Older men's hidden health concerns

Do men harbour concerns about aging in good health? Do they confide these concerns to their physicians? Are men's concerns the same as women's? The answers to these questions can be found in a large cross-sectional survey of 2325 Canadian men, aged 55 to 97 years old, led by Dr. Cara Tannenbaum, Geriatrician and the Michel Saucier Endowed Chair in Geriatric Pharmacology, Health and Aging at the Institut universitaire de gériatrie de Montréal (IUGM) which is affiliated with the Université de Montréal. The results of a parallel survey querying the health concerns of older Canadian women was published in the Canadian Medical Association Journal in 2005.

Priorities: maintaining one's independence and quality of life Health issues of greatest concern to men included ailments that risk compromising independence and quality of life. Mobility impairments (64%), memory loss (64%) and medication side effects (63%) ranked top among their list of concerns. Vision loss (61%), hearing loss (52%) and falls (51%) followed in second place.

Are concerns being addressed by physicians? Paradoxically, health practitioners appear not to be providing older men with adequate health information on the issues of greatest concern to them. With the exception of addressing medication side effects, men reported that only a minority of them had received counselling on strategies to prevent, screen, and treat health-related conditions that could threaten their physical and mental health. For example, respondents reported that risk factors and screening for mobility impairment and memory loss were only discussed with 13% and 9% of them respectively.

The survey reveals important information gaps for depression (only 9.5% declared that their health care provider had discussed this with them), end-of-life care (12%), osteoporosis (13.5%), Alzheimer's disease (16%), anxiety (17%) and incontinence (18%). Additionally, because of stigma surrounding incontinence, patients are reluctant to bring up the issue on their own.

The good news is that health problems such as stroke, heart disease, diabetes, pneumonia and prostate disease appear to be well managed, since more than 80% of respondents said that they had been provided with information, screening or treatment for these conditions.

Solutions for engaging in dialogue and delivering information Dr. Cara Tannenbaum, the geriatrician in charge of the investigation, was struck by the disparity between what older men want and what they seem to be receiving from health care professionals. "It is time for the health care system to invest in strategies for older adults to preserve their autonomy, mental health and well-being. As older men and women's health priorities become better understood, a shift in the way health care is delivered and reimbursed will be required. More time is needed during the patient's health care encounter to provide individualized counselling about exercise, nutrition, bladder, and brain health in old age. Incontinence post-prostatectomy is becoming more frequent and has a devastating impact on a man's self-esteem and sexual function. Depression and anxiety, resulting from sensory impairments or the loss of loved ones, and the resultant social isolation that can ensue, are also important issues for men that need to be addressed in order to promote continued independence and quality of life", states Dr. Cara Tannenbaum. "Increased awareness of these issues through public health campaigns or accredited information on a website for seniors will have to be developed to inform the population of age-related health challenges and how they can be appropriately managed". Along these lines, the Quebec ministère de la Santé et des Services sociaux (MSSS), in collaboration with the Fonds de recherche du Québec, Société et culture (FRQSC), recently launched a call for research proposals aimed at better understanding men's perceptions of their life stressors as a function of their social roles throughout the lifespan. Quebec hopes to identify the challenges for overcoming men's stressors and to provide the necesasary resources to meet their needs.