Health Maintenance: Ages 40–64 Years

Published on 30/05/2015 by admin

Filed under Obstetrics & Gynecology

Last modified 30/05/2015

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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
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