Older patients have many options


June 14, 1994|By Dr. Genevieve Matanoski | Dr. Genevieve Matanoski,Medical Tribune News Service

Until recently, women have tacitly accepted declining health as part of the aging process. The popular notion seemed to be that the older one got, the less control one had over personal-health issues. The advance of chronic conditions and fatal disease seemed not only inevitable, but unchallengeable.

The picture is vastly different today and continues to change for the better. As women have begun to manage many aspects of their lives, long-term health issues are receiving increased attention. Doctors who specialize in aging are working to identify and manage chronic disease so that functioning and quality of life are maintained, as the doctors continue to combat traditional killers, such as heart disease and cancer.

Much of the success of this approach lies in the hands of older patients, who have many options and opportunities to dramatically improve their health. To learn more about health issues and challenges facing women over 50, I consulted Dr. Michele Bellantoni, an assistant professor of medicine, geriatrics and gerontology at Johns Hopkins University School of Medicine.

Q: How have attitudes in the medical community changed concerning women's health?

A: In a very positive fashion, for the most part. Almost all funding mechanisms for research now require that women be studied, along with men. Additionally, numerous unique studies are geared exclusively toward women's health. Men remain exclusively studied, but only when a condition unique to them, such as prostate cancer, is involved.

The National Institutes of Health (NIH) now has an Office of Women's Health Research. A nine-year NIH study, the Women's Health Initiative, currently is examining hormone replacement therapy, nutrition, osteoporosis, cancer and cardiovascular disease.

Q: Do older women seek care as they should?

A: Although middle-age women access care more frequently than do men, and often make family health-care decisions, many older women do not receive the care they need for a variety of reasons. For example, it is estimated that 15 percent of older women suffer from depression -- in many cases from recent life changes, such as being widowed. One percent to six percent of older women are alcoholics, a group still largely "in the closet" in terms of recognition and treatment.

It has been difficult to get these two groups to avail themselves of the care they need. Older women also may experience physical barriers to care, such as lack of transportation. This "shut-in" syndrome in itself may lead to the exacerbation of the above problems, as well as contributing to others, such as malnutrition and functional decline.

Q: What can women over age 50 do to reduce their risk of heart disease and cancer?

A: The No. 1 cause of death for American women remains cardiovascular disease, although much can be done to combat it, including following a healthy diet, exercising and quitting smoking. Nineteen percent of men and women ages 65 to 74 smoke. Even in this age range, quitting can produce dramatically beneficial effects: The life expectancy of a two-pack-a-day smoker who quits increases an average of four years. This fTC debunks the "it's too late for me" myth concerning quitting.

Cancer, particularly breast cancer, remains a major cause of death for women over age 50. It is important to remember that the incidence of breast cancer increases with age, so mammography screenings are critically important in the over-50 age group. If a problem exists, diagnosis and treatment should be performed as soon as possible. Older, otherwise healthy women typically are able to tolerate therapy well.

Q: What other health-related changes should women make?

A: In addition to quitting smoking and undergoing cancer screenings, women can do a number of simple things to significantly increase their prospects for improved health.

With 40 percent of older people leading sedentary lives, a regular regimen of moderate exercise can be key. Even the most basic fitness program can make a difference. For example, the benefits of 30 minutes of walking three times a week have been documented.

Immunizations also are strongly recommended for all women (and men) over age 65, especially vaccines for influenza, pneumonia (the cost of which is covered by Medicare), tetanus (which disproportionately afflicts older people) and diphtheria.

Q: What about nutritional changes?

A: Older women should continue to monitor their total calorie, cholesterol, fat and calcium intake. A high-fiber, low-fat diet can help guard against cancer and cardiovascular disease, and increased calcium intake is fundamental to combating osteoporosis.

Older women are advised to consume 1,000 to 1,500 milligrams of calcium daily. Sources include at least four 8-ounce glasses of low-fat milk, or as an alternative, calcium-fortified orange juice, low-fat yogurt, cheese or calcium supplements.

Q: Is estrogen-replacement therapy of value?

A: Estrogen therapy has been shown to protect against heart disease, as well as osteoporosis, especially at the onset of menopause. Additional research is being conducted to determine the optimal therapy and the target groups who stand to benefit most.

Possible side effects of the treatment include breast tenderness and fluid retention. In addition, estrogen therapy without the hormone progesterone can increase the risk of uterine cancer. The benefits versus the risks of estrogen therapy need to be carefully discussed with a woman's primary-care provider.

Dr. Genevieve Matanoski is a physician and epidemiologist at the Johns Hopkins School of Hygiene and Public Health. She is a founding director of the school's Institute for Women's Health Research and Policy.

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