Menopause and Aging with Disability

Understanding the menopausal experiences of women with intellectual disabilities: A scoping review

During the process of ageing, women experience important hormonal, endocrine and biological changes. Menopause is a natural phenomenon in female development, during which women's ovarian function shifts from a reproductive to a non-reproductive state. The experience of menopause is unique for every woman, including women with intellectual disabilities. Globally, the available literature on women with intellectual disabilities and menopause focuses on providing medical insights into onset and symptoms and little attention has been paid to documenting how menopause affects women themselves. This represents a significant gap in understanding how women understand this change in life and has been a key justification for the need for this research. This scoping review aims to consider published studies capturing the perceptions, experiences and attitudes of women with intellectual disabilities and their caregivers as they transition through the menopause.

Effect of the fourth generation multi-theory model intervention on the quality of life in Iranian postmenopausal women: A randomized controlled trial

OBJECTIVES

Menopause is a natural part of women's lives and is associated with a series of complications that can impair their quality of life. This study was conducted to determine the effect of specific educational interventions on the quality of life among postmenopausal women.

METHODS

This randomized controlled trial was conducted on 80 menopausal women who met the inclusion and exclusion criteria and were selected through the multi-stage stratified random sampling method. The participants were randomly allocated to either the control or intervention group (40 per group). The intervention comprised 5 × 45-min educational sessions based on the Multi-Theory Model on the predetermined days of the week. The scores of the quality of life level were collected at baseline, immediately, and 3 months after the intervention using the Menopause-Specific Quality of Life questionnaire (MENQOL). The control group received a health advice.

RESULTS

Analysis of variance of repeated measures showed a significant interaction between time and intervention. The comparison between the mean score of quality of life of the "before," "immediately after intervention," and "3 months after the intervention" showed a significant difference between the two groups. The intervention group quality of life improved significantly as the intervention went on compared to the control group.

CONCLUSION

Structured simple educational programs based on the Multi-Theory Model could be used as a simple and noninvasive intervention that help menopausal women improve their quality of life through menopausal symptoms relief. Further interventions with larger trials may be required to confirm these findings.

Rise and fall: two sides of a coin of middle aged women's perceptions of reproductive: a qualitative study

The present study was conducted to determine the perceptions of middle-aged women of reproductive changes. The present study was a qualitative research with a content analysis approach. The participants were 30 middle-aged women whose perceptions of reproductive changes had been collected on in-depth semi-structured interviews. The data were analyzed using the Graneheim and Lundman's inductive content analysis method. The main themes extracted from the data were a sense of "fall" and "the beginning of a new life cycle." A feeling of fall was formed from the subthemes "deterioration of youth," "the dusk of femininity," and "fade-out of the gender roles." The theme "beginning of a new life cycle" was formed from the subthemes of "acceptance," "sophistication," and "maturity." Middle-aged women had a wide range of emotions experienced from the reproductive changes ranging from a feeling of decline to that of excellence and rise.

The relationship between estrogen receptors and microtubule dynamics in post-menopausal rat brain

INTRODUCTION

Estrogen is one of the most important regulators of neuron function. There is a broad consensus that a loss of estrogen is associated with neurodegeneration in the hippocampus which leads to cognitive impairment. Hematopoietic-Pbx-interaction-protein (HPIP) is a novel scaffolding protein which interacts with microtubules and estrogen receptors. In this study, we investigated the presence and role of HPIP in hippocampal neurons and examined the relationship between estrogen receptors and microtubule damage in post-menopausal rat brains.

METHOD

Eighty female Wistar albino rats, 12 weeks old, were divided into 10 groups: control, control+17-β-estradiol, control+tamoxifen, control+mitogen-activated protein kinases (MAPK) inhibitor, control+phosphoinositide 3-kinase (PI3-K) inhibitor, ovariectomized, ovariectomized+17-β-estradiol, ovariectomized+tamoxifen, ovariectomized+MAPK inhibitor, and ovariectomized+PI3-K inhibitor. Light and electron microscopic examinations were performed. Real-time polymerase chain reaction (PCR) was used to determine the expression level of HPIP in experimental groups.

RESULTS

Light and electron microscopic examinations revealed morphological changes in hippocampal neuron axons. Axonal fluctuations and shrinkage were detected in all ovariectomized groups. HPIP was detected in all neurons with difference expression levels.

CONCLUSION

Proof that the HPIP protein can be found on hippocampal neurons may give rise to a new focus on neurodegeneration in post-menopausal women. Future molecular and pharmacological studies should be performed to reduce the rate of cognitive symptoms resulting from hippocampal neurodegeneration.

Does functional fitness decline in accordance with our expectation? - a pilot study in healthy female

BACKGROUND

Aging may cause various functional abilities gradually deteriorate. With changes in social forms, the trend of functional fitness decline will change accordingly. Therefore, this study endeavored to identify the trends in functional fitness decline by comparing the differences in the functional fitness of females in various age groups.

METHODS

Thirty six healthy females were divided into 3 age groups: young healthy females (20 to 30 y); middle-age (45 to 55 y); and older (65 to 75 y). Functional fitness test battery included flexibility, muscle strength/endurance, aerobic endurance, balance and agility.

RESULTS

The performance in the elderly group was significantly worse (P < .05) in all the tests, whereas the muscle strength and endurance, as well as aerobic endurance for the middle-age group showed significantly lower than young groups (P < .05).

CONCLUSIONS

The reduction in lower extremity muscle strength occurs in the middle-age group. We recommend that middle-age women be conscious of the reduction in their lower extremity muscle strength and conduct advanced preparations for future aging.

A new hypothesis about hematopoietic Pbx-interaction protein (HPIP): can it be a key factor in neurodegeneration in the post-menopausal period?

Neuronal degeneration in the post-menopausal term leads to cognitive symptoms such as anxiety, difficulty in concentrating, overreacting to minor upsets, quickly becoming irritated and forgetfulness in approximately 70-80% of all women around the world. These symptoms, which result from microtubule damage in the axon extensions of hippocampal neurons in during menopause, greatly reduce individuals' life quality. Thus, an investigation of the estrogen receptor-signaling pathway-microtubule dynamic triangle and the possible links between them is important when it comes to explaining the possible mechanism of neurodegeneration. Hematopoietic Pbx-interaction protein (HPIP), a microtubule-binding protein, is a novel scaffolding protein. The detection of this protein on neurons represents the most important step in our hypothesis. The importance of the hypothesis is that it might provide important clues about the possible role of HPIP and its mechanism through in vivo and in vitro studies of estrogen receptors-microtubules and the HPIP triangle in terms of neuronal degeneration in the post-menopausal period. A preliminary study was performed to test the main part of our hypothesis using real-time PCR. According to the results, the mRNA expression of HPIP was found in hippocampal neurons. After the detection of this novel protein in neurons, it was observed that there were differences in the experimental groups when compared with the control group relating to the mRNA expression of this protein. An important scientific question remains concerning the mechanisms of neurodegeneration appearing in the post-menopausal period and the receptors, proteins, and signaling pathways that play a role in this degeneration. In consideration of the data from in vivo and in vitro studies used to test our hypothesis, we will try to address the relevant questions. As this issue is resolved, new studies and treatment procedures that can help to prevent the possible difficulties in the menopausal period will be illuminated.

Impact of resistance training with or without caloric restriction on physical capacity in obese older women

OBJECTIVE

To investigate the specific impact of resistance training (RT) with or without caloric restriction (CR) on physical capacity in obese older women.

DESIGN

Forty-eight postmenopausal obese women, physically independent and between the ages of 55 and 75 years were recruited. The women were randomly assigned to one of four groups (1: RT [n = 12], 2: CR [n = 12], 3: CR + RT [n = 12], or 4: control group [C; n = 12]) for 3 months. CR and CR + RT groups participated in a weekly group session on nutrition, and RT and CR + RT groups took part in a resistance training program. Physical capacity was measured with 11 different performance tests. A global physical capacity score (range, 0-44) was then computed using quartiles of each test. Body composition was measured by dual-energy x-ray absorptiometry.

RESULTS

Body weight, total fat mass, percentage of fat mass, and body mass index (kg/m) significantly decreased in the CR and CR + RT groups (P < 0.01), whereas only the CR group showed a significant decrease in lean body mass (P < 0.05) after the 3-month program. The global physical capacity score significantly improved in the RT group (10.0 +/- 8.8%; P < 0.01), compared with the C group after 3 months.

CONCLUSION

Overall, the 3-month RT program alone had a greater effect on physical capacity than CR or CR + RT. Thus, a 3-month RT could help prevent long-term decreases in physical capacity in obese older women.

Improving the health and wellness of persons with disabilities: A call to action too important for nursing to ignore

In 2005, the US Surgeon General issued a Call to Action to Improve the Health and Wellness of Persons with Disabilities, with the goal being the improvement of the health status of men, women, and children with disabilities. Despite federal legislation to address inequities in health care for the 54-60 million people in the US with disabilities, many have reported negative experiences in their interactions with health care providers from all health professions. Collectively, the nursing profession has been silent in its response to this call. This article describes the current status of health care of individuals with disabilities in the US, and suggests appropriate responses by the nursing profession to the Surgeon General's Call to Action. Specific suggestions are identified for nursing practice, education, research, nursing leaderships, and the profession of nursing as a whole.

Menopause Health Decision Support for Women With Physical Disabilities

Menopausal women with disabilities present health care providers with unique and challenging health issues. Many women with disabilities already face an ongoing struggle to promote their health and prevent secondary disabling conditions, which may be exacerbated by menopause. This article highlights some of the special health concerns of this population and to suggest ways in which a health care professional might tailor general clinical guidance to meet these women's needs.

Menopause characteristics of women with physical disabilities from poliomyelitis

OBJECTIVE

To describe menopause characteristics of women with physical disabilities from poliomyelitis.

METHODS

Nine hundred and nine women with a history of poliomyelitis completed a survey on health, physical functioning, emotional well being and menopause.

RESULTS

The majority of the sample was postmenopausal having had a natural menopause around the average age of 50.3 years; 34.7% of the sample had had hysterectomies. Thirty-nine percent were using some form of hormone replacement therapy (HRT). Menopause symptoms were clustered into psychological, somatic-sensory, somatic-sleep and vasomotor factors. Among never and past HRT users, there were significant differences in menopause factor severity by menopause status. Somatic/sleep symptoms were lowest in never users; past users had significantly higher vasomotor symptoms; desire for sexual activity and painful intercourse did not vary by HRT use. Compared to population estimates, post-polio women had similar rates of hysterectomies overall, but among some age cohorts they had significantly lower rates, contrary to expectations. However, they used HRT at significantly higher rates than expected.

CONCLUSIONS

This study suggests that basic menopause characteristics of women with polio are generally similar to those of their non-disabled peers. There were few substantial differences in severity of menopause symptoms by HRT use, which is critical in light of the dearth of studies examining its risk-benefit ratio among women with physical disabilities. Until such studies provide some evidence of the specific risks or benefits to women with physical disability, each woman should carefully weigh the known risks and benefits with her physician.

Preventive health screening for breast and cervical cancer and osteoporosis in women with physical disabilities

Although the Americans With Disabilities Act was enacted 15 years ago in an effort to improve access of people with disabilities to a broad range of services, women with physical disabilities continue to receive less preventive health screening than women without disabilities and less than is recommended. Furthermore, women with more severe disabilities undergo less screening than those with mild or moderate severity of disability. This article reviews findings of studies on health screening for breast and cervical cancer and osteoporosis in women with physical disabilities and identifies practice and research implications on the basis of those findings to improve the health status of women with physical disabilities.

Osteoporosis risk and low bone mineral density in women with physical disabilities

OBJECTIVES

To describe the results of bone mineral density (BMD) screening in women with different physical disabilities and to identify their risk factors for osteoporosis and use of strategies to prevent osteoporosis.

DESIGN

A cross-sectional descriptive study.

SETTING

Community.

PARTICIPANTS

Convenience sample of 429 community-residing women with different disabilities.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Peripheral BMD screening of the os calcis, using dual-energy x-ray absorptiometry. A self-administered survey addressed osteoporosis risk factors, use of osteoporosis prevention strategies, and previous recommendations for BMD screening or testing.

RESULTS

Based on World Health Organization criteria, 30.5% and 22.6% of the total sample had BMD values indicative of osteopenia and osteoporosis, respectively. The number of self-reported osteoporosis risk factors ranged from 0 to 10 (mean, 4.5+/-1.7). Subjects reported using few strategies to reduce their osteoporosis risks. One quarter of the women reported previous BMD screening or testing; about one third reported receiving recommendations for testing or screening by a health care provider.

CONCLUSIONS

More than half of the sample had low BMD, and it was present in premenopausal as well as menopausal women. Despite low BMD and the presence of osteoporosis risk factors, less than a third of the women previously had BMD testing or screening or recommendations for such testing. Because low BMD is common in women with disabilities, greater attention must be directed toward their risk for osteoporosis and osteoporotic fractures. Prevention strategies to reduce osteoporosis risk should be considered, although their efficacy is not yet known in populations with disabilities.

Use of a standardized menopause symptom rating scale in a sample of women with physical disabilities

OBJECTIVE

To determine the psychometric properties of a menopause symptom rating scale developed on nondisabled women in a sample of women polio survivors with physical disabilities.

DESIGN

The 25-item Menopause Symptom List (MSL) was administered to 190 women between ages 40 and 65 not taking hormone or estrogen therapy. Factor analysis, bivariate correlation, and analysis of variance were performed to determine the scale's underlying structure, construct validity, and association with menopausal status.

RESULTS

Factor analysis revealed four factors: (1) psychological, (2) somatic-sensory, (3) somatic-sleep, and (4) vasomotor. Factors 1 and 3 were associated with postpolio sequelae, self-rated health, positive and negative affect, life satisfaction, and perceived stress. Factor 2 was associated with postpolio sequelae, basic activities of daily living, self-rated health, negative affect, life satisfaction, and perceived stress. Factor 4 was associated with postpolio sequelae, self-rated health, negative affect, and perceived stress. Comparison by menopause status found Factors 1 and 3 significantly differed between groups (F(2,181) = 6.68 and 4.17, respectively; P = 0.02). Contrary to expectations, vasomotor factor severity was not distinguished by menopause status.

CONCLUSIONS

Menopause symptom scales standardized on nondisabled women should be used cautiously with women with physical disabilities. Associations between construct validity measures and menopause symptomatology suggest a complex relationship between physical disability and menopause.

The effect of exercise on physical fitness and quality of life in postmenopausal women

OBJECTIVES

This study was designed to determine the effect of exercise on the physical fitness level and quality of life in postmenopausal women. 81 volunteer postmenopausal women who entered the menopause naturally and have been taking hormone replacement treatment (HRT) were divided randomly into two groups: exercise (n=41) and control (n=40).

METHODS

Physical fitness tests and the Nottingham Health Profile (NHP) were used to assess physical fitness and quality of life in both groups, both before and after 6 weeks. The study group participated in an exercise programme, which was composed of sub-maximal aerobic exercises for a 6-week period 3 times a week. The statistical analyses were done by paired samples t-test and independent samples t-test.

RESULTS

At the end of 6 weeks exercise period, when the two groups were compared after the exercise period, we found statistically significant differences in strength, endurance, flexibility and balance parameters in the exercise group (P<0.05). There was also a statistically significant change in the exercise group for the NHP indicating an improvement in the quality of life (P<0.05).

CONCLUSIONS

In this study, it was concluded that the fitness level and quality of life on postmenopausal women could be improved by a regular and controlled exercise programme of 6 weeks.

The decision to take hormone replacement therapy among women with disabilities

Whereas making decisions during menopause can be challenging for all women, those with physical impairments face special issues with respect to menopause in general and hormone replacement therapy (HRT) in particular. In this correlational study the authors explored the factors such women consider when making decisions about HRT One hundred sixty-seven women with physical impairments throughout the United States completed surveys concerning their attitudes and knowledge about HRT Approximately half the menopausal women were currently taking HRT The strongest predictor of HRT use was women's perceptions of their health care providers opinions about their taking HRT, combined with their motivation to comply with the provider's recommendation. Thisfinding points to the significant role that nurses and other health care providers play in assisting women to make informed health care choices during menopause.