Vive la difference!

Vive la difference! Sex differences in childhood prompt little boys to play with guns and little girls to play with dolls--admittedly a fading stereotype. As adults, men are from Mars and women are Venusian. Do seniors also reflect sex differences or does a socialization-of-aging process somehow eventually amalgamate and homogenize the two sexes? Beyond the hormonal and muscle mass differences, beyond the archeological history that men are hunters and warriors and women are nurturers and fertility goddesses, beyond the commercial images of the present day, there exists our aging and vulnerable male and female patients. How should our relationship, communication, and focus vary with respect to sex differences in the aging individual?

In this issue of the Journal, the article "Physical Function and Quality of Life in Older Adults: Sex Differences," (1) by Wood and colleagues presents data on a study that is at once deceptively simple, deceptively complex, and ultimately elegant. Beyond the methodology, the content of the study goes importantly to the very heart and essence of geriatric medicine, wherein the wise practitioner focuses less on organ failure and diseases as such, and more on the health-related quality of life. This study answers the most vital of questions: What sustains an older patient's health-related quality of life? The observations regarding sex differences are nicely presented, almost intuitive in retrospect, but powerful in their conclusions. A man's health-related quality of life depends on maintaining strength and function; a woman's health-related quality of life is more significantly related to alleviating pain and discomfort.

Relatively few sex differences in the elderly have been reported in the literature. Among the more interesting and practical differences that are amenable to intervention are those concerned with function and nutrition. Expected nutritional risk factors of living situation, functionality, morbidity, and medication use are more pronounced among women than men. (2) The likelihood of driving less than daily increased significantly with age and female sex. Women were more likely than men to stop driving due to certain adverse conditions and for elective purposes, but the gender gap may be narrowing. (3) Nonfatal disabling conditions, including fractures, osteoporosis, back problems, osteoarthritis, and depression, contribute substantially to greater disability and diminished quality of life among aging women compared with men. (4) Sex differences in morbidity and basic functional dependence are evident only in the oldest old. Women may be at higher risk of developing severe disability than men in the advanced ages due to longer survival with slight disability earlier in adult life. (5) Females recover basic activities of daily living less well 1 year after injuries to the extremities compared with males. (6) The degree of complaints among women surpasses that of men for pain, emotions, sleep, and mobility and for household activities and hobbies. Generally, health-related quality of life decreased with multimorbidity. Specific diagnoses that cause distress in common daily life include anginal pain, urinary incontinence, locomotor problems, visual impairment, and mental disorders. (7)

The compelling data and the topic of health-related quality of life are vital to the body of the geriatric medical knowledge base. We must focus our attention and resources in an attempt to improve the care we provide. Keeping an aging female comfortable and an aging male functional may be sex-specific medicine that sharpens our focus and sensitivity, but it is not sex-exclusive medicine that dulls our sensibilities. Both sexes require both care measures. The point is to know what a patient holds most valuable and to fulfill our role in an empowering relationship that respects that value system. Our newly found knowledge makes that task much easier.

Accepted January 20, 2005.

References

1. Wood RH, Gardner RE, Ferachi KA, et al. Physical function and quality of life in older adults: gender differences. South Med J 2005;98:504-512.

2. Krondl M, Lau D, Coleman P, et al. Tailoring of nutritional support for older adults in the community. J Nutr Elder 2003;23:17-32.

3. Bauer MJ, Adler G, Kuskowski MA, et al. The influence of age and gender on the driving patterns of older adults. J Women Aging 2003;15:3-16.

4. Murtagh KN, Hubert HB. Gender differences in physical disability among an elderly cohort. Am J Public Health 2004;94:1406-1411.

5. von Strauss E, Aguero-Torres H, Kareholt I, et al. Women are more disabled in basic activities of daily living than men only in very advanced ages: a study on disability, morbidity, and mortality from the Kungsholmen Project. J Clin Epidemiol 2003;56:669-677.

6. Kempen GI, Sanderman R, Scaf-Klomp W, et al. Gender differences in recovery from injuries to the extremities in older persons: a prospective study. Disabil Rehabil 2003;25:827-832.

7. Grimby A, Svanborg A. Morbidity and health-related quality of life among ambulant elderly citizens. Aging (Milano) 1997;9:356-364.

John Standridge, MD

From Erlanger, University of Tennessee Family Practice Center, Chattanooga, TN.

Reprint requests to Dr. John Standridge, Erlanger, UT Family Practice Center, 1100 E. Third Street, Chattanooga, TN 37403. Email: [e-mail]