little known facts about women & aging

this semester, in addition to being inundated with work for PBL, OMM, & CE, we first year medical students also have the privilege of taking on 4 additional 5-week classes: ethics, geriatrics, public health, & healthcare management. for geriatrics, one of our assignments is to write a review of an article. the particular one i chose, "comprehensive evaluation of the older woman," (H Amin MD et al. Symposium on Geriatrics: "Comprehensive Evaluation of the Older Woman." Mayo Clin Proc. 2003;78:1175-1185.) offered some surprising information. Here are some of the little-known facts I learned:

• in general, the aging woman accounts for nearly 70% of the caregivers of older persons and a woman is more likely to live alone, experience more years of dependency, and, in her later years, experience more financial difficulty and/or poverty than a man
  
• dementia, defined as an acquired persistent and progressive impairment in intellectual function with compromise in multiple cognitive domains is the fourth leading cause of death in older women, with a prevalence of 25% to 47% in patients over 85
• delirium, defined as an acute, fluctuating disturbance of consciousness, associated with a change in cognition or the development of perceptual disturbances, and has two causes: an underlying medical condition or medication. the most common cause? polypharmacy (i.e. 5+ medications--including vitamins & herbal supplements--taken on a daily basis)
• the prevalence of major and subclinical depression in older women is 15% and women aged 65+ are 2x as likely to have depression as men of the same age (so much for the theory that hormones cause our mood swings, eh?)
• women are twice as likely as men to suffer urinary incontinence
• falls are the 6th leading cause of death in elderly persons and contribute to 40% of nursing home admissions; there's a 20% mortality in the first year after sustaining a hip fracture
• the lifetime mortality risk of coronary heart disease (CHD) among postmenopausal women is 31% compared with 2.8% for hip fracture, 2.8% for breast cancer, & 0.7% for endometrial cancer; of women 65+, 55% experience functional limitations, morbidity, & impairment of quality of life due to CHD (and yet we hear more about cancer than we ever do about CHD)
  
• more than 1/3rd of women (ages 20-70 years) in the united states have hypertension, 25% have hyperlipidemia, 25% are smokers, 25% are obese, & nearly 60% are sedentary (i.e. all this mortality is relatively preventable)
• nearly 70% of sudden deaths in women are from unrecognized CHD; in women, 40% of all coronary (i.e. heart) events are fatal, but women with CHD are not treated as aggressively as men (traditionally, anyway--let's hope that's changing!)
• women who smoke present with their first MI (i.e. heart attack) 19 years earlier than female nonsmokers
• the onset of type 2 diabetes can be reduced by 58% in women who exercise moderately 2.5 hours per week; improvement in cardiovascular risk has been shown even in women who walked only 1 hour per week
• the lifetime risk of developing hypertension (i.e. high blood pressure) in people who never had it before who are 55+ is 90%; in persons over 50, the risk of cerebrovascular disease DOUBLES for each 20/10-mmHg increment of blood pressure level
• more than 80% of patients with diabetes die of cardiovascular disease; the risk of CHD in women with diabetes is 3 to 7 times higher than in women without diabetes
• after age 65, the risk of developing uterine cancer increases by 2x and the risk of ovarian cancer by 3x; and yet...15% of women aged 65 to 74 and 38% of women over 75 have never had a PAP smear
• endometrial cancer is the most common invasive gynecologic malignancy (but we're not even close to having developed a reliable test for it)
• age is the most predominant risk for breast cancer; 1/3rd of breast cancer cases are in women over 70; an increased risk of breast cancer was found in people who drink alcohol (but alcohol lowered the risk of CHD...pick your poison?)
  
• decreased sexual activity is influenced by the fact that by age 80+, there are 39 men for every 100 women; the geriatric population has the second highest rate of HIV infection after teenagers (proving that viagra should be packaged with condoms)
• in women aged 65+, 31% did not graduate from high school