This is the biggest health threat to women in their 60s

A surprising number of women don’t realize it, but their biggest health risk in their 60s is heart disease. It’s the leading cause of death in women in the United States, so many key recommendations focus on maintaining cardiovascular health.

It’s also important to know and recognize the symptoms of a heart attack because they’re often different in women than in men. Though women may experience the typical chest pain associated with a heart attack, they’re more likely than men to experience a combination of symptoms, says Stacey Rosen, a cardiologist at Northwell Health in New York City.

“Women will often get shortness of breath, accompanying chest pain, back pain, a fatigue that’s easy to write off,” Rosen says. “You have that Spidey sense. If something’s not right, get it checked out because this becomes dangerous time for women.”

At age 65, women in the U.S. qualify for Medicare—the government-funded federal healthcare insurance program that replaces individuals’ private insurance—and everyone in this age group should take advantage of the initial “Welcome to Medicare” wellness exam covered in your first year of the program. It gives your provider and you an opportunity to get a thorough snapshot of your current health and biggest risks as well as review the preventive health services and screenings you should be getting.

In fact, Medicare covers a wellness exam every year. You can likely expect basic screenings for hearing loss and for cognitive health at these exams, says Jorge Ruiz, a geriatrician at Memorial Healthcare System in Hollywood, Florida, and your provider will review what else might be recommended for you.

First in our six-part series
Most people know the basics of living healthy: eat and sleep well, exercise, schedule an annual check up, and get the recommended vaccinations. But keeping up with self-care plus getting screenings for cancer and other diseases can be daunting. “Health” also varies for women at different stages of their lives. So, we’re bringing you a women’s health series that covers the most important health issues for women in each decade of their lives. Here is the first of those, reviewing where women in their 60s should be putting their focus to live their best, healthiest life.

But keep in mind, Ruiz adds, that “these are guidelines, and they shouldn’t be too rigid, especially as you get older.” Your provider should be helping you consider the risks and benefits of any screenings for your specific health situation as you start heading toward your golden years.

Cardiovascular, metabolic, and brain health

Nearly half of all adults have high blood pressure, according to the Centers for Disease Control and Prevention, but only one in four adults with high blood pressure have it under control. Unmanaged hypertension substantially increases your risk for heart disease and stroke, so working with your provider to keep it below 130/80 is important for your cardiovascular health.

Another reason to look after your heart is for that other organ people start worrying about as they age — the brain. Risk of dementia begins to increase above age 65, so “being proactive to reduce one’s risk of dementia is obviously very important,” Thomas Wisniewski, a neurologist at NYU Langone Health, says.

“What’s good for your heart is good for your brain,” especially because the brain is the most “oxygen-hungry” organ in the body, he says. “Having a healthy vascular system is very important for brain health and resilience, so just being physically active is very protective,” as well as keeping medical issues such as high cholesterol, high blood sugar and hypertension well managed.

Other ways to reduce risk of cognitive decline include eating a Mediterranean diet, getting adequate sleep, staying mentally active, and getting screened for sleep apnea if you snore—the risk increases with age. “Be diverse with mental stimulation,” Wisniewski says. “Reading, discussing what you read, being socially interactive, doing new things, taking up lessons, adult learning, crossword puzzles, Sudoku, jigsaw puzzles—all of those things in aggregate are highly beneficial.”

(The Mediterranean diet has stood the test of time for a reason: It works)

What’s not beneficial, though, is too much alcohol. Binge and problem drinking have been increasing in older adults, but the risks of alcohol, including risk of dementia, and sensitivity to alcohol’s effects begin increasing as you get older.

Finally, while it may seem obvious, “avoid head trauma,” Wisniewski says. He recommends older adults use stationary bikes instead of treadmills or ellipticals, for example, because there’s a lower risk of falling.

Postmenopause and OBGYN

The average age of menopause is 51, but for many, postmenopausal symptoms can extend into the 60s. That means balancing management of those symptoms with the potential risks of some treatments. For most women, the benefits of hormone therapy throughout their 50s outweigh the risks, such as increased risk of vaginal bleeding, blood clots, stroke, dementia and certain cancers, because these risks are low for women in this age group. But once they reach their 60s, that calculus starts to change. Hormone therapy is linked to reduced risk of coronary heart disease in women under age 60, for example but risks can increase as women get older.

“Studies have shown that it’s over age 60 when the risks start to go up,” Angela Wilson, an OBGYN at Montefiore Einstein Advanced Care says. “If the patient is still on hormone replacement and getting closer to 60, that’s when I start trying to taper down gradually,” though it’s not wise to stop cold turkey, she adds. Stopping suddenly can be a shock to the system that may bring back symptoms initially.

Again, though, that’s not a universal recommendation. Wilson has some patients who continue low-dose hormone therapy into their early 60s because their quality of life suffers too greatly without it. What’s important is discussing your symptoms with your provider and assessing the benefits and risks specific to your circumstances.

(What happens during menopause? Science is finally piecing it together.)

Although many women stop seeing their OBGYN after age 65, Wilson says, there are reasons to continue, such as the risk of pelvic organ prolapse, when one or more pelvic organs—such as the vagina, bladder, uterus, urethra or rectum—drop from their position, often bulging into the vagina. Up to half—or more—women experienced prolapse, and the risk increases with age, often resulting in incontinence.

Both urinary and fecal incontinence in general become more prevalent in women’s 70s, but it can start much earlier, particularly in those who had complicated childbirths, such as a vaginal delivery with a large baby, or third- or fourth-degree lacerations.

“Those women will often later in life have some fecal incontinence,” whether it’s leakage or urge incontinence, where they can’t make it to the bathroom in time once they feel the need to go, Rajeev Jain, a gastroenterologist at Texas Digestive Disease Consultants, says. “It’s common, but because it’s perceived as embarrassing, nobody talks about it that much.”

Another aspect of health that women may be reluctant to discuss is sexual health, whether it’s vaginal dryness, pain during intercourse, or changes in your sex drive, Rosen says. It’s unfair, she adds, that women may feel like, “you’re old, it doesn’t matter anymore,” but “a focus on sexual health is important.” If you’re experiencing pain, loss of libido or other sexual issues, talk to your doctor about treatment options now that a variety exist.

Cancer screenings

As in previous decades, you should continue most of your cancer screenings with one exception: the U.S. Preventive Services Task Force, an independent panel of experts who review the evidence on prevention of many health conditions, recommends women stop undergoing cervical cancer screening at age 65 if they have been adequately screened until then and are not at high risk for cervical cancer.

“Adequately screened” means three consecutive negative Pap smear screens, or two sequential negative screens with co-testing (a Pap smear and the high-risk human papillomavirus (HPV) test), in the past decade.

If you’ve had a precancerous lesion, however, monitoring should continue for the next 20 years, even if that goes beyond age 65. If you are at higher risk for cervical cancer, such as having prenatal exposure to the drug diethylstilbestrol, you should discuss your screening options with your provider.

Other cancer screenings should continue:

1) Colorectal cancer screening, most effectively with a colonoscopy every 10 years, is recommended through age 75.

2) Mammograms every two years are recommended for breast cancer screening through age 74.

3) Lung cancer screening is recommended through age 80 for those who have a 20-pack-year history (such as a pack a day for 20 years, or two packs a day for 10 years) and currently smoke, or quit within the past 15 years.

Oral, eye, bone, and skin care

As women age post menopause, they begin to lose muscle mass and bone density. Strength and resistance exercise can help keep your muscles strong, which is important to reduce risk of falls as you age. To look after your bone health, the USPSTF currently recommends women begin undergoing screening for osteoporosis at age 65.

Chances are high that you’re needing to slip on some reading glasses as your eyesight suffers the usual decline from aging. But there are other reasons to be sure you get an eye exam every one to two years: Risk of glaucoma—a disease that damages the eye’s optic nerve—increases in people older than 60, particularly those who are Black, have diabetes, or have a family history of the condition.

Hormonal changes of menopause can affect your gums, and oral health is closely tied to heart health, so keep up dental check-ups every six months, says Julie Kim, a dentist at the University of California Los Angeles. Older adults may also develop dry mouth, often from medications older adults take, but drinking water and chewing gum can help, Kim says. If those aren’t enough, there are other treatments too.

As women reach their 60s and beyond, they will notice their skin gets thinner, dryer and more prone to damage, says April Armstrong, a dermatologist at the University of California Los Angeles. “They need more protections,” she says, such as being extra vigilant about sunscreen, staying well-hydrated, and using physical protection during sports or other activities that may lead to bruising or skin trauma.

The USPSTF does not recommend routine skin cancer screenings in adults without symptoms. But many dermatologists advise people at higher risk for skin cancer, such as those with a family history or those with fair skin, to do monthly self checks and undergo a screening each year, especially since skin cancer risk increases beyond age 50, Armstrong says.

Get the recommended vaccines

As your body ages, so does your immune system. Adults ages 60 and older become more susceptible to infections and cannot fight them off as easily as they did in their youth. That means getting the immunizations recommended by the CDC is more important than ever.

Even if you skipped the seasonal flu shot or the annual COVID vaccine in the past, now is the time to start making those vaccines a yearly habit. Every flu season, adults ages 60 and older make up most influenza hospitalizations and account for most deaths. In the 2022-2023 flu season, for example, more than half of all flu hospitalizations and seven out of 10 flu deaths were in adults 65 and older.

The following vaccines are also recommended to reduce risk of infectious disease, hospitalization, disability and death:

1) Adults age 60 and older should get one of the two vaccines against respiratory syncytial virus(RSV), a respiratory disease that kills an estimated 6,000 to 10,000 older adults every year.

2) Adults age 65 and older are advised to get a pneumococcal vaccine against pneumonia if they haven’t received one in the past.

3) Adults should have received two doses of the shingles vaccine after turning 50. But it’s not too late if you haven’t gotten both doses.

Finally, if you were born in 1957 or later, you should have already received at least one dose of the measles vaccine in childhood. But with the measles outbreaks occurring right now, you might consider getting a second dose if you work in healthcare, a long-term care home, childcare, or if you’re traveling overseas.

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