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 homogenize /ho·mog·e·nize/ (ho-moj´in-iz) to render homogeneous.
to convert into material that is of uniform quality or consistency throughout; to render homogeneous. 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 The fertility goddesses are the female deities to watch over and promote fertility, pregnancy, and birth in many polytheistic cultures. In some cases these deities were directly associated with sex, and in others they simply embodied related attributes. , 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 de·cep·tive·ly
In a deceptive or deceiving manner; so as to deceive.
Usage Note: When deceptively is used to modify an adjective, the meaning is often unclear. 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 dis·a·ble
tr.v. dis·a·bled, dis·a·bling, dis·a·bles
1. To deprive of capability or effectiveness, especially to impair the physical abilities of.
2. Law To render legally disqualified. conditions, including fractures, osteoporosis, back problems, osteoarthritis osteoarthritis
or osteoarthrosis or degenerative joint disease
Most common joint disorder, afflicting over 80% of those who reach age 70. It does not involve excessive inflammation and may have no symptoms, especially at first. , 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 anginal adjective Relating to or characterized by angina pain, urinary incontinence Urinary Incontinence Definition
Urinary incontinence is unintentional loss of urine that is sufficient enough in frequency and amount to cause physical and/or emotional distress in the person experiencing it. , locomotor lo·co·mo·tor or lo·co·mo·tive
Of or relating to movement from one place to another.
of or pertaining to locomotion. problems, visual impairment Visual Impairment Definition
Total blindness is the inability to tell light from dark, or the total inability to see. Visual impairment or low vision is a severe reduction in vision that cannot be corrected with standard glasses or contact lenses and , and mental disorders mental disorders: see bipolar disorder; paranoia; psychiatry; psychosis; schizophrenia. . (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.
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 nutritional support,
n the supply of foods and liquids necessary to advance healing and support health. 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 ambulant /am·bu·lant/ (am´bu-lant) ambulatory.
Moving or walking about.
walking or able to walk. elderly citizens. Aging (Milano) 1997;9:356-364.
John Standridge, MD
From Erlanger, University of Tennessee The University of Tennessee (UT), sometimes called the University of Tennessee at Knoxville (UT Knoxville or UTK), is the flagship institution of the statewide land-grant University of Tennessee public university system in the American state of Tennessee. Family Practice Center, Chattanooga, TN.
Reprint reprint An individually bound copy of an article in a journal or science communication requests to Dr. John Standridge, Erlanger, UT Family Practice Center, 1100 E. Third Street, Chattanooga, TN 37403. Email: email@example.com