences for well-being. This is of particular concern for men, who are
marginalised in long-term care settings as a result of their reduced numbers and greater
difficulty in accessing effective social support, relative to women. However, researchers
in the social identity tradition argue that developing social group memberships can
counteract the effects of isolation. We test this account in the present study by examining
whether increased socialisation with others of the same gender enhances social
identification, well-being (e.g., life satisfaction, mood), and cognitive ability.
Method: Care home residents were invited to join gender-based groups (i.e., Ladies and
Gentlemen’s Clubs). 9 groups were examined (5 male groups, 4 female groups)
comprising 26 participants (12 male, 14 female), who took part in fortnightly social
activities. Social identification, personal identity strength, cognitive ability, and well-
being, were measured at the commencement of the intervention and 12 weeks later.
Results: A clear gender effect was found. For women there was evidence of maintained
well-being and identification over time. For men, there was a significant reduction in
depression and anxiety, and an increased sense of social identification with others.
Conclusion: While decreasing well-being tends to be the norm in long-term residential
care, building new social group memberships in the form of gender clubs can counteract
this decline, particularly amongst men.
Gender and Well-Being 3
No country for old men? The role of a ‘Gentlemen’s’ Club’ in promoting social engagement and
psychological well-being in residential care
For most of their lives men are in a privileged social and economic position relative to
women. However, this changes as men grow older. With increasing age, men become a distinct
minority in terms their actual group size. Only 32% of the UK population aged 85 and over
(420,000) are men, compared to 68% (914,000) women. This raises questions about men’s
increasing marginalisation and whether this experience has a detrimental impact on their
psychological well-being. This may be a particular concern for men who live in long-term care.
Living in residential care is generally perceived as challenging and can have a negative impact on
a person’s sense of self-continuity and their understanding of who they are (Iwasiw, Goldenberg,
Bol, & MacMaster, 2003; Lee, Woo, & Machenzie, 2002). Moreover, for older men in care their
status as a numerical minority is likely to be a more salient aspect of their day-to-day living than
it would be in the general community because the majority of care workers and most other
residents are female. Numerical marginalisation is also compounded by several other factors.
First, the ageing process is associated with a loss of physical strength, control, independence and
social power (Wanklyn, 1996) and this tends to contradict male (self-) stereotypes that associate
masculinity with being athletic, competitive, aggressive and powerful (Prentice & Carranza,
2002). Second, men typically find it more difficult to draw on effective social support and this
might put them in a position of disadvantage relative to women in a care context. In particular, in
the seminal review by House, Landis, and Umberson (1988) it was argued that men have less
experience with social relationships and this can contribute to their reduced effectiveness in
drawing on social support when under stress. Men’s increasing marginalization may therefore be
associated with decreases in well-being as it may strip older men of their sense of identity, lead to
Gender and Well-Being 4
fewer encounters with other men and decrease access to forms of contact that help men adjust to,
and feel comfortable in, residential care. Despite these potential barriers to men’s well-being in
these settings, the experience of older men is largely ignored, with most research on aging and
gender focusing on women (Canham, 2009; Fleming, 1999).The present study addresses this gap
by investigating the effectiveness of gender-based social groups in improving the well-being of
both men and women in care.
Social support and well-being
The association between perceived social support and better physical and psychological
health is one of the most robust in health psychology (Beals, Peplan, & Gable, 2009; Uchino,
2009). There is now a considerable amount of evidence that social interaction and engagement
can have a range of positive consequences for health (for a recent review see; Holt- Lunstad, J.,
Smith, T.B., Layton, J.B., 2010; Jetten, Haslam & Haslam, in press). For example, greater social
integration and membership of social groups reduces the risk of stroke (Boden-Alabala, Litwak,
Elkind, Rundek, & Sacco, 2005), protects well-being during recovery from stroke (Haslam,
Holme, Haslam, Iyer, Jetten, & Williams, 2008), reduces memory decline (Ertel, Glynour, &
Berkman, 2008), and can reduce vulnerability to dementia (Fraglioni, Paillard-Brorg, & Winblad,
2004). This research complements the social isolation literature which in turn highlights the
negative effects that reduced social contact has on physical and mental health (e.g., Berkman,
1995) and the associated risk of ill-health and mortality (Holt-Lunstad, Smith, & Layton, 2010;
House, 2001; House, Landis, & Umberson, 1998; House, Umberson, & Landis, 1988).
Importantly, we know that these effects are particularly pronounced for older adults (Tomaka,
Thompson, & Palacios, 2006).
Most of this research, however, has focused on community-dwelling adults. Hence, we
know relatively little about social engagement and social support among older people living in
Gender and Well-Being 5
long-term care. Yet, findings from the few studies that have been conducted with people in
residential care show that social interaction and relations has positive effects on well-being. For
example, Garcia-Martin and colleagues (Garcia-Martin, Gomez-Jactino, Martimportugues-
Goyenechea, 2004) found that diverse leisure activities (e.g., fitness exercise, computing,
handcraft, and art lessons) had a positive effect on perceived social support, and that this was
associated with decreased depression and increased life satisfaction. More recently, Park (2009)
showed that the development of meaningful relationships with other residents and staff was a
critical factor in increasing mental health (see also Barkay & Tabak, 2002; Cheng, 2009;
Cummings, 2002). Complementing this work, there is some evidence for the negative experience
that men may encounter in care. Based on interviews with 21 men in long-term care, Moss and
Moss (1997) found that ageism, the relatively negative context of long-term care in general, and
physical frailty threatened men’s positive views of their masculinity, which had a negative effect
on their psychological well-being (Moss & Moss, 2007; Thompson, 1994). Although these
studies show a positive association between (social) engagement and well-being, they say very
little about the mechanisms through which we gain social support. We believe that social identity
approaches offer the theoretical framework needed to address this gap in the health literature.
The social identity approach to health and well-being
The findings reviewed in the previous section are consistent with, and could be explained
by, recent research that has been informed by a social identity approach to health. According to
this approach, membership in social groups, such as those centered in church, family, recreation,
or work, are critical in forming a shared sense of identification through which people are able to
understand who they are and gain the social support needed to protect and enhance health and
well-being (see Haslam, Jetten, Postmes, & Haslam, 2009; Jetten, Haslam, Haslam, &
Branscombe, 2009, Jetten, Haslam, & Haslam, in press). When these groups are internalized as
Gender and Well-Being 6
part of a person’s social identity, they provide individuals with a sense of belongingness and
connectedness to others because those others are incorporated into their self-definition. Hence it
is not groups in and of themselves, but rather people’s strength of identification with them that
determines the degree to which they will be beneficial for our health. The stronger these identity-
based ties are, the more people feel similar, close and responsible for others in the group (Levine,
Prosser, Evans, & Reicher, 2005). In this way too, social identities provide a basis for the
provision and receipt of effective social support from others (Branscombe, Schmitt & Harvey,
1999; Haslam, O’Brien, Jetten, Vormedal, & Penna, 2005; Tajfel & Turner, 1979) and a resource
in times of challenge (Jones & Jetten, 2010).
As alluded to earlier, the beneficial effects of such social support have been demonstrated
in a range of contexts. People who have access to social groups live longer (e.g., Berkman &
Syme, 1979; Durkheim, 1897/2000; House, Robbins & Metzner, 1982), show cognitive integrity
(e.g., Baumeister, Twenge & Nuss, 2002), experience less pain (e.g., Platow, Voudouris, Coulson,
Gilford, Jamieson, Najdovski, Papaleo, Pollard & Terry, 2007), are less prone to physical illness
(e.g., Cohen, Doyle, Skoner, Rabin & Gwaltney, 1997), and experience enhanced life satisfaction
(Knight, Haslam, & Haslam, in press; Park, 2009). However, fewer studies have shown the direct
link between the strength of identification with others in supporting health and well-being.
Crabtree, Haslam, Postmes, and Haslam (in press) showed that for individuals with mental illness,
identification with others who were members of a relevant support group provided a basis for
social support and had a positive impact on self-esteem by buffering them from the effects of
stigma. Similarly, Jones and colleagues (in press) found that for individuals with acquired brain
injuries (ABIs) the development of group-based social relationships (i.e., perceived support)
promoted increased life satisfaction after these injuries. In both these studies receiving effective
support from group members (i.e., others with a mental illness or an acquired brain injury,
Gender and Well-Being 7
respectively) with whom one shares a particular social identity had a positive impact on well-
being (e.g., Cohen & Wills, 1985). In addition to these effects on well-being and life satisfaction,
identity processes have also been shown to influence cognition. For example, Jetten, Haslam,
Pugliese, Tonks, and Haslam (2010) found that older people’s sense of identity helped them
counteract, and adjust to, the negative effects that memory loss has on well-being. Whilst
memory decline is often considered simply in medical or biological terms, these data highlight
the importance of complementing medical models with those that examine the social dimensions
of memory loss.
Despite the clear role for identity processes in protecting and promoting mental health and
well-being, this is rarely a focus for treatment or intervention in residential care. Recently,
however, researchers have sought to redress this situation. First, Knight, Haslam and Haslam (in
press) showed that when a group was established within which care residents were empowered to
make decisions about the décor of a new care facility, this had a positive impact on their levels of
social interaction and their identification with fellow residents and staff. Significantly too, this
also led to improved mental and physical well being, as assessed by both self-report and care staff
ratings (see also Gleibs, Haslam, Haslam, & Jones, 2010a). Along slightly different lines, Haslam,
Haslam, Jetten, Bevis, Ravencroft, and Tonks (2010) have shown that group-based interventions
can enhance both the well-being and cognitive performance of residents in care. These
researchers compared the effects of individual and group-based activities on well-being, arguing
that the latter should have an advantage over the same activities delivered on a one-on-one basis
because they are more likely to foster a sense of shared social identity. Consistent with this
argument, it was found that only group-based interventions improved residents’ cognition and
well-being — with group reminiscence enhancing memory performance and group skittles
enhancing subjective well-being. In both cases there was evidence of maintained sense of social
Gender and Well-Being 8
identification with others in care, whereas one-on-one reminiscence not only led to a reduction in
such identification but was also associated with no enhancement in either cognition or well-being.
In summary, it appears that positive interaction and engagement with others is the basis
for development of a sense of social identification from which positive effects on various
dimensions of health (physical and cognitive), social functioning and well-being emerge (see also
Amiot, Terry, Wirawan, & Grice, in press; Blader & Tyler, 2009; Gleibs, et al., 2010a). Helping
people to develop such identification by encouraging them to build new and meaningful social
ties is therefore an important vehicle via which we are likely to achieve positive health outcomes.
The present study
As noted in the introduction, the relatively negative context of long-term care in general and
the lack of social support and engagement for older adults in these settings may decrease
psychological well-being. These challenges might be even greater for men, who are typically the
numerical minority in care and have greater difficulty in drawing effective social support — two
factors which contribute to their increased isolation relative to women. Importantly, though, previous
research also shows the restorative value of strategies for increasing social engagement in residential
care homes. In particular, there is growing evidence which points to the value of group-based
interventions, that enhancing well-being by increasing individuals’ sense of shared social
identification and thereby provides a basis for the provision and receipt of effective forms of social
Extending this line of research, the present study sought to investigate the impact of a social
group intervention that had a gender focus on residents’ social identification and well-being. In this,
it had a particular goal of seeking to enhance the well-being of men in long-term care. To this end,
older people residing in long-term care were recruited to take part in a gender-based social group
intervention, initiated by a care home provider, and these residents were followed over the course of
Gender and Well-Being 9
the initial 12 weeks of this intervention. On the basis of a social identity approach to health, we
predict that participation in gender-based groups should be associated with positive outcomes
because group interaction provides a basis for participants to build a sense of shared social identity (a
sense of ‘us’) that (1) strengthens their sense of personal identity or the notion of a sense of self
(Postmes & Jetten, 2006), (2) encourages cognitive engagement (Ertel et al., 2008; Haslam et al,
2010), and (3) promotes well-being (Haslam et al., 2009; Knight et al., in press). However, because
men’s identities are likely to be more threatened than those of women in this context, we also
expected that they would stand to benefit more from the process of social identity building and hence
would benefit most from this intervention.
Initially, 30 residents (18 female, 12 male; Age: M = 85.34, SD = 7.94, range 62-99)
across six care homes (Care home (CH)1: n = 8 [nmale=4], CH2: n = 2 [nmale=2]1, CH3: n =3
[nmale=1], CH4: n = 3 [nmale=3], CH5: n=9 [nmale=3], CH6: n=5 [nmale=0]) were recruited into the
study. All were residents of residential care homes run by the same provider in the south-west of
England, Cornwall Care. Four participants (13%; all female) were unable to complete the study
due to ill-health (n=3) or were unavailable for an interview at the time of data collection (n=1).
Accordingly, the final sample comprised of 26 residents (14 female, 12 male; Age: M = 86.06, SD
= 7.94, range 70-90 years) across the six homes (CH1: n = 7, CH2: n = 2, CH3: n =2, CH4: n = 3,
CH5 n=8, CH6: n=4).
The Psychology Ethics Committee at the researchers’ university provided approval for the
study. Care home residents were contacted by their managers with a view to taking part in a study
on ‘engagement and well-being in residential care’. Managers contacted residents and invited them
Gender and Well-Being 10
to join a gender club – either a Gentlemen’s or Ladies Club. For the purpose of the present research,
outcomes were monitored at two time points (within four weeks of commencement of the clubs
and 12 weeks after the first measurement point), though the intention was that the clubs would
continue beyond this point. Participants could generally choose the activities in which the group
took part. These activities included outings (e.g., to museums), flower arranging (female only),
movie afternoons, and lunch-time outings. Groups met on a fortnightly basis and were facilitated
by one staff member of the care home, who was of the same gender as the group members.
Generally, the activities were chosen by the members of the club and did not follow a specific
program. Participation was voluntary and rather informal and participants chose to take part in each
session. Meetings were at a fortnightly basis and where both ladies and gentlemen's club existed in
the same care home the meetings alternated on a fortnightly basis. All facilitators were experienced
care staff, had introductory training in delivery of the activity, and could ask the Education and
Training Coordinator of Cornwall Care for support if needed.
The study was designed to evaluate the effect of gender clubs on the well-being of
participants. Participants were interviewed at both measurements points. One member of the
research team met with participants individually to administer the survey, which took
approximately 45-60 minutes to complete.
A series of measures was administered at two time points to assess identity, cognitive
ability, and well-being. If not stated otherwise, responses were given on five-point scales
(1=completely disagree, 5=completely agree). The first page contained some demographic
questions (Time 1 only) and we provided details about the study as a whole. The questionnaire
assessed five key constructs as described below.
Two scales were used to assess social identification with others in care and personal
Gender and Well-Being 11
identity strength (Jetten et al., 2010).
(1a) Social Identity was measured with two items adapted from a social identification scale
developed by Doosje, Ellemers and Spears (1995). The items were “I see myself as a member of
[care home].” and “I am pleased to be a member of [care home].” and they were highly correlated,
rt1 = .70, p < .001, rt2=.80, p < .001.
(1b) Personal Identity Strength. This scale comprised five items (t1 = .72, t2 = .63) to
assess the extent to which participants had a clear understanding of who they were. The items were
adapted from a self-clarity scale developed by Campbell, Trapnell, Heine, Katz, Lavallee, and
Lehman (1996) and a personal identity strength scale devised by Baray, Postmes and Jetten (2009).
Both measures have recently been used to assess identity strength in older adults (Haslam, et al.,
2010; Jetten et al., 2010). These items were: “I know what I like and what I don’t like”, “I know
what kind of person I am”, “I have strong beliefs”, “I know what I want from life”, and “In general,
I have a clear sense of who I am and what I am”. Higher ratings indicated a stronger understanding
(2) Cognitive ability was measured with the Addenbrooke’s Cognitive Examination
Revised (ACE-R; Mioshi, Dawson, Mitchell, & Arnold, 2006). The test has been widely used in
previous research and assesses performance in five domains: attention/orientation, memory,
verbal fluency, language, and visuospatial ability. Scores from each domain are summed to give a
total out of 100. The ACE-R is sensitive to dementia (a score less than 88 gives 94% sensitivity
and 89% specificity for dementia) with good sensitivity and specificity in diagnosing dementia
(Mioshi et al., 2006).
Well-being was indexed using two measures:
(3a) Life satisfaction was indexed using a single item; “I feel frequently satisfied about
Gender and Well-Being 12
myself” (Andrews & Whitney, 1976).
(3b, 3c) The Hospital Anxiety and Depression Scale (HADS; Zigmond & Snaith, 1983)
was used to assess both anxiety (seven items) and depression (seven items). This test was
designed for use in medical outpatient clinics in order to detect clinical cases of anxiety and
depression and to assess the severity of anxiety and depression separate from physical symptoms
(the latter being a common confound in assessment of these variables in older adults). However,
it has been used (e.g., Haslam et al., 2010) and recommended for use (e.g., Clare, 2002) with
older adults, particularly for those with dementia. Each item is rated on a four-point scale (from 0
to 3) with lower scores indicating lower levels of anxiety and depression.
Scores on all measures were subjected to a 2 Gender (male, female) X 2 Time (Time 1,
Time 2) mixed ANCOVAs with Time as the within-participant factor and age as the covariate.
Relevant means, standard deviation and statistics are presented in Table 12.
Social identification. In line with prediction, we found a marginally significant interaction
between time and gender, F (1, 22) = 3.70, p = .06, p2 = .14. This reflected the fact that for male
participants, identification was low at T1 (M=3.12, SD=1.31) but increased over time (M = 3.87,
SD = 1.22; p = .093), while for female residents identification was initially higher than it was for
men (p = .02) and did not change significantly over time (T1: M = 4.16, SD = 0.68; T2: M = 3.91,
SD = 1.14; p =.44). No other effects were significant, all Fs < 2.1, ps > .27.
Personal identity strength. Analysis revealed a significant main effect for time, F (1, 22)
= 7.99, p =.01, p2=.27, but no main effect for gender, F (1, 22) = 0.30, p = .57, p2 = .01, and no
interaction between time and gender, F (1, 22) = 0.80, p =.78, p2=.004. This effect reflected the
Gender and Well-Being 13
fact that for both female (T1: M = 3.80, SD = 0.93; T2: M = 4.35, SD = 0.56; p =.04) and male
participants (T1: M = 3.97, SD = 0.76; T2: M = 4.42, SD = 0.44; p = .08) there was evidence of
an increase in personal identity strength over the period of the intervention.
We examined whether male and female participants differed in terms of their cognitive
ability - as assessed by ACE-R scores - and whether engagement in the Gentlemen’s or Ladies
clubs had an effect over time. This analysis revealed a marginally significant main effect for
gender, F (1, 20) = 3.53, p = .075, p2= .15. Among female participants cognitive ability was
higher (T1: M = 57.00, SD = 26.98; T2: M = 60.38, SD = 28.71), than for male participants (T1:
M = 42.50, SD = 18.82; T2: M = 43.30, SD = 18.79). Neither age as a control variable, change
over time, or the interaction between time and gender revealed any significant effects, all F’s
<.50. There is thus no evidence that cognitive function changed as a result of engagement in the
gender-based groups. Generally, female participants displayed superior cognitive ability to males,
but this effect did not reach conventional levels of significance.
Life satisfaction. Analysis of this measure revealed a significant interaction between time
and gender, F(1,21)=4.88, p=.04, p2=.19. This reflected the fact that, for male participants, life
satisfaction increased from T1 (M=2.80, SD=1.39) to T2 (M=3.70, SD=1.70; p=.09). For female
residents life satisfaction was significantly higher at T1 (M=4.00, SD=1.11) than it was for men
(p=.03) and did not change over time (T2: M= 3.79, SD=1.12; p=.42). No other effects were
significant, all F’s <1.7, p>.21.
HADS-Depression. The analysis of depression scores also revealed a significant
interaction between time and gender, F (1, 21) = 4.86, p = .044, p2=.18. In line with our findings
Gender and Well-Being 14
for life satisfaction, male participants’ depression was higher at T1 (M = 5.27, SD = 3.52, range
from 0-155) but decreased significantly (p = .03) at T2 (M = 2.36, SD = 2.29, range 0-6). For
female participants depression at T1 (M = 3.00, SD = 2.38, range 0-8) and T2 (M = 2.69, SD =
2.46, range 1-9) was lower than it was for men (p = .047) and there was no significant change
over time (p = .62). No other effects were significant (all Fs < 2.1, ps > .15).
HADS-Anxiety. Similar results were found for anxiety. Again, the only significant effect
was an interaction between time and gender, F (1, 21) = 4.86, p = .04, p2 = .19. Among male
residents anxiety was initially higher (T1: M = 5.36, SD = 3.64, range 0-12) but this decreased
over time (T2: M = 3.36, SD = 2.50; p = .09, range, 0-7). For females, anxiety was initially lower
than it was for men (T1: M = 2.76, SD = 2.86, p = .05). This increase over time was not
significant (T2: M = 3.53, SD = 3.47; p = .39). None of the other effects approached significance,
(all Fs < 1.2, ps> .27).
Overall, then, the pattern of results for the well-being measures showed that participation
in the gender-based club was especially beneficial for men. Accordingly, while well-being was
maintained at reasonably high levels over time for women who participated in Ladies Clubs,
participation in the Gentlemen’s Club increased men’s life satisfaction and decreased their
depressive symptoms. Contrary to prediction, there were no significant effects on cognition.
4. Relationship between variables
On the basis of the social identity approach, we argued earlier that social identification
should generally be associated with enhanced well-being. Thus, we should find that social
identification is negatively correlated with depressive symptoms and anxiety, but positively
correlated with life satisfaction. In line with this reasoning, we found that social identity at T2
was negatively associated with depression at T2, r (23) = -.37, p = .04. This effect also remained
Gender and Well-Being 15 Download full-text
after partialling out the effects of age (rp(21) =-.40, p= .03). Identification and anxiety were also
negatively related, r (23) = -.10, p = .31, but this effect was not significant. Social identity was
also positively correlated with life satisfaction, r (23) = 0.23, but this effect non-significant, p
The present research was designed to investigate the potential benefits for health and
well-being of creating gender-based social groups — specifically, a Ladies and Gentlemen’s Club
—for residents in long-term care. Three key findings emerged from the study. First, we found that
the engagement in gender-based social groups was especially beneficial for male participants.
Participating in a Gentlemen’s Club led men to report higher levels of life satisfaction, and at the
same time it reduced symptoms of depression and anxiety. Moreover, it also led participants to
report higher levels of social identification with other members of their residential community.
Significantly too, at the beginning of the intervention several of the male residents were found to
experience problematic levels of depression (i.e., scoring > 8; Westoby et al., 2009; n = 4 (33%))
and anxiety (n = 3 (25%)), but after 12 weeks, no-one reported symptoms above the benchmark
of 6 (indicating no anxiety/depression). Second, for female participants, general well-being and
identification was high to start with and both were maintained over the course of the intervention.
Third, the gender-based groups led to higher levels of personal identity strength for male and
female residents, thus enhancing participants’ understanding of who they were as individuals (a
pattern that accords with effects previously reported among support groups established to support
individuals with acquired brain injury; Jones et al., in press). However, there was no evidence
that gender-based social clubs led to improved cognitive performance for either men or women.
While this finding appears inconsistent with reports that social relationships can arrest the
cognitive decline of people living in the community (e.g., Ertel et al., 2008), it mirrors evidence