Our Bodies, Ourselves (119 page)

An eighty-one-year-old woman describes how she and her friends have learned how to incorporate health issues into a discussion without making it the only discussion:

I find that, like most women my age, I have frequent doctors' appointments for eyes, teeth, chronic conditions, etc. Going to the doctor always raises mortality issues: What does this ache or pain mean? I started bunching my appointments together because health issues can take over your life, and I want to focus on the many activities I enjoy. I have a group of friends I get together with regularly, and we have ten minutes of “health reports”—and then on to other things
.

She also outlines her efforts to be prepared:

I am aware that an unexpected emergency room visit could happen at any time, and so I carry my cell phone with me at all times and have picked up on the ICE (In Case of Emergency) campaign. I have programmed ER contact information into my cell phone under the acronym ICE which, when activated, speed dials my ER contact. Also, I have at all times with me a list of medications that I take, my doctors' names, my blood type, any allergies to medications or foods, and a health care proxy
.

We all age differently; some women have disabilities from an early age, while more of us develop disabilities in midlife and our older years as a result of chronic conditions and diseases. Often our fears of aging are fears of disability and dependency and the isolation that results. We may feel stigmatized if we require an assistive device for mobility, hearing, or vision. Just as the disability movements have done, we need to work for change so society is more supportive as we adapt to physical changes.

Some of the effects of aging, once thought biologically inevitable, are preventable and sometimes even reversible. Prevention is the key word—doing what we can to take care of ourselves so as to avoid or ease the chronic conditions associated with later life. Acquiring healthy habits—reducing dependence on nicotine and alcohol; exercising; and eating nutritious, balanced meals—can help many of us achieve a more fulfilling quality of life.

There are, however, numerous obstacles to making lifestyle changes, including financial insecurity, home and community safety, and our own current health. Many factors are beyond our control. Years of exposure to occupational health hazards may result in chronic and/or debilitating disease. Women of color, 40 percent of whom work in physically demanding or hazardous occupations, are at higher risk for chronic diseases in later life. Between 60 and 80 percent of women over age sixty have high blood pressure, with rates for black women higher that those for white or Latina women. Among women ages sixty to seventy-four, one in three black and Mexican-American women has type 2 diabetes, compared with about one in six white women. We must strive to make the changes that are within our power and advocate for labor, environmental, and health care policies that will improve conditions everywhere so that more people can age in better health.

Some basic preventive measures that can make a difference in our later years include:

Start or continue exercising
. Exercise can help maintain or improve some chronic conditions associated with old age, including diabetes, high blood pressure, and cardiovascular disease. It can lower blood pressure and reduce the risks of heart attack, stroke, arthritis, and osteoporosis, and even helps to improve sleep and bowel function. Exercise has also been shown to improve mental ability, and studies indicate that it can help relieve mild to moderate depression. Walk, swim, or move in any way possible. Gentle exercises such as yoga, tai chi, or the Alexander Technique can help with posture, balance, and stress.

Many exercises can be adapted as we age or modified to match our capabilities. A sixty-seven-year-old woman says:

I go to the gym five times a week (doing aerobics, spinning, and weight lifting). I started going in my fifties, and since then I have developed arthritis and chronic back problems and have a little less energy. I have adapted my routines to these changes. I love exercising—it's central to my sense of vitality, well-being, and taking care of my aging body
.

Engage your mind
. Activities that stimulate brain activity—such as doing crossword puzzles, reading, and playing trivia games—may offer some protection against the cognitive decline that comes with aging. Brain exercises don't help people who have already been diagnosed with Alzheimer's disease, a study found.
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Minor memory lapses and slowing of cognitive processes are a result of normal aging and need to be distinguished from serious neurological disorders such as Alzheimer's.
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Get to bed
. Older adults require the same amount of sleep as younger adults. Sometimes sleep patterns might change—you may find yourself going to bed earlier and rising earlier—but sleep disturbances and decreased sleep are not a natural part of aging and should be discussed with your health care provider.

© iStockphoto.com / Rich Legg

Schedule a checkup
. Under the 2010 health care reform act, Medicare will pay for annual wellness visits and preventive screening tests, including Pap tests; mammograms; bone density, blood pressure, and cholesterol tests; and colorectal screenings. Older women are also encouraged to get an annual blood test to check triglycerides and homocysteine levels, as well as blood sugar level (for diabetes), thyroid function, general electrolytes level, liver and kidney output, vitamin B levels (especially vitamin B
₁₂
), and vitamin D levels. Dental checkups are also recommended but are not covered by Medicare.

As we live longer, we become more at risk of acquiring one or more chronic conditions such as heart disease, osteoporosis, diabetes, arthritis, some cancers, and urinary incontinence. These conditions can affect our ability to live independently and participate in daily activities. In addition, older women are often caregivers and may be taking care of a loved one also suffering from one or more chronic health conditions.

Successful management of chronic conditions is one of the hallmarks of healthy aging. Our health care system, which devotes more resources to acute problems and late-stage chronic illness, is not designed for an aging population. Resources need to be focused more on the following areas: prevention; support for self-care and ongoing maintenance of chronic conditions; slowing the progression and reducing the symptoms, complications, and functional limitations of conditions; coordination of preventive, medical, and management interventions; and optimum communication between ourselves and our families and health care providers.

If you have had access to routine health care, by the time you're in your sixties you have probably had decades of regular screening tests for common sexual and reproductive health problems, including cervical cancer and breast cancer. As we age, screening guidelines change. What follows are some recommendations concerning tests and treatments in our sixties and beyond.

Since greater longevity is a recent phenomenon, there is not yet an abundance of good data on screening guidelines for women over the age of eighty-five. We need to advocate for more research for this age group.

It's important to maintain vulvovaginal health in postreproductive years. Medicare pays for gynecological visits every other year. If you are experiencing any problems such as vaginal dryness or dyspareunia (pain before, during, or after intercourse), consult a gynecologist who is trained to identify and address specific problems. For a fuller discussion, see
“Vaginal Changes,”
and
“Painful Intercourse/Penetration.”

Guidelines issued by the U.S. Preventive Services Task Force in November 2009 recommend regular screenings to detect possible cancer once every two years for women age fifty to seventy-four.
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This guideline refers only to screening mammograms, not diagnostic. Studies have found no benefit from more frequent screenings for women who don't have a history of breast cancer, though women are urged to talk with their health care providers if they experience any changes in their breasts. The task force concludes that the current evidence is insufficient to assess the additional benefits and harms of screening mammography in women age seventy-five or older. For more
discussion of mammograms.

The Pap test (also known as a Pap smear or cervical cytology screening) is a simple test that can detect abnormal cervical cells that could lead to cervical cancer. According to the American Congress of Obstetricians and Gynecologists,
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if you are age sixty-five or older, you should discuss with your health care provider whether cervical cancer screening is still necessary. It is reasonable to stop screening at sixty-five or seventy if you have had three or more negative cytology results in a row and no abnormal test results in the past ten years.

If you have had a hysterectomy, talk to your provider about whether you still need routine Pap tests. The answer may depend on the reason for your hysterectomy, whether your cervix was removed, and whether you have a history of moderate or severe dysplasia.

Older women are more at risk for osteoporosis because bone loss is accelerated by the decline of estrogen at menopause. As bones weaken, fractures and breakage are more common. It is recommended that all women over age sixty-five be screened. Studies have not evaluated the optimal intervals, but women should allow a minimum of two years or more between tests to review changes. There are no data regarding at what age to stop testing.