COMMENTARY

November 2002: Little Red Riding Hood's Grandmother

Ursula Snyder, PhD

Disclosures

November 13, 2002

Introduction

Not only do we not clearly understand the effects of ovarian hormone therapy on the female body, but we also do not clearly understand why only human females survive well beyond menopause at all. As Jared Diamond, Professor of Physiology at the UCLA School of Medicine, puts it:

The winners of evolution's race are those who can leave behind the most offspring to carry on their progenitors' genes. So doesn't it seem odd that human females should be hobbled in their prime by menopause?... Any theory of menopause evolution must explain how a woman's apparently counterproductive evolutionary strategy of making fewer babies could actually result in her making more. Evidently, as a woman ages, she can do more to increase the number of people bearing her genes by devoting herself to her existing children, her potential grandchildren, and her other relatives than by producing yet another child. [1]

"Who better to keep the wolf from the door than Grandma?" ends Natalie Angier in an article in The New York Times (November 5) that discusses work presented by researchers at the first ever international conference (unfortunately, the conference is not identified) devoted to the role of elderly women, grandmothers in particular, as a powerful influence on the lives of their descendants in both traditional and contemporary societies.[2] Just by way of example, in recently published work, British anthropologists Mace, Seer, and colleagues, who have been studying the evolutionary ecology of reproduction in rural Gambia, found that the presence of maternal grandmothers in particular increases the survival of their grandchildren:

We find that the only kin to improve the nutritional status of children significantly (apart from mothers) are maternal grandmothers, and that this is reflected in higher survival probabilities for children with living maternal grandmothers. There is also evidence that the reproductive status of the maternal grandmother influences child nutrition, with young children being taller in the presence of non-reproductive grandmothers than grandmothers who are still reproductively active. Paternal grandmothers and male kin, including fathers, have negligible impacts on the nutritional status and survival of children.

Except that if Ms Angier is referring to Red Riding's Hood's grandmother, this particular grandma could not keep the wolf from the door at all. Grandma was bedridden with an illness and, indeed, was gobbled up in an instant by Mister Wolf. As a result, Little Red Riding Hood didn't fare so well either (although both were saved in the end by an apparently unrelated male).

As soon as 2011, the elderly population will reach 40 million in the United States. By 2030, 1 in 5 Americans will be older than 65, and the number of those older than 85 could be as high as 31 million by 2050, according to the Bureau of the US Census. More than half will be women. Currently in the United States, about 24 million women are obese (with the highest rates in poor and minority women). Obese women are 13 times more likely than nonobese women to develop type 2 diabetes, 4 times more likely to become hypertensive, and 3 times more likely to have a heart attack. Currently, about 1 in 6 women between the ages of 55 and 65 have no health insurance.[3] (Women who lack insurance have higher mortality, higher in-hospital mortality, are at greater risk for avoidable hospitalization, are diagnosed at later stages of life-threatening diseases, are at greater risk of death from breast cancer, and have a worse cardiovascular disease profile[3]). We can expect that on the order of 200,000 women will be diagnosed with breast cancer this year in the United States.[4] Many women with cancer will live more than 5 years after diagnosis, with the exception of lung cancer. Lung cancer has surpassed breast cancer as the leading cause of female cancer death in the United States, now accounting for 25% of all cancer deaths among women.[5] There has been a 70% increase in mortality attributed to asthma over the past 20 years; elderly black women have the highest asthma-associated mortality, but mortality in elderly white women contributed largely to this increase in asthma-related mortality.[6] In the United States, 1 in 4 women already have osteoporosis by age 50; about 32% of women who live to 80 will suffer a hip fracture.[7] Elderly women are also living with such chronic conditions as arthritis/rheumatism, nonarthritic back problems, migraines, stomach/intestinal ulcers, bronchitis/emphysema, urinary incontinence, depression, and malnutrition.

Women (and men) are living dangerously, as the just-published World Health Report, 2002, says boldly, either because they have no choice or because they are making the wrong choices about consumption and activity.[8] And it is not just in North America. The report shows that "lifestyles of whole populations are changing around the world" and that they are having profound impact on the health of individuals, families, and communities. High blood pressure and high blood cholesterol levels, tobacco use, excessive alcohol consumption, obesity, physical inactivity, and low fruit and vegetable consumption -- now the dominant risks in all middle- and high-income societies -- are becoming more prevalent even in the developing world.

Thus, if current trends continue, we will be faced with a very large population of sickly elderly women incapable of enjoying their older years and unable to contribute to the health and well-being of their families.

On Medscape Ob/Gyn & Women's Health, clinicians can find a wealth of information and CME programs on therapies for many of the conditions mentioned above. Of recent note are CME programs on incontinence and cardiovascular disease and conference coverage from the American Society for Bone and Mineral Research, the North American Menopause Society, and the American Urogynecologic Society.

However, as clinicians, as individuals, and as a society, we also must address the root causes of chronic illnesses in elderly women and do much more to prevent these conditions. Clearly, poor nutrition and physical inactivity are key factors contributing to the ill health of elderly women. I encourage you to read "Keep Fit for Life. Meeting the Nutritional Needs of Older Persons," recently published by the World Health Organization, and "Active Ageing: A Policy Framework."

But, let us not forget other important factors that contribute to the ill health of elderly women, including:

  • Lack of education

  • Inadequate financial resources

  • Lack of health insurance

  • Lack of access to healthcare (eg, a clinic located too far away from the patient or difficult to reach via public transportation poses problems)

  • Overmedication and undermedication

  • Environmental stressors (eg, air pollution; exposure to extreme heat in the summer/cold in the winter -- see the recent MedGenMed book review, "Heat Wave: A Social Autopsy of Disaster in Chicago")

  • Multiple role strain (ie, stress associated with care of husbands, relatives, friends, children, grandchildren)

  • Social isolation (eg, as a result of widowhood, death of friends/family, lack of means to go out, or fear of going out for fear of falling and breaking bones, getting lost/being attacked, or experiencing episodes of incontinence)

Addressing these factors also requires that individuals, communities, governments, and industry/business commit to changing the way we live in our world -- creating an environment that promotes the health of creatures and the planet. Grandmothers are considered a distinctive evolutionary category, fundamental in our evolutionary heritage. One wonders where we are headed. Into the jaws of wolves? Or into the arms of strong grandmothers?

If you have comments or questions about this column or about the site, please contact me at womenshealtheditor@webmd.net

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