26
S
ince
1980
the
world
population
of persons
60 years and
older has
doubled and is expected to reach 2
billion by 2050.The life expectancy
of females is greater than males hence
the gynaecologist is now faced with an
increasing number of patients who are
post menopausal approximately one
third of their lives. Regular physical
examination forms the cornerstone of
preventative medicine. The goal is to
detect developing problems before
they cause symptoms and to monitor
risk factors for future illness.
Some basic screening tests that need
to be done are:
Blood Pressure.
Normal is under 120/80 mmHg and
hypertension is over 140/90mmHg.
More than half of females over
55years have high blood pressure
which predisposes them to strokes and
heart attacks.
Body Mass Index
This is measured by weight (kg)
divided by the square of the height
(meters) and should be done annually.
Normal is under 25, Obese is over 30.
A high B.M.I. has all the ills linked to
obesity like diabetes, hypertension,
arthritis and high cholesterol. A
low value increases the risk of
osteoporosis. Even though some loss
of muscle mass is expected as you age
, a loss of over 10lbs in 12 months can
be one of the pointers of the Frailty
Syndrome.
Fasting Blood Sugar
A sample of blood is taken after a
12-hour fast which should be less than
125mg/dl. To be done every 3 years or
more frequent if a family member has
diabetes or if frequent urination and
yeast infections occur. A diabetic risk
of a heart attack is 3-7 times higher
than a non diabetic.
Lipid Profile.
A blood sample taken after a 12-hour
fast. Cholesterol under 200 mg/dl,
triglycerides under 150mg/dl, L.D.L
under 160mg/dl and H.D.L. under
60mg/dl are all normal values. This
test should be done every 5 years
unless other risk factors are present
like cardiac disease in your family or if
one suffers from diabetes, one would
screen more frequent and aim for
lower values.
Thyroid Function Test
The thyroid gland at the base of
the neck can enlarge and form a
goitre. The gland can under function
(hypothyroidism) and can present as
weight gain, hair loss, hoarse voice,
lethargy, constipation and depression.
Sub clinical hypothyroidism can occur
in 15% of women over 65 yrs where
the typical signs are not present.
Normal ranges are T.S.H (.0.4-4),T3(
81-178) and T4 (5.2-12.5). This test
should be done every 5 years in
patients over 50yrs.
Complete Blood Count.
Iron deficiency anaemia Haemoglobin
under 12mg/dl may indicate blood
loss such as loss from a gastrointestinal
source like a bleeding stomach
ulcer, from over use of arthritic
medication or the more ominous
bowel (colon) cancer. A high white
blood cell count can indicate infection
or even leukaemia. There is some
disagreement in performing a C.B.C.
annually .However a haematocrit (the
% of blood that is red blood cells)
should be done annually.
Pap smears.
This screen for cancer of the cervix
.This is the second highest cancer in
women. These are done yearly, then
every 2-3 years after 3 consecutive
negative tests until the age of 70yrs.
One should note, a vaginal vault
smear (cells taken from the vaginal
wall) is sometimes done after a
hysterectomy in those at high risk .
Mammogram and Breast M.R.I
Since1 in 8 women will develop
breast cancer in a lifetime, the value
of the monthly self exam cannot be
emphasized enough. Not only should
lumps be a cause of concern but a
rash around the nipples or a nipple
discharge can indicate a cancer.
Mammograms (X-ray studies of the
breast) should be done every 1-2 yrs,
after 40yrs and every year, after 50yrs
.M.R.I. of the breast does not give any
radiation risk and seems to be a more
specific test. Patients with a close
relative diagnosed with breast cancer
need to be tested more frequent.
Colonoscopy
Colon cancer is often detected late.
Some patients presents with a change
in stool size, alternating constipation
and diarrhoea, bloody stools, weight
loss or just appear pale due to a low
blood count. This test involves the
passage of a flexible scope into the
anus to visualize the large intestine
with the option of taking samples of
any suspicious areas .It should be
performed annually after the age of
50yrs.Having a first degree relative
with colon cancer or having had
intestinal polyps or ulcerative colitis
increases ones risk. For those who
have reservations of putting any thing
up their behind, have no fear the
virtual colonoscopy is here which is a
C.T scan of the abdomen.
Bone Density Test
Elderly women are at risk for
osteoporosis (thinning of the bone).
This is seen by a decrease in height
and bending of the back .A bone
density test involves X-rays of certain
bones which determine the amount
of calcium in them, this predicts
the chance of a fracture. Fractures
of the hip are very common and by
using Biphosphonates medication
in addition to calcium and vitamin D
supplements reduces this risk. This test
Dr Sherene Kalloo-
Consultant Obstetrician
and Gynaecologist
Care of the Older Woman
