Loneliness, social isolation, and cardiovascular disease among nonveteran and veteran women.

We examined the prospective associations of social isolation and loneliness with incident cardiovascular disease (CVD) among aging nonveteran and veteran women, and effect modification by veteran status. Participants with no history of myocardial infarction (MI), stroke, coronary heart disease (CHD), or coronary heart failure from the Women's Health Initiative Extension Study II self-reported social isolation, loneliness, health behaviors, health status, and veteran status. CVD and CVD subevents were physician adjudicated. Hazard ratios (HR) and 95% confidence intervals (CI) for the Interquartile Range (IQR) in social isolation (IQR = 1) and loneliness (IQR=.33) were calculated using Cox proportional hazard models adjusting for sociodemographic, health behavior, and health status characteristics. Veteran status was tested as an effect modifier. Among 52,442 women (Mean age = 79 ± 6.1; veterans n = 1023; 89.2% non-Hispanic White), 3579 major CVD events occurred over an average 5.8 follow-up years. Compared to nonveterans, veteran women reported higher levels of social isolation (p < .01) and loneliness (p < .01). The CVD HR was 1.07 (95% CI, 1.04-1.10) for the IQR in social isolation and 1.03 (95% CI, 1.10-1.06) for the IQR in loneliness. The HR for the IQR in both social isolation and loneliness was 1.10 (95% CI, 1.05-1.15). Social isolation was associated with CHD (HR = 1.12; 95% CI, 1.03-1.21). The CHD HR for the IQR in social isolation was 1.12 (95% CI, 1.03-1.21). Associations did not differ by veteran status (all p-interactions > 0.08). Findings suggest that the adverse associations of social isolation and loneliness with CVD are similar among veteran and nonveteran women.

I'm a 45-year-old woman in the body of an 80-year-old: The multiple losses of living and aging in the shadow of prostitution.

INTRODUCTION: Research on aging women who are involved in prostitution is currently limited, both in terms of the number of studies conducted and their scope. Nevertheless, the available research suggests that women who are aging while involved in prostitution may confront some unique challenges. Thus, the study aims to explore the experiences of aging as narrated by Arab women in prostitution, using Intersectionality as a theoretical framework. METHOD: Interpretive phenomenological analysis was used, and semistructured interviews were performed with 12 participants. FINDINGS: Four themes emerged: "I'm a 45-year-old woman in the body of an 80-year-old:" Loss of physical and mental health; "There is no retirement plan in prostitution: Economic and social losses; As they were taken, my soul went with them too: The loss of the parenting experience and motherhood"; and "I'm going to get older with the disgust clinging to me:" The loss of authentic identity and dignity. CONCLUSION: The findings demonstrate how aging serves to exacerbate overlapping forms of discrimination and marginalization. CLINICAL RELEVANCE: Healthcare professionals, including nurses caring for older women in prostitution, should be aware of their unique circumstances, considering the social, economic, and healthcare obstacles they face. By being cognizant of these factors, healthcare practitioners can provide meaningful assistance in their pursuit of improved quality of life.

Positive body perception and its link to sexual satisfaction in aging women - findings from the Women 40+ Healthy Aging Study.

Research on the relation between physical appearance and sexual satisfaction in aging women is scarce. This study uniquely links attractiveness, body perception, and sexual satisfaction in 124 healthy aging women. Two-thirds reported being highly sexually satisfied. BMI and fat mass correlated significantly with sexual satisfaction. Weight and shape concerns moderated this relationship, affecting sexual satisfaction beyond the effect of body size and composition. Given the "unattractive stereotype" of older women related to the enduring social beauty ideal of a youthful and thin body, positive body perceptions in light of age-associated bodily changes should be promoted.

Polycystic Ovarian Syndrome in Aging Women: An Observational Study.

BACKGROUND: Polycystic ovarian syndrome (PCOS) in aging women has not been extensively studied, although it is a very common disorder. Most of the research has been conducted on women of the reproductive age group, although PCOS is a disease occurring in all age groups. This study aims to provide an idea of the PCOS pattern prevalent in aging women presenting at a tertiary care center in Eastern India. METHODS: This was a prospective, single-center, observational cohort study conducted over three years, from October 2016 to September 2019. A total of 36 patients between 35 and 65 years of age were found to have PCOS according to Rotterdam's criteria during this period. These patients were prospectively followed up to study their demographic characteristics, symptoms, management, and outcomes. RESULTS: A total of 80% of the women were below 40 years of age, while only 20% were above 40. In total, 70% of the women were overweight or obese. Infertility was seen in 75% of patients below 40 years of age and 28% of patients above 40. Among these, 23 (95%) conceived successfully after proper management. The main presenting complaints were infertility and menstrual irregularities. With aging, diabetes increased from 24%, in below 40, to 28%, in above 40; hypertension increased from 13% to 28%. The occurrence of impaired oral glucose tolerance test (OGTT) and impaired lipid profile increased with age: from 48% to 57% and 13% to 28%, respectively. CONCLUSION: PCOS in aging women causes considerable morbidity and greatly affects the quality of life, although it is less understood. Further research in this field is very much needed to understand and appropriately manage the problems in aging women, to improve their quality of life.

An overview of polycystic ovary syndrome in aging women

The manifestations of polycystic ovary syndrome (PCOS), a ubiquitous reproductive disorder, may vary significantly depending on the severity of a number of endocrine and metabolic changes. Although no diagnostic criteria are presently available for PCOS for perimenopausal and menopausal women, the condition can still be suspected in case of a previous diagnosis of the condition, a chronic history of irregular menstrual cycles and hyperandrogenism, and/or polycystic ovarian morphology during the reproductive period. PCOS is associated with long-term health risks, including obesity, diabetes, hypertension, dyslipidemia, metabolic syndrome and cardiovascular risk factors during reproductive age, especially in patients possessing classic phenotypes. The aim of this review was to outline the available data about the impact of PCOS on long-term health risks after reproductive age in patients with PCOS. Previously, it was assumed that women with PCOS would be more prone to develop cardiometabolic diseases after reproductive age but current data suggest that in accordance with the healing in the phenotypic characteristics of PCOS, no deterioration appears to occur in cardiometabolic health in these patients. While there is substantial evidence for a greater prevalence of abnormal subclinical atherosclerotic markers among younger patients with PCOS, data for older women are insufficient. However, there is also support for an increased risk of endometrial cancer in PCOS patients. Extensive prospective cohort studies in which healthy controls as well as patients with defining PCOS phenotypes are observed and monitored from the early reproductive period into the late postmenopausal period should now be performed in order to clarify morbidities and mortality in aging women with PCOS.

Influence of Drugs of Continuous Use on the Sensory Regulation of the Static Balance of Elderly Regular Practitioners of the Pilates Method / Influência de Fármacos de Uso Contínuo Sobre a Regulação Sensorial do Equilíbrio Estático de Idosas Praticantes Regulares do Método Pilates

The combination of types of medications can compromise the regulation of body balance in older adults. This study evaluated the effect of continuous use drugs on the sensory regulation of static balance in elderly women who regularly practice the Pilates method with and without a history of falls and estimate the risk of falls in this population. Cross-sectional study, carried out with 94 women (67.12±4.74 years) practicing Pilates, divided into: non fallers (n = 74) and fallers (n = 18). Sociodemographic data, comorbidities, medications, and Mini Mental State Examination (MMSE), Falls Efficacy Scale (FES), Confidence in Balance Scale (ABC) were applied. The examination of static balance was performed by the Clinical Test of Sensory Interaction and Balance (CTSIB). The risk of falling was analyzed using an adjusted multiple logistic regression model, while the effect of drugs on falls was estimated by binary regression, results were presented using the odds ratio (OR). The CTSIB test revealed Condition 4 (OR = 3.038; 95% CI = 1.321­15.674) and Condition 5 (OR = 5.542; 95% CI = 1.678­18.303) as predictors of falls. Drugs showing an effect on fall were ß2 agonist associated with glucocorticoid (OR = 0.245; 95% CI = 1,233­2,400), thiazide diuretic (OR = 0.344; 95% CI = 1.122­2.234), statin (OR = 0.245; 95 % CI = 1,237­2,338), angiotensin II receptor antagonist (OR = 0,245; 95% CI = 1,236­2,339), beta blocker (OR = 0,245; 95% CI = 1,238­2,402) and anti-vertigo (OR = 0,245; 95 % CI = 1.230­2.399). Regardless of the history of falls, the risk of falling was present in older adult regular Pilates practitioners. Six different drugs for continuous use showed an effect on falls. (AU)

A combinação de tipos de medicamentos pode comprometer a regulação do equilíbrio corporal de idosos. Este estudo avaliou o efeito de fármacos de uso contínuo sobre a regulação sensorial do equilíbrio estático de mulheres idosas praticantes regulares do método Pilates com e sem histórico de queda e estimar o risco de queda dessa população. Estudo transversal, realizado com 94 mulheres (67,12±4,74 anos) praticantes de Pilates, divididas em: não-caidoras (n=74) e caidoras (n=18). Foram coletados dados sociodemográfico, comorbidades, medicamentos, e aplicado Mini Exame do Estado Mental (MEEM), Falls Efficacy Scale (FES), Escala de Confiança no Equilíbrio (ABC). O exame do equilíbrio estático foi realizado pelo Clinical Test of Sensory Interaction and Balance (CTSIB). O risco de queda foi analisado pelo modelo de regressão logística múltipla ajustado, enquanto, que o efeito dos fármacos sobre queda foi estimado pela regressão binária, resultados foram apresentados pelo odds ratio (OR). O teste CTSIB revelou a Condição 4 (OR= 3,038; 95% IC= 1,321­15,674) e Condição 5 (OR= 5,542; 95% IC= 1,678­18,303) como previsora de quedas. As drogas que mostram efeito sobre queda foram agonista ß2 associada com glicocorticóide (OR=0,245; 95% IC= 1,233­2,400), diurético tiazídico (OR=0,344; 95% IC=1,122­2,234), estatina (OR=0,245; 95% IC=1,237 2,338), antagonista do receptor de angiotensina II (OR=0,245; 95% IC=1,236­2,339), betabloqueador (OR=0,245; 95% IC=1,238­2,402) e antivertiginoso (OR=0,245; 95% IC=1,230­2,399). Independente do histórico de quedas, o risco de cair esteve presente em idosas praticantes regulares do Pilates. Seis diferentes medicamentos de uso contínuo mostraram efeito sobre queda. (AU)

Impacts of Social Participation on Self-Rated Health of Aging Women in China: With a Mediating Role of Caring for Grandchildren.

Population aging is a global challenge and the degree of population aging is continuing to deepen in China. Under the active aging policy framework by WHO, great importance has been attached to aging women and participation is emphasized for the well-being of the elderly. This study aimed to investigate the relation between social participation and self-rated health status of aging women in China and whether caring for grandchildren mediated such an association. Adopting data from the 2018 China Health and Retirement Longitudinal Study (CHARLS), this study used Oprobit regression, propensity score matching (PSM), and instrument variable regression to estimate the effects. The result showed that there was a positive association between social participation and self-rated health among aging women in China, and social activities that directly made contributions to others had the most significant impacts on self-rated health. Furthermore, the mediator analysis confirmed that caring for grandchildren played a role between social participation and self-rated health. In conclusion, to deal with population aging challenges, the society should recognize the value of intergenerational care for aging women and the government need to strengthen policy supports to guarantee platforms and opportunities for the elderly to participate in social activities.

The sociocultural relationships of older immigrant Punjabi women living in Nova Scotia: Implications for well-being.

With the increase of South Asian immigrants in Canada, the relationship between older immigrant Punjabi women's sociocultural relationships and their mental health and well-being needs to be understood. Guided by the social determinants of health and intersectional feminist frameworks, five Punjabi women living in Nova Scotia, Canada were interviewed. Three themes were identified: (a) having freedom yet being dependent on families, (b) conflating having a happy family with having good mental health, and (c) needing ways to connect with other older Punjabi women. These findings articulate how Punjabi relationships affect women's views on mental health and well-being.

Nature as nurture: Rural older women's perspectives on the natural environment.

Rural older women are surrounded by nature, a dynamic context for human development. Informed by place attachment and attention restoration theory, and guided by a life course perspective, this qualitative study focused on the perceived influence of nature in the lives of 34 rural older women. Using grounded theory techniques to analyze in-depth interviews, two primary findings emerged: (a) nature was integral to the women's identity; and (b) interactions with nature were motivated by prior positive spiritual and psychological outcomes. Findings revealed the power of the natural environment as a resource for coping with the challenges associated with aging.

"If you can breathe, you can dance": Fine lines contemporary dance for mature bodies in Melbourne, Australia.

Older women ballet and contemporary dancers resist the pervasive stereotypes of the dancing body as young, graceful, and athletic. They embody and enact a generative habitus, resisting cultural socialization that would deny them voice, visibility, and validation. This study explores the understandings of a group of older women dancers who are members of the Fine Lines contemporary dance ensemble for mature bodies, Melbourne, Australia. The data for this phenomenological study were gathered in 2017 and employ Interpretative Phenomenological Analysis as an analytic strategy. Our findings are reported under three overarching themes: Dance as a Community, Older Women Dancing, and Learning: Choreography and Improvisation.

The female aging body: A systematic review of female perspectives on aging, health, and body image.

While most body image research has focused on young female populations, evidence has shown that as few as 12% of older women are satisfied with their body size. Recent studies have also highlighted how anti-aging discourses are promoting unrealistic body norms, which have shown to contribute to poor body image and altered health behaviors. A systematic review of empirical studies focused on older women's perspectives of health, body image, and the aging body is presented. Findings support that body image is a persistent, lifelong issue for women and should be considered when implementing healthy aging policies and practices.

Influence of menopause status and age on integrated central and peripheral hemodynamic responses to subsystolic cuffing during submaximal exercise.

Although pathophysiological links between postmenopause and healthy aging remain unclear, both factors are associated with increased blood pressure and sympathetic nerve activity (SNA) in women. Activation of polymodal musculoskeletal neural afferents originating within adventia of venules modulates SNA and blood pressure control during exercise in healthy adults. We hypothesized transient subsystolic regional circulatory occlusion (RCO) during exercise sensitizes these afferents leading to augmented systemic vascular resistance (SVR)-mediated increased mean arterial pressure (MAP) in postmenopause vs. premenopause. Normotensive women in premenopause or postmenopause (n = 14 and 14; ages: 30 ± 9 and 55 ± 7 yr, respectively; P < 0.01) performed: 1) peak exercise testing and 2) fixed-load cycling at 30% peak workload (48 ± 11 and 38 ± 6 W, respectively; P < 0.01), whereby the initial 3 min were control exercise without RCO (CTL), thereafter including 2 min of bilateral-thigh RCO to 20, 40, 60, 80, or 100 mmHg (randomized), with 2 min deflation between RCO. Both MAP (17 ± 4 vs. 4 ± 4%, P = 0.02) and SVR (16 ± 8 vs. -3 ± 8%, P = 0.04) increased at 80 mmHg from CTL in postmenopause vs. premenopause, respectively. However, cardiac index was similar in postmenopause vs. premenopause at 80 mmHg from CTL (1 ± 6 vs. 7 ± 6%, respectively; P = 0.15). There was no continuous effect of aging in MAP (P = 0.12), SVR (P = 0.07), or cardiac index (P = 0.18) models. These data suggest transient locomotor subsystolic RCO sensitizes musculoskeletal afferents, which provoke increased SVR to generate augmented MAP during exercise in postmenopause. These observations provide a novel approach for understanding the age-independent variability in exercise blood pressure control across the normotensive adult pre- to postmenopause spectrum.

Feminisation of ageing in Asia-Pacific: health implications.

PIP: In most Asia-Pacific countries, the trend of women outliving men, called the feminization of aging, is becoming more prominent with women living on average of 1 to 7 years longer than men. Women aged above 60 years comprise up to 9% more than their male counterparts in the region. In addition, the number of widows aged 60 years and over in 1996, was more than triple the number of widowers in several Asia-Pacific countries. This trend has several health implications, including the need for women's health care services to address the health care needs of elderly women. Women need access to affordable and adequate health care services from infancy to adulthood in order to experience healthy aging. Health care providers must recognize the specific needs of older women and reorient existing programs to address them. Health care systems should also consider the development of home-based care services besides counseling and support services that recognize the needs of older women. These actions are imperative in order for older women to achieve an acceptable quality of life.^ieng

The effect of aging on fertility.

In the developed world, deferment of marriage and postponement of child-bearing in marriage are resulting in unprecedented numbers of couples who desire pregnancy relatively late in life. These factors combine with a decline in fertility and an increase in pregnancy wastage with advancing age to present new challenges for the clinician treating infertility. Experience with young oocytes donated to older women indicates that the major responsibility for the decline in fertility with age can be attributed to aging oocytes. Oocyte donation offers new hope for infertile older woman, but important moral and social questions remain unanswered.

PIP: In the US reproduction has been increasing deferred as has marriage, and births to women aged 35-49 years are expected to increase to 8.6% in the year 2000. Decreased reproductive potential has been associated with the age and quality of the oocyte. Uterine aging can be compensated for by hormonal means, and oocyte quality can be compensated for with donations from young women. This possibility brings with it the ethical and social considerations of whether women over the age of 50 years should have children. A pregnancy rate of 30% per cycle can be achieved among women over 50 years with oocyte donors. The abortion rate increases with the age of the oocyte recipient from 14.0% among those aged 20-24 years to 44.5% among those aged 35 years and older. The risk of spontaneous abortion also was found to increase to about 75% for overall abortion and 26% for clinically recognized abortion among women over 40 years of age compared to only 12% among women aged less than 20 years. Use of fertility drugs also carries risks. In vitro fertilized pregnancy cases have provided sufficient evidence of reduced pregnancy with the advanced age of oocytes. When progesterone was given along with young oocyte donations, the achieved pregnancy rates were similar among women aged less than and more than 40 years of age. Among unassisted pregnancies, findings have shown a higher risk of obstetrical complications among older women; these outcomes could be minimized with good screening and modern obstetrical care. US vital data showed a doubling of the risk of infertility for women aged 35-44 years compared to women aged 30-34 years. Donor insemination programs have found it necessary to increase the number of cycles of treatment to 9-10 from the usual six among older women. The differences in cumulative conception rates between women aged more or less than 30 years of age was found to be statistically significant. The increased risk of ovarian cancer from superovulation was considered plausible.

Population ageing and women in Kerala State, India.

"In this note we examine the ageing of the female population in the State of Kerala, India, in the light of current and future demographic trends as well as the social and economic implications of this process." Consideration is given to the gender gap in mortality, marital status among elderly women, age at marriage, the dependency ratio, and economic status and support for the elderly, including welfare programs.

Age, metabolism and oral contraception.

PIP: Because of the elevated risk of pathological problems for women over 35, the recommendation for an oral contraceptive (OC) must be carefully considered after the physician has studied the individual's health history and assessed the risks. The physician is responsible for understanding specific needs of each patient as well as understanding risks inherent with the aging process of the female population such as an increased risk of diabetes, a rise in weight and blood pressure, and an increased risk of heart disease. The administration of exogenous hormones and the affect of these hormones pertaining to each of the risk areas is studied. Studies concluding that estrogen deficiency is related to hypertension risk seem to support the assumption that estrogens counteract the development of hypertension. However, other studies have shown an increase in the incidence of hypertension following OC intake. Exogenous hormones have not been linked to an increase in the volume of fat cells. Oral contraceptives do not increase the risk of diabetes if there is no genetic disposition to the disease; patients who do show evidence of the existing disease should be carefully monitored. A further conclusion is that oral contraceptives have a minimal affect on blood clotting. The most effective way to limit health hazards is by limiting the dosage and the frequency of hormonal contraceptives. With careful medical supervision, older women can be open to alternative methods of contraception including oral contraceptives with a minimal level of use.^ieng

Contraception for the perimenopausal patient.

All the existing data show that combination estrogen/progestogen therapy is mandatory if any replacement therapy is to be given to the woman over age 40. Sufficient evidence has indicated that estrogen alone is inadequate; progestogen must be given to prevent endometrial hyperplasia, lower the risk of breast cancer, and prevent bone loss. In the premenopausal woman, such therapy should also provide contraception. Because of the lack of minimal dose products fulfilling such criteria, many physicians will allow women to continue with their contraceptive if they do not smoke and have no other contraindications. It will remain to be seen if a product close to ideal can be found to fulfill the contraceptive and therapeutic needs of women traversing the most physiologically hazardous period of their lives.

PIP: Epidemiological studies of oral contraceptives pertaining to premenopausal women are briefly reviewed. Therapeutic considerations are noted. The clinical effects of aging and hormone replacement therapy are indicated in terms of metabolism, the endometrium, and bone mass. The pharmacological advantages and consequences of nonhormonal and hormonal contraception are explored. For aging women over 40, there is a need for relief of menopausal symptoms, contraception, and reduction of risks for atherosclerosis, hypertension, coronary heart disease, endometrial carcinoma, breast cancer, and osteoporosis. With the availability and use of low estrogen products, women over 40 can insure tissue support and prevent bone loss as long as the therapy is instituted within 3 years of the last menses. Over-40 women who drink and smoke should not use oral contraceptives. Sterilization does not satisfy longterm hormonal needs, and has other reported menstrual side effects. The dose and duration regimen of hormonal therapy must be carefully considered due to the effects on the endometrium., the coagulation system, the liver, lipids, and bone. Combination estrogen and progestogen is necessary, but consideration must be given to existing levels of endogenous hormones. Lipid patterns may change due to hormone replacement or as a result of aging and contribute to coronary heart disease. Hormone replacement can reverse the atherogenic pattern of increased low density lipoprotein levels and decreased high density lipoprotein levels; a chart gives the effects on lipids and coagulation from various estrogen or estrogen plus progestogen products. For the estrogen-deficient menopausal woman, high estrogen can decrease antithrombin III plasminogen and alpha-antitrypsin antigen levels. Lower dose progestogens are recommended. Studies of dose and effects on bone mass are reviewed and vaginal rings and transdermal steroid patches, triphasic formulations, and new progestational agents such as 19-nortestosterone derivatives are described. Newer low dose formulations are needed for the aging woman, as well as further research on what product best suits the variability of women aged 40-50

Age of biological maturity of Malaysian girls by ethnicity.

PIP: This study estimates the age of biological maturity, defined as the end of adolescent sterility, of Malaysian girls by employing an indiredt methodology. Biological maturity usually occurs about 3 years after puberty. Adolescent subfecundity is due to anovulatory cycles or to short luteal phases among menarchial girls. In this study, age at biological maturity is estimated by considering retrospective fertility and family survey data on marriage, 1st birt, and contraceptive use. The waiting time for the biologically mature females to conceive is 3.0 months; 3.2 months among the Malays, 2.7 months among the Chinese, and 2.8 months among the Indians. The maximum age of attaining biological maturity is 20 for all ethnic groups except Indians (19 years). The maximum age is estimated by considering females whose 1st pregnancy ended in a live birth and who have been living most of the time with their husbands since marriage, with no contraceptive usage. The expected age of biological maturity at birth is 15.6 years; 15.3 years for the Malays, 15.4 years for the Chinese, and 14.8 years for the Indians. The means age of attaining biological maturity coincides with the expected age of attaining biological maturity at birth.^ieng