Physicians involved in care of older adults have long realized that they are in fact practising a form of womens health. This is primarily driven by the fact that women live longer than men, so that the 80+ population is predominantly women. There are, of course, other factors as well: older women are more likely to consult their doctors, are more likely to be widowed (and thus do not have a spousal caregiver), and likely have a higher prevalence of dementia. I am particularly proud of the fact that geriatric medicine was the first specialty in Canada to reach equality of numbers between men and women. Perhaps the demographics of our target patients is one of the factors in this achievement.
Despite this, for some time womens health seemed to be focused on birth control issues, reproductive dilemmas and the horror of breast cancer in younger women. These are of course important issues, but not to the exclusion of the problems that face older women. The vast majority of breast cancer cases are in fact in older women, and their concerns are every bit as important as those of younger women. For years the issue of cardiovascular disease in older women (by far the most common cause of death in this group) barely hit the consciousness of the general public and the health care community. This did nothing to promote good cardiac care for older women.
Fortunately, things are finally starting to change. I think that the change in public consciousness has little to do with the efforts of geriatric physicians, however. If there is any group of doctors we should thank, it is those who have championed research and management of osteoporosis in older women (and now in men as well). The resultant public campaigns have not only heightened awareness of bone disease, but also have highlighted the fact that older women benefit greatly from informed medical management.
This months issue highlights many of the recent advances in older womens health. Dr. Wilbert Aronow reviews ischemic heart disease in older women, and our column on screening and treatment of low levels of high-density lipoprotein cholesterol by Drs. Gustavo Cardenas, Carl Lavie and Richard Milani adds a preventive twist to Dr. Aronows dissertation on diagnosis and treatment.
Drs. Anne-Chantal Braud and Martine Extermann review cancer screening and prevention in older women. It is important to remember that a healthy 70-year-old woman has a life expectancy of over 17 years, making attention to preventive measures potentially very important. Sue O'Hara and Dr. Michael Borrie review the management of urinary incontinence in older women.
Enjoy this issue.