written by 
Founder & medical director of siahmsr wellness.in

Written by Dr. Sanjana V.B Bhms,dbrm,cdn

Reviewed by SIAHMSR

  Ageing is a phase of life associated with changes in physical and mental state of women.  From the view point of biological science, ageing results from the impact of the accumulation of various molecular and cellular damage happening over the years. This wear and tear of cells and tissues eventually causes reduction in physical and mental capacity, makes the women or the population in general at risk of diseases and ultimately leads to death.  

   Ageing population has a characteristic trend in the recent decades & that is called by world health organization [WHO] as “feminization of ageing”.  As the population begins to age, the female to male ratio increases globally.  Women account for 61% of the ageing population and they are above the age of 80 years .In the world population, longevity of women is longer than that of men and as advances women may yield to serious illness.

   For ensuring " healthy ageing"  for women it is very important to understand determinants of healthy ageing in advancing years. It should be a significant topic of study in the interest of public health.
 Currently, women over 50 years of age comprise over 17.2 percent of the global population. Aging is associated with changes in physical appearance and increased dependency on others due to multiple factors such as financial and social insecurity , deteriorating organ functions ,diseases etc.

   Common conditions in older age include hearing loss, cataracts and refractive errors, back and neck pain and osteoarthritis, chronic obstructive pulmonary disease, diabetes, depression and dementia or loss of memory. As people age, they are more likely to experience several diseases together or comorbidities.
   Older age is also characterized by the occurrence of several complex health states commonly called geriatric syndromes. It is associated with multiple underlying factors and includes frailty, urinary incontinence, falls, delirium and pressure ulcers.

Role of physical and social environment in the health of ageing women.

    In the aged people, physical and social environments have a crucial role in influencing health directly or indirectly affecting decisions and health behavior.
Maintaining healthy behaviors such as eating a balanced diet, engaging in regular physical activity and refraining from tobacco use etc. have important role in reducing the risk of non-communicable diseases. They can also improve physical and mental capacity of ageing women, delaying care dependency.

    Supportive physical and social environments also enable women to do things of their choice despite having age related incapacities. The availability of safe and accessible public buildings and transport, and places that are easy to walk around, are examples of supportive environments.

   Globalization, technological developments (e.g., in transport and communication), urbanization, migration and changing gender norms are influencing the lives of older women in direct and indirect ways.
The United Nations (UN) General Assembly has declared 2021–2030  as “the UN Decade of Healthy Ageing” and  WHO world health organization has been directed to lead the implementation.
    It seeks to reduce health inequities and improve the lives of older people, their families and communities through collective action in four areas: changing how we think, feel and act towards age and ageism; developing communities in ways that foster the abilities of older people; delivering person-centered integrated care and primary health services responsive to older people; and providing older people who need it with access to quality long-term care.

   Health is a dynamic concept, which incorporates the biological, psychological, and social perspective. Normal aging is associated with a decline in physical, social, and cognitive function. Contrary to this, healthy aging is characterized as involving a low risk of disease and disability, high cognitive and physical functioning, and an active engagement in life.

   Several studies have found that a normal body mass index (BMI) and regular physical activity were promising predictors of current health in ageing women accounting for the longevity.

                                           SIAHMSR                                       

Role of hormones in women’s ageing & occurrence of depression

   Women are subjected to stronger fluctuations in hormones of the hypothalamic-pituitary-gonadal axis, throughout their lifespan. These fluctuations can have some psychological and physical impacts  making women vulnerable to depression. 

Menopause is a phase of transition in women’s life and the years preceding menopause[ pre menopause ]are associated with more intense fluctuations in sex hormones and gonadotropins. These hormonal fluctuations are manifested with psychological symptoms (i.e. anxiety and depression) as well as physiological symptoms (i.e., hot flushes and vaginal dryness) in women.

  During the menopausal transition, depressive symptoms  appear and they have been linked to estradiol hormone fluctuations and lowering testosterone levels in a woman's body.

Brain functions of cognition & sex hormones in women:

     Moreover, it is found that higher or more stable than average estradiol levels in midlife women have been associated with higher cognitive function. Therefore, specific steroid hormones and gonadotropins actions seem to be more favorable for women’s healthy aging than others. 

Role of mental and emotional factors on women’s health

  On a psychological level, positive traits such as optimism, resilience, and self-esteem seem to influence the maintenance of health and wellbeing in elderly women. Optimistic people generally have positive expectations about life and seem to recover faster from surgeries or acute disease.

  Resilient individuals manage to keep a stable equilibrium in the face of loss or trauma and it contributes to healthy ageing.

  Self-esteem describes a person’s self-evaluation or self-appraisal and studies suggest that it is not only a result but also a cause of positive life outcomes. Self-esteem can positively affect physical health, mental health, and subjective wellbeing. Positive psychological traits may therefore also be predictive of healthy aging. Therefore fostering these traits is important for healthy ageing.

Major health issues of ageing women

.   Social insecurity

  Older women, who live in urban areas, are more prone to social alienation in comparison to women living in villages. This lack of social protection has forced elder women to lead a life full of distress.

·  Financial insecurity
   Financial concern is a major problem faced by ageing women. Majority of the women are not entitled their right on ancestral property and money. Many women are not allowed to make financial decisions due to social traditions and beliefs. However, women education, employment and pensions associated with job have been of some help to a fraction of women population.

·  Medical Problems
   Older women usually suffer from some unnoticed symptoms of chronic health problems which are just correlated as age-related changes. This may cause undue delay in their treatment. Negligence, lack of awareness, financial support, and religious mindset of women also hinder the timely diagnosis and management of health issues.
 Studies show that the number of hypertensive women [high blood pressure] among the elderly population was nearly 9 million. The prevalence rate of coronary heart disease among the urban population was nearly three times higher than rural population. An estimated 5 million were diabetic and the prevalence rates were about 177 for urban and 35 per 1,000 for rural elderly people.

                                                       SIAHMSR                                     

Ageing  & gender differences

   Women suffers more from ill-health and associated incapacities  than men of similar age group. The differences might be due to variations in biological, social, and cultural factors.

   Various studies based on primary and secondary data have analyzed various health and health-related issues faced by elderly men and women which include:

 Physical mobility is high among elderly men than elderly women in both urban and rural areas.
The health condition and physical mobility is poorer for urban elderly women than rural elderly women.
Rural elderly women perceive that they are in poor health condition than their urban counterparts.

Elderly  women were depicted with hypertension (78.65%), osteoarthritis (73.03%), diabetes (66.29%), and bronchial asthma (77.52%). Others included cataract (65.16%), and anemia and skin problems (61.79%).
 The study concluded that older women as they age , often show the cumulative impact of poor diets, lack of good food and safe drinking water, a gender-based division of domestic tasks, and environment hazards, etc.

   It is also discussed often that economic security, good health, and adequate housing, in general, constitute fundamentals for aging with dignity. However, the impact of gender differences and inequalities limits women to access aging with dignity, and women suffer in old age. Due to their secondary status in society, women remain socially, economically, and medically marginalized.

  The old age dependency of women who are usually unemployed, illiterate, and poor poses a huge challenge for their survival.
 At the same time, their longevity compared to men makes them end up to a great numbers living without the spouse to take care of them.
 Studies have shown that there is likelihood of widows living alone, living in poverty, and living with poorer health. Old widows ignore their health status and consider it as being normal until they suffer from serious medical ailment. At the time of health emergency, it is the family which still determines the health situation of widows in terms of support and care.

  Post-menopausal changes among elderly women to the lining of the vagina can reduce innate protective mechanisms against infection. Older women, who already have a chronic or acute pelvic infection and compromised immunity, have increased vulnerability to additional infectious diseases including HIV.
      It is evident from the review of above studies that issues faced by elderly in general and elderly women in particular are affected by many  social and physical environmental factors. The socioeconomic and health needs of the elderly are huge and multifactorial. 

      Unfortunately , the financial resources, policies, and programmatic capacities available to meet them are inadequate and lack gender sensitivity. Economic security, good health, and adequate housing, in general, constitute fundamentals for aging with dignity.
    The free medical service system by the government sector can provide some help to the health issues of older women. Some non-governmental organizations also work and do funding in this matter, with the goal achieving healthy ageing for women.  Legislative system also has formulated rules for ensuring security and well-being for the ageing parents by the family. However it is aspired that women themselves take some initiatives to safeguard their health interests and social and financial security.

    Enkindle the strength of womanhood by strengthening yourself. That is crucial in achieving healthy ageing. Train yourself to be focused right from your young ages about your health priorities and be prepared to adapt with the physical changes post menopause. Focus on your diet , exercise regimen and mental health. Moreover it is very important to empower  every girl child emotionally, financially and physically with a steady income, healthy food , shelter, financial freedom and security.  The change should begin from every mother or parents to motivate their  girl children to take take care of themselves till the end along with family. The society and the family also need to be more women friendly  regarding their role in the society and home and understand their physical and mental health issues. Awareness has to be generated giving a deliberate thought on this issue globally.

 written by dr. sanjana vb BHMSdbrm cdn [copyright]

References

 
1.    United Nations, Department of Economic and Social Affairs. (2017). World population ageing 2017 highlights. New York, NY: United Nations. [Google Scholar]
2.    Howden LM, Meyer JA. Age and Sex Composition. 2010 Census Briefs. 2010 Retrieved May 2011, 2011, from http://www.census.gov/prod/cen2010/briefs/c2010br-03.pdf.
3.    https://www.who.int/news-room/fact-sheets/detail/ageing-and-health
4.    https://bmcwomenshealth.biomedcentral.com/articles/10.1186/s12905-020-0888-x
5.    https://www.ctdt.co.in/abstractArticleContentBrowse/CTDT/17749/JPJ/fullText