Читать книгу Pathy's Principles and Practice of Geriatric Medicine - Группа авторов - Страница 100

At birth, the male to female birth rate is approximately 1.05:1. However, females generally have a longer life expectancy than males, which leads to a shifting of the gender ratio in older adults, such that females outnumber males. There are many proposed reasons for longer female life expectancy. Biologically, oestrogen may be protective against cardiovascular disease. Additionally, women are less susceptible to X‐linked genetic disorders. Males are more likely to engage in high‐risk behaviour, including dangerous occupations, reckless driving, and substance use. Historically, political upheaval and wartime have disproportionately affected men. For example, the fall of the USSR and resulting political prosecutions led to a profound gender gap in modern‐day Russia, resulting in an almost 11‐year discrepancy in male life expectancy compared to females.⁵ Finally, behavioural science suggests women generally engage with medical care and seek medical attention earlier than men, possibly leading to earlier diagnosis and treatment of common conditions.⁶ As mortality from cardiovascular disease improves, and as women engage in the workforce and high‐risk behaviours like smoking at increasing rates, the gender gap in older adults is expected to narrow.⁷

According to date from the UN, in the US, as of 2020, females outnumber males at a ratio of 1.1:1 at age 65, 1.2:1 at 75, 1.5:1 at 85, and 2.5:1 at 95. These ratios are projected to decline by 2050, such that the male to female ratio in adults age 65 will equalize, however females will continue to outnumber males at older ages but to a lesser degree (Figure 4.2). In the US, there is also a fair amount of regional variability. The ratio of females to males is much less in rural counties, particularly in the Western part of the country (excluding California), possibly due to male migration for occupational reasons.⁷

In much of the developed world, gender ratios of older adults are similar to those in the US. In developing countries, due to less access to education and healthcare, higher rates of physical abuse, and risk of poverty in widowhood, women have lower life expectancies, resulting in female to male ratios closer to 1.¹ India and China, which have historically practised female infanticide, have significantly more males than females, and these effects extend into older adulthood.

Approximately 0.5% of adults over 65 identify as transgender in the United States.⁸ Transgender older adults face a unique set of challenges, including cumulative effects of a lifetime of discrimination, and generally report higher rates of anxiety, depression and loneliness and less robust support networks than age‐matched peers. There is also a dearth of cultural competency training for providers of older adults around issues of gender and sexual identity. Additional information on LGBT+ older adults can be found in Chapter 5.