In the 2000 census, 16.3% of the population was older than the age of 60 years. As the numbers of women older than 65 years in the United States increases, projections for the year 2050 note that they will join 100 million elderly or 22.9% of the population. The clinician caring for elderly women should be familiar with the general approach to screening and management of common gynecological problems in this group. It may not be practical for women to be referred immediately for all gynecological complaints and examinations. The primary care physician can triage and manage basic issues and refer as appropriate to their training and skill level. This chapter will discuss the approach to evaluating the patient in the office and nursing home setting, review screening guidelines for gynecological malignancies and osteoporosis, and then present approaches to common presenting complaints that often lead to referral to a gynecologist, including issues concerning hormone replacement therapy (HRT).

APPROACH TO THE PATIENT

The older patient should have regular gynecological care and screening for malignancies of the female genital tract as part of routine primary care evaluations. This includes asking patients about symptoms and problems that they might not volunteer. This area might be overlooked when focusing on a patient's more pressing chronic disease states. Breast and pelvic examination may not be viewed as part of a “routine” examination. If the primary physician is not performing these examinations, they should ensure that the patient is seeing a gynecologist for this part of the examination.