President

affected equally. After the disadvantage of having lost both the sexual
hormones produced in the ovaries, as well as the precious DHEA, produced by
the adrenal gland, it appears in all its strength: women are three times more
likely then men to be affected in the knee, hip and hands. In about 25% of
women, osteoarthritis increases incredibly quickly in the first two years after the
menopause. Today we know that in this 25% of women there is an alteration in
the oestrogen receptor, which seems to make them more sensitive to their lack.
The fourth age of life, however, seems to be less sensitive to the lack of steroid
hormones, almost as if the years bring a progressive adaptation.
Thyroid illnesses, both in the sense of hyper as well as hypo-function,
affect mostly women in a ratio of over 15 to 1. Drugs containing cortisone are
also taken more by women, due to the high prevalence of auto-immunitary
diseases, rheumatic illnesses, etc.
We will mention anaemia only in passing, as it occurs in elderly women
due to a lack of iron, vitamin B12 or folic acid (Andersen, 1996).
Finally, there are pathologies which interest exclusively women:
urogynecological disorders and changes in the pelvic floor (cystourethrocele
and prolapse); vulvar pathologies, and female tumours (breast, uterus, ovaries).
The lack of oestrogens after the menopause substantially contributes to the
development of urinary tract infections (UTI) in elderly women. The incidence of
UTI increases vertiginously with age. Repeated infections can affect elderly
women, especially if they are already debilitated or suffering from neurologic
pathologies associated to urination problems. Urogynecological pathologies in
this age group can be one of its major problems, because it interferes
considerably with the quality of life, although today the incidence of prolapse
and cystourethrocele is considerably lower. Stress-incontinence, nocturia and
pollachiuria, leading to urge incontinence, need specialist surgery and medical
treatment and must not be ignored when it first appears. It is therefore
necessary to make healthcare institutions more sensitive towards this, so that
they can offer adequate information and services.
A chapter should then be reserved to vulvar pathologies. As well as
aesthetic and sexual issues linked to ageing, in old age there are in fact lesions
which can only be identified with a biopsy.
Finally, a frequent pathology in old age, both because of its incidence and
as a cause of death, is cancer. In fact, the risk of getting cancer increases with
age and about 60% of tumours affect people over 65 years of age. The
correlation between tumours and age is due to a prolonged exposition to
carcinogens.
Female tumours (breast, uterus, ovaries) differ in their incidence according
to the various organs and the histological chart. The cancer of the uterus
appears mostly in old age. Breast cancer, the most frequent in women (even
though it is less and less deadly thanks to early diagnoses and new therapeutic
opportunities) affects, according to ACOG data (2003), 2% of 50 year-old
women and 13% of 90 year-olds. Today, it is therefore recommended that
women to start having mammograms at 40 years old and then repeat them
every year for the rest of their lives. Ovarian cancer in elderly women is difficult
to diagnose, so it is suggested that every cist, after the menopause, is
removed. Elderly women are instead affected as much as men by lung cancer
(smoke related) and cancer of the colon, as well as skin tumours.
A chapter that must be tackled particularly delicately and carefully, and
having access to services and treatments fully paid for by the State, is therefore
242