Men are a distinct minority of Americans over 65. Older women outnumber older men three to two, and this disparity becomes even greater in the older-old. In 1985, there were only two men for every five women 85 and older. Women have a longer life expectancy, outliving men by an average of seven to eight years.

Today's generation of older men age differently than today's older women, having had lifestyles that place them at higher risk for today's leading causes of death. It is worth noting that this can be expected to change if successive generations of women take up smoking and other harmful practices that place them at equal risk for diseases such as lung cancer and heart disease. In addition, certain diseases/conditions affect men only. Some of the specific health issues facing today's older men are:

• Coronary heart disease. CHD is the number one cause of death in men over 40 and is responsible for half of all deaths among older people. Control of blood cholesterol, blood pressure, and weight, and smoking cessation can help reduce an older man's risk for CHD.

• Stroke. Strokes affect 1.5 times as many men as women and are a major cause of disability as well as death. The same risk factors as those mentioned for CHD increase a man's risk for stroke.

• Lung disease. Many lung diseases are more prevalent among men than women. For example, lung cancer kills four times as many men than women. More men die from emphysema and pneumonia, too. The major causes are occupational hazards and smoking. While smoking rates have gone down considerably for the general population, one-third of men over 65 still smoke. Quitting at any age benefits the pulmonary system, and some damage may even be reversed.

• Digestive system cancers. Cancer of the colon and rectum is a major cause of death among older men. The incidence of colorectal cancer is increasing for white men and even more dramatically for black men. When detected early, this type of cancer can often be arrested with surgery.

• Osteoporosis. While generally thought of as a women's disease, 20% of the 24 million Americans with osteoporosis are men. Men are largely unaware of the positive measures that can be taken in the area of diet and exercise.

• Prostate disease. As many as 80% of men over age 50 experience some problem with their prostate gland. The problem may just be enlargement, or it could be cancer. Prostate cancer is the second most common form of cancer in both white and black males and has caused 30,000 deaths in 1990 alone. Early detection is critical to effective treatment and survival.

• Sexual function. While changes in sexual function, including changes in erection and orgasm, occur in the older man, most older men can lead a satisfying sex life. Problems may be caused by disease, medications, or other physical conditions that can be successfully treated.

• Older men come from a generation in which much of their self-worth was derived from work. They may have prepared for retirement with a focus on financial planning but with little attention to knowledge or skills for coping with life after work.

• Some older men may resist showing emotions, talking about their feelings, or asking for help. This may make adjusting to losses more difficult, as studies have shown the grief process may actually be intensified by the in-ability to talk about or show feeling.

• Older men have not typically spent a lot of time and energy developing support systems outside of work and family that could help them with adjustments in later life.

• Older men see themselves as being self-reliant. Yet they may lack skills in self-care, such as cooking, shopping, and doing laundry.

• While most caregiving is provided by women, some older men find themselves in this role and are unprepared for the demands and stress.

• Many older men lack information about available services and programs or perceive the services and programs as being irrelevant to them.

Suicide is a serious problem among older men. The suicide rate among older white men is higher than it is for any other age group, and is significantly higher than for women. For example, the rate for men age 75 to 84 is eight times higher than the rate for women of the same age. Depression, illness, and changes in marital status may contribute to the increased risk of suicide for older men.

There are many issues that place older men at risk:

• Living alone. It is estimated that there are 1.8 million older men living alone. Men who are widowed or divorced at this time of their lives often lack self-care skills and become socially isolated, increasing the burdens of loneliness. The death rate among widowers is much higher than that of their married peers: four times as high from suicide, three times as high from auto accidents, ten times as high from strokes, and six times as high from heart disease.

• Bereavement. AARP's Widowed Persons Service, a community-based self-help program across the country (click Here), found that only one widower out of every ten widowed persons will seek help in coping with bereavement. In fact, studies have shown that in the first four months after the death of a wife, a man is vulnerable to both physical and emotional problems. The assumption that men experience different feelings following a loss is simply not true. But WPS research found men do not view themselves differently and are less likely to seek help. Often it's a shock to the widowed man himself that he is not as strong and self-sufficient as he thought. Men may have little understanding of how support groups work and worry about being embarrassed, outnumbered by women, or pressured into disclosing feelings. Any efforts at developing support or self-help groups for older men must take these fears and characteristics into consideration.

• Retirement. This is a major change in a man's life. Again, a man may be surprised that once retired he encounters feelings of loss--loss of authority, purpose, and self-worth. Changes in a man's relationship with his spouse and other family members can occur when he retires and can cause stress. As many as 90% of retirees may experience a health crisis requiring a hospital stay in the first year of retirement. More is needed than standard retirement planning that deals with finances, insurance, and housing. Men need to develop interests, friendships, and a sense of self-worth beyond work.

Programs That Help
For many of the above reasons, older men are less likely to ask for help, attend programs, or seek support services than women. Yet, each and every male can benefit greatly from health promotion programs offered by the health and aging professionals that are trying to help. Some programs include teaching food shopping, food preparation, and what you can do to keep healthy. In addition, the classes create a social and support network among individuals in the class. If you or someone you know needs help you can find out more about programs in your area by contacting:

A Chance to Volunteer
You don't have to wait for a health professional to start a program in your area. You can get help to start a program by contacting your local manager of the Area Agency on Aging or AARP's area office. For example, in Eureka, California, the Gent's Kitchen Survival Class is offered by the Area Agency on Aging and Humbolt Senior Citizens council. A staff dietician led the first six lessons, and then the participants were able to take over the class and carry it on. The class continues to meet without professional leadership. In many other programs, in addition to leading the meeting, the peer leader makes calls to participants, announces the topics, and arranges for a snack.

Spruce up your Life
Many find retirement boring but here's a chance to spruce up your life, meet new friends, and do something worthwhile for yourself and others. If you do decide to start a program here are some tips:

1. Recruit other male volunteers and have them find other men to participate.
   
2. Conduct "men-only" programs that are specific to men's needs and interests, addressing some of the topics and issues in this article.
   
3. Establish ongoing, focused outreach efforts to reach men. Consider using a visible older male spokesperson or celebrity from the community.
   
4. Stress comradeship; begin with social activities like card parties or sports events. Go on to develop the idea and group framework for mutual support.
   
5. Discussion groups can integrate health issues and other topics of interest to men, such as politics, current events, sports, or local history.
   
6. Teach household management skills to all "men-only" groups to ensure individual comfort. Include how to do laundry, cooking, shopping, and mending.
   
7. Sponsor programs at places where men regularly get together, such as veterans' associations or sports clubs.
   
8. Make information about potential ser-vices widely available to organizations that men belong to such as veterans' or fraternal groups.
   
9. Address "life adjustments" rather than "mental health." Include activities that may help men socialize with each other and express emotion.