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Furthermore, it is important to consider some parameters that can influence the effects of walking, such as walking speedily/slowly or strongly/weekly. Actually, there is evidence that an intervention of more than 6 months in duration can provide significant and positive effects on femoral neck BMD in peri- and postmenopausal women [18].
Some studies show how a brisk walking or jogging can have positive effects on hip and column BMD in women of menopausal age [19]. Certainly, some low-impact activities, such as jogging combined with stair climbing and walking, favor minor loss of BMD in both the hip and the spine in menopausal women. Hence, walking/jogging must reach a sufficient high level of mechanical stress determining an important ground reaction force able to stimulate bone mass [9, 10, 20, 41].
Similarly, Sinaki et al. [48] have shown that the strength of the back muscles in osteoporotic women is significantly reduced compared to healthy subjects; therefore, the strengthening of these muscles can reduce the risk of vertebral fractures with simple programs of antigravity extension in the prone position. After two years of exercise, there was a significant reduction in the loss of BMD in the subjects being treated. This significant difference, compared to controls, was maintained eight years after, despite the decrement of both BMD and muscle strength.
Also, in the review of studies analyzed by Marquez et al. [59, 60], the combination of non-high-impact weight-bearing exercises for muscle strengthening, resistance, aerobic, and balance exercises determined an increase in BMD at the lumbar spine and femoral neck in elderly subjects. According to this group, a multicomponent exercise program with moderate-high impact (marching on the spot, stepping at 120/125 b/m, on a bench of 15 cm, and heel drops on a rigid surface) was able to determine an increase in BMD in the femoral neck in a population of elderly women who had never performed exercise programs before.
Conversely, a previous systematic review [34] showed that while the use of vibration platforms can improve muscle strength in the lower limbs of elderly patients, it does not seem to induce significant changes in bone mineral density in women. Similarly, while the analysis performed by Cheung and Giangregorio [41] on 5 systematic reviews shows only a modest clinical improvement of BMD at the hip in postmenopausal women, the review of Jepsen et al. [35] reports only a reduction in fall rate, but not in BMD.
Think of the movies and television shows you have watched recently. Did any of them feature older actors? What roles did they play? How were these older actors portrayed? Were they cast as main characters in a love story? Grouchy old people? How were older women portrayed? How were older men portrayed?
However, the gender imbalance in the sex ratio of men to women is increasingly skewed toward women as people age. In 2013, 67 percent of Canadians over the age of 85 were women (Statistics Canada 2013b). This imbalance in life expectancy has larger implications because of the economic inequality between men and women. The population of old-old women are the cohort with the greatest needs for care, but because many women did not work outside the household during their working years and those who did earned less on average than men, they receive the least retirement benefits.
As we noted above, not all Canadians age equally. Most glaring is the difference between men and women; as Figure 13.6 shows, women have longer life expectancies than men. In 2013, there were ninety 65-to-79-year-old men per one hundred 65-to-79-year-old women. However, there were only sixty 80+ year-old men per one hundred 80+ year-old women. Nevertheless, as the graph shows, the sex ratio actually increased over time, indicating that men are closing the gap between their life spans and those of women (Statistics Canada 2013c).
Globally, Canada and other wealthy nations are fairly well equipped to handle the demands of an exponentially increasing elderly population. However, peripheral and semi-peripheral nations face similar increases without comparable resources. Poverty among elders is a concern, especially among elderly women. The feminization of the aging poor, evident in peripheral nations, is directly due to the number of elderly women in those countries who are single, illiterate, and not a part of the labour force (Mujahid 2006).
Some impacts of aging are gender specific. Some of the disadvantages that aging women face rise from long-standing social gender roles. For example, the Canada Pension Plan (CPP) favours men over women, inasmuch as women do not earn CPP benefits for the unpaid labour they perform as an extension of their gender roles. In the health care field, elderly female patients are more likely than elderly men to see their health care concerns trivialized (Sharp 1995) and are more like to have the health issues labelled psychosomatic (Munch 2004). Another female-specific aspect of aging is that mass-media outlets often depict elderly females in terms of negative stereotypes and as less successful than older men (Bazzini and Mclntosh 1997).
For some, overcoming despair might entail remarriage after the death of a spouse. A study conducted by Kate Davidson (2002) reviewed demographic data that asserted men were more likely to remarry after the death of a spouse, and suggested that widows (the surviving female spouse of a deceased male partner) and widowers (the surviving male spouse of a deceased female partner) experience their postmarital lives differently. Many surviving women enjoyed a new sense of freedom, as many were living alone for the first time. On the other hand, for surviving men, there was a greater sense of having lost something, as they were now deprived of a constant source of care as well as the focus on their emotional life.
In some ways, old age may be a time to enjoy sex more, not less. For women, the elder years can bring a sense of relief as the fear of an unwanted pregnancy is removed and the children are grown and taking care of themselves. However, while we have expanded the number of psycho-pharmaceuticals to address sexual dysfunction in men, it was not until very recently that the medical field acknowledged the existence of female sexual dysfunctions (Bryant 2004).
The earliest gerontological theory in the functionalist perspective is disengagement theory, which suggests that withdrawing from society and social relationships is a natural part of growing old. There are several main points to the theory. First, because everyone expects to die one day, and because we experience physical and mental decline as we approach death, it is natural to withdraw from individuals and society. Second, as the elderly withdraw, they receive less reinforcement to conform to social norms. Therefore, this withdrawal allows a greater freedom from the pressure to conform. Finally, social withdrawal is gendered, meaning it is experienced differently by men and women. Because men focus on work and women focus on marriage and family, when they withdraw they will be unhappy and directionless until they adopt a role to replace their accustomed role that is compatible with the disengaged state (Cumming and Henry 1961).
ABSTRACT: Breast cancer is the most commonly diagnosed cancer in women in the United States and the second leading cause of cancer death in American women 1. Regular screening mammography starting at age 40 years reduces breast cancer mortality in average-risk women 2. Screening, however, also exposes women to harm through false-positive test results and overdiagnosis of biologically indolent lesions. Differences in balancing benefits and harms have led to differences among major guidelines about what age to start, what age to stop, and how frequently to recommend mammography screening in average-risk women 2 4.
Breast cancer risk assessment is very important for identifying women who may benefit from more intensive breast cancer surveillance; however, there is no standardized approach to office-based breast cancer risk assessment in the United States. This can lead to missed opportunities to identify women at high risk of breast cancer and may result in applying average-risk screening recommendations to high-risk women. Risk assessment and identification of women at high risk allow for referral to health care providers with expertise in cancer genetics counseling and testing for breast cancer-related germline mutations (eg, BRCA), patient counseling about risk-reduction options, and cascade testing to identify family members who also may be at increased risk.
The purpose of this Practice Bulletin is to discuss breast cancer risk assessment, review breast cancer screening guidelines in average-risk women, and outline some of the controversies surrounding breast cancer screening. It will present recommendations for using a framework of shared decision making to assist women in balancing their personal values regarding benefits and harms of screening at various ages and intervals to make personal screening choices from within a range of reasonable options. Recommendations for women at elevated risk and discussion of new technologies, such as tomosynthesis, are beyond the scope of this document and are addressed in other publications of the American College of Obstetricians and Gynecologists (ACOG) 5 6 7.
The main factors for breast cancer are female sex (more than 99% of cases of breast cancer occur in women) and advancing age. Although other characteristics have been associated with an increased risk of breast cancer Box 1 6 10 11 12 13, most women in whom invasive breast cancer is diagnosed do not have identifiable risk factors.
The U.S. Preventive Services Task Force systematic review on the harms of breast cancer screening found that women who received clear communication of negative test results reported minimal anxiety, whereas those called back for further testing reported increased anxiety, breast cancer-specific worry, and distress 25. In some women, anxiety and distress persisted despite negative test results on the follow-up testing. Two studies reported that women with false-positive test results were less likely to return for their next screening mammography. False-positive test results also have financial costs, which often need to be paid all or in part by the patient. 2b1af7f3a8