Taking the pulse of older women's health. Despite advances, gender gap still exists in medical education, research, and clinical care.
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Biomedical subjects
Publications and source records attributed to R N Butler.
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Prevention of late-life disability is an important goal in managing the health care of older women. Hormone replacement therapy and regular exercise can protect against osteoporosis and heart disease. Dietary measures can control weight and prevent diabetes. Adequate calcium and vitamin D intake help protect bones from fractures. Mammography and Pap smears are proven screens for early cancer detection. Depression is not unusual in older women, but it is often masked by physical symptoms. Physicians can help women at risk for caregiver burnout by providing referrals and information on community resources. Use of other health professionals, as well as patient education videos and printed materials, can help physicians provide comprehensive care within the time limits of office practice.
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In the medical evaluation of older men with erectile dysfunction, obtain a detailed history to determine whether the dysfunction is organic or psychogenic. Determine if there are underlying pathologic processes--most notably vascular diseases--or other factors responsible for the dysfunction, such as medications or nerve or arterial damage from surgery. Lifestyle changes in mid-life (regular exercise, a low-fat diet, and smoking cessation) increase a man's chances of remaining potent as he grows older. Treatments for impotence include injection therapy, vacuum devices, and implants. Each therapy has advantages and disadvantages, and the informed patient plays an important role in choosing the therapy that is right for him.
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In the medical evaluation of older female patients with sexual problems, you need to assess the woman's psychological state, as well as her physical condition. An important question to ask is whether her level of sexual activity is satisfactory to her. Women's early sexual experiences, in some cases including childhood sexual abuse, impact greatly on their sexuality in later life. When sexual problems are related to the menopause, customized hormone replacement therapy is the treatment of choice. Other clinical factors that impact on older women's sexuality include urinary incontinence, breast surgery, and hysterectomy.
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