Europe has the highest proportion of older women in
the world. By 2010 one in four women will be over 60. As life expectancy
rises, European mid-life and older women will find themselves increasingly on the frontline of a looming financial and social crisis if action is not taken
- Women are living longer, but those extra years are often marked by chronic illness, disability and difficulties in functioning independently.
- Dependence has physical economic, psychological and social dimensions that not only tax medical and community services but also have a powerful negative impact on the quality of women’s lives. Many women are also unpaid carers, responsible for spouses and ageing parents. When older women are impaired, their whole family suffers.
- From a financial perspective, women’s earnings and savings tend to be lower than men’s, and they are less likely to benefit from a full pension, shifting more of the burden of care to the State.
- At the same time, Europe’s wage and salary earners, who must bear the mounting costs of health care and social services, are a shrinking proportion of the population.
This report focuses on four major health problems – coronary heart disease, cancer, osteoporosis and depression – that have a particularly strong impact on women in their middle and later years, and suggests programmes of action for dealing with each. The four conditions together illustrate a wide spectrum of women’s health issues: the role of recognition, early detection and treatment in some disorders, the critical need for research in others, and the importance of lifestyle changes in each area. Disease and disability are not inevitable accompaniments to growing old. The challenge facing the European Union’s to help more Member States to expand opportunities for healthy ageing, particularly by detecting disease earlier when it is more amenable to treatment.
Coronary heart disease
Traditionally regarded as a disease affecting men
primarily, coronary heart disease is the single leading cause of death for all
European women. It is also a major cause of serious illness and disability.
- Most of the research has been conducted on men, leaving a dearth of data on how prevention and treatment may differ for women.
- Despite what is known about risk factors for coronary heart disease such as cholesterol levels and hypertension, doctors do not always treat women as intensively as they treat men.
- Promoting changes in lifestyle and best practices of medical treatment to control risk factors among women will be far more effective if it is done as a coordinated effort at the European Union level.
Women in mid-life need to take the risk of coronary heart
disease seriously and insist that their doctors do the same.
Cancerdeaths in the European Union have risen sharply, in large part because of theprogressive ageing of the population. Cancer is responsible for a quarter ofthe deaths in the European Union and is second only to heart disease as the causeof death in older women.
- Ovarian cancer usually goes undetected until it is too late to effect a cure. There are currently no effective methods for prevention or early detection.
- Death and illness from cervical cancer have largely declined in countries where well-organised screening and treatment programmes are in operation, illustrating the effectiveness of proactive public health measures on the course of a potentially fatal disease.
- The incidence of breast cancer rises dramatically with age. It cannot be prevented, and there’s no certain cure except in the early stages of the disease. Survival rates can be significantly increased if breast cancer is found and treated early enough. Widespread education and screening programmes for women over 50 must therefore be a high priority.
- Lung cancer, at one time far more prevalent among men, is now the sixth most frequent cancer in the world among women. Lung cancer is virtually impossible to detect early but is largely preventable. Persuading women to stop smoking, or better yet, never to start, would help Member States save thousands of lives and reduce the incidence, severity and high cost of smoking related illnesses.
Concertedaction by the European Union would ensure that prevention, screening and care
met high-quality standards set by the Europe Against Cancer programme, and thatdata-gathering was comparable from country to country.
Over the last decade researchers have learned a great deal about the causes, prevention and management of osteoporosis, an underlying bone condition responsible for many of the hip, wrist and vertebral fractures in older women. Osteoporosis is a particularly serious problem for Europe’s ageing population.
- Caucasian women over 50 have a 30-40% lifetime risk of osteoporosis related fractures, which rises 20-fold between ages 60 and 90. Fractures are painful, disabling and costly, both in terms of quality of life and economics. Many patients with hip fractures never return to full function or good health.
- Although osteoporosis is the most common metabolic bone disorder and a major cause of illness and disability, neither women nor their health care providers are sufficiently well informed about the genetic, ethnic, hormonal, lifestyle and medical factors that play a part in osteoporosis.
- Osteoporosis can in many cases be prevented or mitigated. There are many diagnostic and treatment options, but they tend to be under-utilised. This may be because family doctors are not sufficiently aware of the disease to refer their patients for screening. Also screening and treatment may not be covered by health insurance.
Women in mid-life, particularly those entering the menopause, their doctors and those in policy-making positions, must be educated about osteoporosis and its implications. They must understand the risk, prevalence and cost of osteoporosis and related fractures, learn what can be done to prevent the disorder, become informed about options for treatment and provide medical and social support for those who suffer from it.
The conventional stereotype – that depression is a normal part of ageing – is as pernicious as it is persistent. Depression can often be treated or managed.
- Depression has significant impact on health-related quality of life and is responsible for a high level of impairment and disability.
- The rate of depression among women is twice as high as that of men. Women are more vulnerable for many reasons – a mix of physical illness, psychosocial factors, both psychological and external, and, in some cases, genetic susceptibility. Suicide rates are twice as high in the elderly as in younger adults.
- Depression that goes untreated, or is treated inappropriately with tranquilisers that sedate women rather than help them recover from the disease, is an enormous burden for women, their families and society. Depression ultimately taxes health and social services as well, since women persistently seek help for physical symptoms that have underlying psychological causes.
Doctors must learn to recognise symptoms of depression, discuss them openly with their patients and secure appropriate treatment. Mental and physical health are closely intertwined. No health care policy can be fully effective if it does not incorporate concern for both.
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Copyright©1996, 2013 European Institute of Women’s Health