Spectrum of Gynecological disorder in Geriatric Women: a Tertiary Care Centre Study

Author(s): Fathima Sultana, Lizwana Nusrat Lia, Afreen Kabir Kheya, Rezwan Sultana, Jasmin Ara Zaman

Background: Geriatric care focuses on addressing the multifaceted needs of the elderly, emphasizing health promotion, disease prevention, and treatment. Ageing is a gradual, inevitable process, and geriatrics aims to distinguish between expected ageing effects and diseases, promoting healthy ageing. Gerontology, a broader field, encompasses the physical, mental, and social aspects of ageing. Specialized areas like geriatric gynecology tackle pathologies in postmenopausal women, including uterine prolapse, malignancies, and urinary issues. Despite the prevalence of these conditions, research on their collective impact needs to be improved, leading to poor quality of life, prognosis, and economic burden. Such research should be more noticed in health priorities.

Aim of the study: The study aims to know gynecological diseases with their demographics and to assess clinical profile and comorbidities in geriatric women.

Methods: This study was prospective and cross-sectional. The study was conducted in Sir Salimullah Medical College Mitford Hospital (SSMCH), and the data were collected from the gynae inpatient department. The study period was from May 13 2018 to November 12' 2018. One hundred sixty selected patients, aged between 60 and 79 years, admitted to six Gynae units (SSMCH), were included in this study and evaluated. The patients were managed according to standard clinical protocols. Written informed consent was taken from patients or their relatives. All data were collected in an individual case record form. Data were analyzed using the SPSS version 16.0 and presented as mean and percentage as applicable.

Results: In this study, 160 geriatric women were enrolled. Their age ranged from 60-79 years, mean age was 66.21±4.72 SD. 47.5% of the patients were from the 60-65 age group, while 40% were 66-70 years old. The majority of patients were married (67%), rural (69.37%), and illiterate (84.37%). Low socioeconomic condition was also remarkable (71.25%). The age of menopause extended from 35 to more than 50 years, with a mean menopausal age of 46.25± 3.51 SD. They were presenting age since menopause was 19.61±5.58 SD. The majority of the patients were multiparous (87%). Uterovaginal prolapse, urinary tract infections, and malignancies were the most frequent diseases encountered in the study, out of which prolapse was 37.5%. 3° UV prolapse was the most typical (28.12%) associated either with cystocele, rectocele, or both. Among malignancies (10.63%) had ovarian cancer, followed by cervical cancer. Urinary incontinence was also present in 19.32% of patients. The largest group of patients presented with the symptom of something coming down per vagina was 37.5%. Next to this, postmenopausal bleeding and frequency of micturition had the same frequencies (20.62%). The symptoms were more than two years in 42.50% of patients. Among systemic symptoms, generalized weakness (65.62%), backache (43.12%), and loss of appetite (39.37%) merits should be mentioned. Moreover, the majority (75%) had multiple symptoms. Anaemia was the most significant general examination finding (54.37%). Among comorbidities, Hypertension (39.38% and Diabetes mellitus (24.38%) were more prevalent than any other comorbidities in the study population.

Conclusion: In the present study, Pelvic organ prolapse and genital malignancy are the major gynecological causes of hospital admissions in patients above 60 years. Something coming down per vagina is the most typical complaint. The prolapse at this age is generally advanced and extensive. Ovarian and cervical cancers are showing a rising trend in this age group. The majority of the patients with cervical cancer presented at an advanced stage and hence were inoperable.