Gynecological disorders in geriatric women regarding their frequency, diagnosis and management in the state of Himachal Pradesh, India

Abstract

INTRODUCTIONThe word Geriatrics was coined by Dr. Ignatz Natcher an Austrian physician in 1909. However, it was in 1935 that a British doctor Marjory Warren, working in USA first developed the practical concept of geriatric rehabilitation. With her initiation the elderly patients were gradually taken over by teaching hospitals. 1Many studies from developed countries defined older persons as those aged more than 65 years, whereas some use the cut off of 60 yrs. Life expectancy of India is 61 years as compared to 72 to 82 years in the developed countries. Thus, the cutoff of 65 years may not be appropriate in Indian context and therefore a lower cut off of greater than and equal to 60 years is used. 2A major challenge for the world in the 21 st century is the ageing of its population 2 . The world's elderly population is growing at a rate of 2.4% per year. The age shift is the result of reduced birth rates, improvement in health and nutrition and increased longevity. The aging population ABSTRACT Background: Geriatric gynaecological problems have not received adequate attention in India. This study was undertaken to assess gynaecological disorders in geriatric women regarding their frequency, diagnosis and management in Himachal Pradesh, India. Methods: It was a prospective observational study of patients aged above 60 years, admitted in Gynecology ward, IGMC Shimla over one year. Spectrum of gynecological disorder, comorbidities, diagnosis and management were noted and analyzed. Results: 224 patients aged 60 years and above were admitted over a period of one year. The commonest presenting complaint was postmenopausal bleeding in 41.07% of patients. 80.80% patients had one or more comorbid conditions. Malignancy was the most frequent diagnosis 54% followed by uterovaginal prolapse in 30.35%. Ovarian cancer constituted 47.93% followed by cervical cancer 31.40%. 89.65% patients of ovarian cancer had surgical treatment whereas only 21.05% of cervical cancer patients underwent surgical treatment and rest were referred for radiation. In 62 out of 68 cases of pelvic organ prolapse had definitive surgical treatment. Conclusions: Pelvic organ prolapse and genital malignancy are the major gynecological causes of hospital admissions in the patients above 60 years. Ovarian and endometrial cancer are showing a rising trend in this age group. Cervical cancer was the second most common malignancy in this group and most of these patients presented at advanced stage. Therefore, recommendations to discontinue screening in older age groups must be viewed with caution.

Assessment of gynecological disorders among geriatric women

“…We found that common disorders were pelvic organ prolapse in 50, Ca ovary in 4, Ca cervix in 6, endometrial hyperplasia in 12, cervical polyp in 8, Ca vulva in 7, proliferative endometrium in 13, vulval papilloma in 6 and genital malignancies in 14. Sood et al [11] assessed gynaecological disorders in geriatric women regarding their frequency, diagnosis and management. 224 patients aged 60 years and above were admitted over a period of one year.…”