S Knellesen | PubMed Health

PubMed1990

[Interactive relations between sexual behavior and post-menopausal replacement hormone therapy: a survey].

A study carried out in 1988 using a representative sample of the French male and female population aged between 52 and 70 provides information concerning one of the presumed motivations for the use of replacement hormone therapy: to "always be a woman". In 1988 the sexual activity of French couples decreased on average after the age of 50 or thereabouts in a proportion identical to that seen in 1970. The chief limiting factor is reduced libido in women, far more than simple dyspareunia or relative male impotence. The majority of women interviewed did not wish to react against this fall in sexual activity, had abandoned "seductive" behaviour, would not use treatment which would increase sexual appetite even if it were ideally active and free of side-effects and did not consider that the menopause had any influence whatsoever on their behaviour. Eighty per cent of women had never sought to use replacement hormone therapy. A minority, 17 p. cent of those interviewed, had used postmenopausal hormone therapy for a time at least. This sub-group had a far higher level of sexual activity, attached greater importance to their personal appearance, took more physical exercise and controlled their weight better. The group was also more educated and better informed regarding the possible consequences of the menopause. Differences in life style and dietary behaviour between spontaneous non-users and users of hormone replacement therapy could falsify the interpretation of a non-randomised epidemiological study.

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[Causes and consequences of elderly's agitated and aggressive behavior].

Agitation and aggressiveness are frequent in the elderly and often related to dementia. As a result of the ageing of the general population this is becoming a major public health concern. No or little epidemiological data, during primary health care, about symptoms, co-morbidity, nor medical and social consequences of elderlys' disruptive behavior have been gathered or published in the French literature. Thus, in order to describe these disorders, a survey in cooperation with general practitioners (GP) was conducted. A representative sample of 212 French GP's, all with preferential geriatric activity were asked to conduct a study by including retrospectively their two most recent patients older than 65, who had exhibited agitation and/or aggressiveness. From this cross sectional study, 410 patients (female: 61%, male: 39%) were included. The mean age was 81 years (sd: 7.65). The patients suffered from change in verbal behavior (80%), verbal aggressiveness (71%), physical agitation (60%), wandering (48%), and/or physical aggressiveness (31%). The average of disruptive behavior symptoms per patient was 2.9. The symptoms appeared progressively in 81% of patients, the mean duration was two years and it was the first episode in 40% of patients. Disruptive behaviors may be explained in view of organic illness in 62% of patients (cardiovascular disease: 37%, neurologic: 12%, diabetes: 7%, dehydratation: 5%), dementia (Alzheimer disease: 20%, vascular dementia: 18%, mixed dementia: 14%). In 54% of patients disruptive behavior may be explained in view of depression: 34%, and anxiety disorder: 31%. A triggering factor was observed in 57% of cases (psychosocial stress: 39%). Somatic consequences of the symptoms were frequently identified: decrease of alimentary intake: 39%, weight loss: 27%, dehydratation: 11%, falls: 32%, and irregular medication intake: 31%. Limitation of daily life activities: 85%, and family life: 97% were also noted. Acceptability of patient's symptoms by the family was good (no discomfort or transitory and mild irritability) in 61% of cases, and very bad (reactions of exhaustion, hospitalization requirement) in 13%. This study carried out during primary care, showed that the elderly's disruptive behaviors cause severe medical consequences and familial and social distress.

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