Health AreasNon-communicable Diseases

Aging gracefully: Taking care of our parents’ reproductive health

Last week, I met a 74- year old lady who underwent a three-hour surgery to remove her uterus and cervix. (Hysterectomy). This was the treatment option for early stage cervical cancer (Stage 0). After the surgery, she was happy that she had caught the symptoms early enough through a discussion with her children and had gone for screening hereafter.

Despite the generational gap, she shared her symptoms with her daughters who advised her to get checked. She believes this tête-à-tête conversation saved her life. The treatment plan was drawn and her children were involved right from the beginning and this family is glad they had an honest approach to their mother’s reproductive health. But is this an ideal situation?

The sexual and reproductive health of older persons in our society is often overlooked and ignored. Photo by Swaraj Tiwari on Unsplash

Sexuality in older persons is a taboo in many of our cultures. However as people are living longer today, this is an area we urgently need to address because reproductive health matters, including sexual desire and sexual activity will be with us every day.

Dr Muthoni Gichu, a medical gerontologist at the Ministry of Health asks this pertinent question as we cringe whenever we have the words ‘parents and sex in the same sentence;
When do we stop being women and men? According to Dr Muthoni Gichu; we should not shy from discussing reproductive health, even when it’s about our parents. She notes that until we take our last breaths, we should not shy from discussing reproductive health, even when it’s about our parents. Studies have shown that older women conceal their sexuality to conform to social norms. In men sexuality is a prowess gauge or meter, making a case for the need for safe sexual health. The same applies to reproductive health challenges that older persons get. But what happens when these men and women face a reproductive health issue?

“My children call me every two days and send money at the end of every week but Ihave found it hard to tell them that I have had uncontrolled bleeding and pain for the last three months,” Esther, 76 had told me in a recent conversation after a cervical cancer diagnosis. “I felt ashamed, so I stayed quiet,” said added.

When did we stop discussing reproductive health pertaining our parents? Or did we never start?

Dr Muthoni notes that older persons, above 60 years have routinely been excluded by HIV screening programmes. “We continually tailor safe sex interventions almost exclusively to target younger people. Why are we leaving out the senior citizens?” She said.

The WHO further notes that as a result, older women, particularly those who are widowed or single, may find it embarrassing or difficult to procure condoms or to seek advice on safe sexual practices. In fact, medicine has shown that older persons are physiologically more vulnerable to these sexually transmitted infections due to, for example in women, the post-menopausal changes to the lining of the vagina can reduce innate protective mechanisms against infection.

Dr Muthoni further notes that discussing sexuality is not only a social-cultural issue, but also a policy blind spot that needs to be urgently addressed by Kenya. Shirin Haidari, a director and Editor at Reproductive Health Matters, describes sexuality in the 60’s and beyond as an important and enduring part of life. ‘With increased life expectancy, women can live 30 to 40 years post-menopause, thus it is essential to understand how to promote healthy sexuality in this stage of life,” the author says in a paper titled, ‘Sexuality and older people: a neglected issue”

On the same note, Sharon Hincliff notes that some of the sexual health challenges in older persons can be caused by prescribed medications like hypertensive drugs that can cause erectile problems, many of which are prescribed to people aged 50 and older.Reduction in testosterone with ageing is no justification for viagra introduction.

Dr Muthoni Gichu says we need to talk to our parents more often, more intimately.

Loneliness and our parents
Loneliness is a common source of suffering in older persons. Psychosocial distress is greatly affecting our parents and their peers in the golden ages. Loneliness is the subjective feeling of isolation, not belonging, or lacking companionship.“Loneliness will send you faster to the grave than any medical condition,” Dr Muthoni noted.

A 2012 study on loneliness in older persons by Carla M Perissinotto from the Division of Geriatrics at University of California at San Francisco showed that the health outcomes in older people may be improved by focusing on policies that promote social engagement and more importantly, by helping elders develop and maintain satisfying interpersonal relationship.

Physical activity in the latter years
Dr Muthoni is optimistic that these social engagements can be nurtured by getting the older persons to get more involved in physical activity. How can this be done? “Get them moving,” Dr Muthoni sums up the five year plan.

How about games and physical activities for older persons? Kenya has a national physical activity action plan under the Ministry of Health that hopes to promote health-enhancing physical activity for all.

But is physical activity only carried out in the gym?
The World Health Organisation defines physical activity as any bodily movement produced by skeletal muscles that require energy expenditure including activities undertaken while working, playing, carrying out household chores, travelling, and engaging in recreational pursuit.
Dr Muthoni observes that physical inactivity is the 4th leading risk factor for deaths globally after high blood pressure, tobacco use and high blood glucose.
The benefits of physical activity include;
• Reduced risk of excessive weight gain
• Reduces feelings of anxiety and depression
• Improves sleep and quality of life
• Improves physical function

According to Dr Gichu, some of the barriers to physical activity in Kenya include urbanization with poor built environment planning, security, inadequate information, motorized transport and social cultural factors.
However, Dr Gichu is optimistic that something can be done to reverse the current trend of non-communicable diseases associated with sedentary lifestyles.

The recommended physical activity for persons above 65 years include;
• At least 150 minutes of moderate-intensity aerobic physical activity throughout the week,
• or do at least 75 minutes of vigorous-intensity aerobic physical activity throughout the week,
• Aerobic activity should be performed in bouts of at least 10 minutes duration.
• Increase physical activity to 300 minutes per week, or engage in 150 minutes of vigorous intensity aerobic physical activity per week,
• Perform muscle-strengthening activities on 2 or more days a week
We end on this note; sexuality and reproductive needs of older men and women need to be acknowledged and respected.

Call your mum and dad today and ask them how they are doing. Realistically. Then pay them a visit.

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