Women and men both face various health conditions as age advances. However, there are specific illnesses and disabilities that either overwhelmingly affect women more than men or that can only affect women due to bio-physiological reasons. While females are more likely to survive into older age than males, they have more disabilities than males in every age group after the age of 60, as well as more co-morbidities.
As we all know, for ageing women, menopause is a significant transition from a biological perspective, leading to different medical problems unique to them. Also ageing women provide an important contribution to the socio-economic well-being of their families, communities and the nation. Much of this is unpaid and unrecognised work in care giving, child rearing, domestic and volunteer occupations. Therefore, looking after elderly women should be a priority in any community.
Q: What are the common health problems among elderly women?
When age advances, people lose their in-built physiological reserve, a phenomenon called frailty, making them more vulnerable to disease and disabilities. Frailty is commoner among women compared with men of the same age, predisposing them to many medical problems. Also, with ageing, there is a loss of muscle mass, strength and function called sarcopenia, more common among women compared to men. Therefore, mobility, balance and flexibility decline are commoner in females. Due to unfavourable hormonal imbalance following menopause, there is laxity in the muscles and tissues of the pelvis. This leads to high prevalence of urinary incontinence among women.
Osteoporosis or thinning of the bone happens with ageing, leading to high risk of fractures of the hip, spine and wrist. As a result of menopause, osteoporosis greatly affects women over 50 compared to men. In addition, elderly women are more prone to osteoarthritis. Common joints affected are the knee and hip. There are many factors contributing to this including obesity, which is a frequent problem in elderly women.
Diabetes mellitus is one of the biggest health issues among many seniors. Its occurrence is evenly distributed between men and women. However, due to the high prevalence of diabetes and related problems, it is considered a major health and socio-economic hazard among elderly women. There are some common risk factors affecting women as regards developing diabetes including higher incidence of obesity, pregnancy induced diabetes at a young age, lack of exercise and hormonal changes following menopause.
Heart diseases are also common in elderly women and are the leading cause of death, both in men and women. Higher prevalence of non-communicable diseases like diabetes, high levels of blood cholesterol and high blood pressure predispose them to heart diseases. Obesity and menopause are also major risk factors.
Dementia is a frequent problem among them. We can only see the tip of the iceberg as many elderly women do not seek medical treatment. Family members misunderstand the symptoms of dementia as a part of normal ageing and are reluctant to seek medical attention for them. As there is a higher incidence of non-communicable diseases in the female population, they are more vulnerable to developing dementia with ageing.
Depression is a common psychological problem affecting elderly women and is a silent killer. Multiple medical problems, social isolation, financial hardship and underlying dementia are precipitating factors for the development of overt dementia in elderly females. They are twice aslikely to acquire depression than men. Usually they complain of lack of sleep, lack of interest in the social networking, poor appetite, and multiple unrelated symptoms of aches and pains. Thorough analysis of the complaints and focused examination by a clinician will diagnose the depression.
Breast cancer is the most common cancer among women. More than half of the breast cancer diagnosis occurs among women aged 65 and over. Many studies suggest that women who are over 65 and are diagnosed with breast cancers have a higher mortality rate than those under 65.
Because of the high rate of prevalence of this disease, it is important for them to understand how to identify breast cancers and get screened and know the available treatment options. A small lump in the breast is the most common and prominent early sign and should be immediately checked by a doctor. If there is a family history of breast cancers on the maternal side, it is important to have regular screening to detect early signs.
Cervical cancers are also a common malignancy among elderly women. Most women present at a very late stage as they try to hide symptoms like post-menopausal vaginal discharge or bleeding. With a simple screening test called Pap smear, it can be diagnosed at the early stages and could be cured.
Q: What are the social issues compromising health in elderly women?
Since women live longer than men and are more likely to be alone in old age, they lack support from the spouse both financially and psychologically. In countries like Sri Lanka, most of the elderly females are less privileged compared to men in several ways, including finance, health and education. Also, the vast majority of Sri Lankan elderly women are reluctant to become involved in health-promoting programmes like physical exercise and community-based activities. Studies have shown that elderly women are under physical and emotional stress compared to older men. Developing gender sensitive national policies are important to overcome these hardships faced by them.
Q: What are the preventive measures that elderly women can take to improve their health?
Mainly professionals need to understand and recognise sex and age differences when prescribing medications. Elderly women should be encouraged to see their healthcare provider regularly even though they feel perfectly healthy. A balanced diet is important to prevent the common non-communicable diseases explained previously. They should select a variety of natural foods of different colours and shapes. Grains and legumes with higher portions of vegetables and green leaves should be consumed. Adequate amount of protein intake is necessary to prevent early onset of frailty and sarcopenia. They should take minimum amount of foods containing sugar, oily foods and very salty foods. It is recommended that they eat at least three to five handfuls of fruits per day. Fruits, vegetables, green leaves, fish and dairy products are good sources of Vitamin D and calcium, and both are important to preserve muscle and bone strength and function in elderly women. They should take medications, vitamins and other supplements only as directed by a doctor. They usually try to take supplements without medical advice when they have aches and pains.
To lead a healthy life, all elderly women should undergo appropriate screening for diabetes, cholesterol, blood pressure, bone health evaluation, hearing and vision, and breast and cervical cancers.
Regular exercise is important to maintain strength, balance and flexibility. It is well known that regular exercise improves muscle mass and function as well as bone health. It helps to control blood sugar, blood pressure, cholesterol levels, weight and brain functions.
It is important to improve memory and other brain functions with regular brain exercises. Reading and word and number puzzles are good brain exercises. In addition, elderly women should be encouraged to socialise with family and friends to relieve mental stress and hidden depression.
Q: Finally, could you explain further about suitable types of physical exercise?
As I explained earlier, the vast majority of Sri Lankan elderly females are reluctant to do physical exercise due to reasons like traditional myths and the lack of awareness of its importance. Our health authorities together with the mass media, especially the electronic media, should take initiatives to remove these mental barriers and encourage them to do suitable exercises.
To stay healthy or to improve health, older adults need to do two types of physical activity each week – aerobic exercise and strength exercises.
According the National Health Services guidelines in the UK, adults over 65 can do at least 150 minutes or two-and-a half hours of moderate aerobic activity such as cycling or walking or play tennis in doubles every week and do strength exercises that work all the major muscles such as the legs, hips, back, abdomen, chest, shoulders and arms on two or more days a week.
Alternatively, you could do a mix of moderate and vigorous aerobic activity every week, as for example, two 30-minute runs plus 30 minutes of brisk walking which equates to 150 minutes of moderate aerobic activity and strength exercises on two or more days a week that work all the major muscles as I explained previously. It is noteworthy to mention that daily tasks such as shopping, cooking or housework do not count towards your 150 minutes because the effort is not enough to raise your heart rate.
Older adults at risk of falls, such as people with weak legs, poor balance or having medical conditions should exercise to improve balance and coordination on at least two days of the week.
These exercises are good irrespective of gender; however, selecting the suitable combination would depend on one’s age and health condition. If you have some complications, it is pertinent to have medical advice from a suitable doctor.
(Dr. Lasantha Ganewatta works as a Consultant Physician at the Ministry of Health in Sri Lanka. She has qualifications in Geriatric (care of the elderly) Medicine from the Royal College of Physicians, London and has obtained on-the-job training at the Geriatric Medical Ward at Queens University Hospital, London, UK. She is a member of the British Geriatric Society. Email:jaw_123_jaw@yahoo.com)
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