Health Maintenance: Ages 40–64 Years

Published on 30/05/2015 by admin

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Last modified 22/04/2025

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Chapter 5 Health Maintenance: Ages 40–64 Years

IMPORTANT CONSIDERATIONS (PHYSIOLOGIC CHANGES)

The 40- to 64-years age group is notable for the transitions from reproductive function to maturity, from rhythmic menstrual function to menopause, and from robust health to the emergence of age-related health changes.

Leading Causes of Death

• Breast, lung, colorectal, and ovarian cancer
• Coronary artery disease
• Cerebrovascular disease
• Obstructive pulmonary disease
• Accidents
• Diabetes mellitus and its complications

Leading Causes of Morbidity

• Nose, throat, and upper respiratory conditions
• Osteoporosis
• Arthritis
• Hypertension
• Depression
• Orthopedic deformities, including back and upper and lower extremities
• Obesity
• Heart disease
• Hearing and vision impairments

SCREENING

History

• Reason for visit
• Health status: medical, surgical, family
• Dietary/nutritional assessment
• Physical activity
• Tobacco, alcohol, other drugs (including complementary and alternative medicines)
• Abuse/neglect
• Sexual practices
• Urinary and fecal incontinence (These issues become more common with childbearing and age, but patients seldom volunteer these complaints.)

Physical

• Height
• Weight (body mass index)
• Blood pressure
• Oral cavity
• Neck: adenopathy, thyroid
• Breasts
• Abdomen
• Pelvic and rectovaginal examination
• Skin

Laboratory

Periodic

• Pap test (physician and patient discretion after three consecutive normal test results if low risk)
• Cholesterol, high-density lipoprotein cholesterol (every 5 years, starting at age 45 years)
• Fecal occult blood test (Testing requires the collection of two to three samples of stool collected by the patient at home to be valid. A single stool sample collected at the time of digital rectal examination is not sufficient to adequately screen for colon cancer.)
• Sigmoidoscopy (every 3 to 5 years after age 50 years; double-contrast barium enema study may be substituted or a complete colonoscopy may be performed every 10 years)

As Indicated by Risk Factors

• Bacteriuria testing
• Colonoscopy
• Fasting glucose test
• Hemoglobin
• Human immunodeficiency virus testing
• Lipid profile
• Mammography
• STD testing
• Thyroid-stimulating hormone test
• Tuberculosis skin test

Imaging

• Mammography (every 1 to 2 years until age 50 years, yearly beginning at 50)
• Bone density assessment (Testing should be performed on the basis of an individual woman’s risk profile and is not indicated unless the results will influence a treatment or management decision. Testing may be recommended to postmenopausal women younger than age 65 years who have risk factors for osteoporosis.)

COUNSELING

Health care encounters during this period are an excellent opportunity to discuss long-term health improvement strategies such as weight control, exercise, and nutrition. As women approach the transition from reproduction to maturity, opportunities for rededication to leading healthy lifestyles and preventing illness and morbidity increase. The increasing importance of surveillance as one ages is also an important message for patients in this age group.

Sexuality

• High-risk behaviors
• Contraceptive options

• Genetic counseling (for selected women in this age range)
• Prevention of unwanted pregnancy (including emergency contraceptive options)

• STDs

• Partner selection
• Barrier protection

• Sexual function

Fitness

• Hygiene (including dental)
• Dietary/nutritional assessment (1000 to 1200 mg of calcium by diet and/or supplements; folic acid supplementation of 0.4 mg of folic acid per day to age 50 years)
• Exercise: discussion of program and the importance of remaining physically active

Psychosocial Evaluation

• Interpersonal/family relationships
• Domestic violence
• Job/work satisfaction
• Lifestyle/stress
• Retirement planning
• Sleep disorders

Cardiovascular Risk Factors

• Family history
• Hypertension
• Dyslipidemia
• Obesity/diabetes mellitus
• Lifestyle

Health/Risk Behaviors

• Hormone replacement therapy (Recent data suggest that when hormone replacement is begun within 10 years of menopause it is not associated with some of the adverse effects reported in the Women’s Health Initiative [WHI] study and may even be associated with reductions in such things as cardiovascular disease.)
• Breast cancer chemoprophylaxis (selective estrogen receptor modulator therapy for women older than age 35 years at high risk)
• Injury prevention

• Safety belts
• Recreational hazards
• Sports involvement
• Vision and hearing

• Breast self-examination
• Skin exposure to ultraviolet rays
• Suicide: depressive symptoms
• Tobacco, alcohol, other drugs

COUNSELING RESOURCES

American College of Obstetricians and Gynecologists: Cholesterol and your health. ACOG Patient Education Pamphlet AP101. Washington, DC, ACOG, 2004.
American College of Obstetricians and Gynecologists: Eating disorders. ACOG Patient Education Pamphlet BP144. Washington, DC, ACOG, 2000.
American College of Obstetricians and Gynecologists: Midlife transitions: A guide to approaching menopause. ACOG Patient Education Pamphlet AP013. Washington, DC, ACOG, 2003.

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American College of Obstetricians and Gynecologists: Staying healthy at all ages. ACOG Patient Education Pamphlet AB006. Washington, DC, ACOG, 2006.
American College of Obstetricians and Gynecologists: The menopause years. ACOG Patient Education Pamphlet AP047. Washington, DC, ACOG, 2003.

INTERVENTIONS: IMMUNIZATIONS

Periodic

• Tetanus–diphtheria booster (every 10 years)
• Influenza vaccine (annually beginning at age 50)

High-Risk Groups

• Measles, mumps, rubella vaccine
• Hepatitis A and/or B vaccine
• Influenza vaccine
• Pneumococcal vaccine
• Varicella vaccine

REFERENCES

Level II

Grodstein F, Manson JE, Stampfer MJ. Hormone therapy and coronary heart disease: The role of time since menopause and age at hormone initiation. J Women’s Health. 2006;15:35.

Rossouw JE, Prentice RL, Manson JE, et al. Postmenopausal hormone therapy and risk of cardiovascular disease by age and years since menopause. JAMA. 2007;297:1465.

Level III

American College of Obstetricians and Gynecologists. Guidelines for Women’s Health Care, 2nd ed. Washington, DC: ACOG, 2002.

American College of Obstetricians and Gynecologists. Osteoporosis. Clinical management guidelines for obstetricians-gynecologists No. 50. Washington, DC: ACOG, 2004.

American College of Obstetricians and Gynecologists. Primary and preventive care. Clinical Updates in Women’s Health Care. 2007;VI(2):1.

American College of Obstetricians and Gynecologists. Routine cancer screening. Committee Opinion No. 356. Washington, DC: ACOG, 2006.

American College of Obstetricians and Gynecologists. Use of botanicals for management of menopausal symptoms. Clinical management guidelines for obstetricians-gynecologists No. 28. Washington, DC: ACOG, 2001.

Hahn KA, Strickland PA, Hamilton JL, et al. Hyperlipidemia guideline adherence and association with patient gender. J Womens Health (Larchmt). 2006;15(9):1009.

Lentz GM. History, physical examination, and preventive health care. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM, editors. Comprehensive Gynecology. 5th ed. Philadelphia: Mosby/Elsevier; 2007:148.

Manson JE, Hsia J, Johnson KC, et al. Estrogen plus progestin and the risk of coronary heart disease. N Engl J Med. 2003;349:523.

O’Brien WF. Weight control in women: A challenge to the obstetrician-gynecologist. Obstet Gynecol. 1996;88:888.

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