Medical research has been neglected for many years. This is very true for older women, leaving doctors lacking necessary details about best protect their health.
Late last yr, the Biden administration promised to tackle this problem with a brand new initiative called the White House Initiative on Women's Health Research. This raises an intriguing query: What must be on the initiative's list of priorities in the case of older women?
Stephanie Faubion, director of the Center for Women's Health on the Mayo Clinic, was critical once I asked her concerning the current state of research on older women's health. “It's completely inadequate,” she told me.
For example, many medications commonly prescribed to older adults, including statins for top cholesterol, have been studied primarily in men, with results that will be extrapolated to women.
“It is assumed that a woman's biology does not play a role and that women react similarly before and after menopause,” said Faubion.
“This must stop: The FDA must require that clinical trial data be disaggregated by gender and age so that we can determine whether drugs work equally well, better or less well in women,” Faubion insisted.
One example is the Alzheimer's drug Leqembi, which was approved by the FDA last yr after the manufacturer reported a 27 percent slower rate of cognitive decline in patients taking the drug. A supplementary appendix to a Leqembi study published within the New England Journal of Medicine showed that there have been significant differences between the sexes – a 12 percent slowdown in women in comparison with 43 percent in men – raising doubts concerning the drug's effectiveness in women.
This is very necessary because nearly two-thirds of older individuals with Alzheimer's disease are women. Additionally, in line with quite a few research studies, older women are more likely than older men to suffer from multiple diseases, disabilities, difficulties with every day activities, autoimmune disorders, depression and anxiety, uncontrolled hypertension, and osteoarthritis, to call a couple of.
Nevertheless, women are robust and live greater than five years longer than men within the United States. In their 70s and 80s, women significantly outnumber men. If we care concerning the health of the older population, we must also care concerning the health of older women.
Regarding research priorities, listed here are some suggestions from doctors and medical researchers:
Heart disease
Why are women with heart disease – which is much more common after menopause and causes more deaths than another disease – beneficial worse medical care than men?
“We are much less aggressive in treating women,” said Martha Gulati, chief of preventive cardiology and associate director of the Barbra Streisand Women's Heart Center at Cedars-Sinai, a health system in Los Angeles. “We delay testing for chest pain. We don't give blood thinners as often. We don't do procedures like aortic valve replacement as often. We don't treat high blood pressure adequately.”
“We need to find out why these biases exist in nursing and how we can eliminate them.”
Gulati also found that older women are less likely than their male counterparts to suffer from obstructive coronary artery disease – blockages in large blood vessels – and more more likely to suffer from undetected damage to smaller blood vessels. Women usually tend to experience bleeding and complications during procedures resembling cardiac catheterization.
Given these problems, what are the perfect treatment options for older women? “We have very limited data. That's what we need to focus on,” Gulati said.
Brain health
How can women reduce their risk of cognitive decline and dementia in old age?
“This is an area where we really need clear messages for women and effective interventions that are feasible and accessible,” said JoAnn Manson, chief of the Division of Preventive Medicine at Brigham and Women's Hospital in Boston and a key researcher for the Women's Health Initiativethe biggest study on women's health within the USA
Many aspects affect women's brain health, including stress – sexism, caregiving responsibilities and financial pressures – which may increase inflammation. During menopause, women experience a lack of estrogen, a hormone necessary for brain health. Women are also more more likely to suffer from diseases which have serious effects on the brain, resembling multiple sclerosis and stroke.
“Alzheimer's doesn't start at age 75 or 80,” says Gillian Einstein, Wilfred and Joyce Posluns Chair in Brain Health and Aging in Women on the University of Toronto. “We should look at the life course and try to understand how what happens in women's early years makes them more vulnerable to Alzheimer's.”
Mental health
Why are older women more susceptible to anxiety and depression?
Studies suggest quite a lot of aspects, including hormonal changes and the cumulative effect of stress. Writing within the journal Nature Aging, Paula Rochon, a professor of geriatrics on the University of Toronto, also criticized “gender ageism,” an unlucky combination of ageism and sexism that makes older women “largely invisible,” in an interview in natural breeding.
Helen Lavretsky, a professor of psychiatry at UCLA and former president of the American Association for Geriatric Psychiatry, identifies several topics that require further study. How does the menopausal transition affect mood and stress-related disorders? What non-drug interventions can promote psychological resilience in older women and help them get well from stress and trauma? (Think yoga, meditation, music therapy, tai chi, sleep therapy and other options.) What combination of interventions is more likely to be only?
Cancer
How can recommendations for cancer prevention and treatment be improved for older women?
Supriya Gupta Mohile, director of the Geriatric Oncology Research Group on the University of Rochester's Wilmot Cancer Institute, wants higher guidance on breast cancer screening for older women, broken down by health status. Currently, women age 75 and older are lumped together, though some are remarkably healthy and others are downright frail.
The US Preventive Services Task Force recently found:The current evidence is insufficient to weigh the professionals and cons of screening mammography in women aged 75 and over,” leaving doctors with no clear guidance. “I consider that we currently underscreen healthy older women and overscreen frail older women,” Mohile said.
The doctor also wants to conduct more research into effective and safe treatments for lung cancer in older women, many of whom have multiple illnesses and functional impairments. This age-related disease kills more women than breast cancer.
“In this population, decisions need to be examined about who can tolerate treatment based on their health status and whether there are gender differences in tolerability for older men and women,” Mohile said.
Bone health, functional health and frailty
How can older women maintain their mobility and ability to care for themselves?
Osteoporosis, which leads to weakening and brittle bones, is more common in older women than in older men and increases the risk of dangerous bone fractures and falls. Here, too, the loss of estrogen during menopause is cited as a cause.
“This is hugely necessary for the standard of life and life expectancy of older women, but it surely is an neglected and under-researched area,” said Manson of Brigham and Women's.
Jane Cauley, a distinguished professor on the University of Pittsburgh School of Public Health who studies bone health, would really like to see more data on osteoporosis in older black, Asian and Hispanic women, who’re undertreated for the disease, and higher drugs with fewer unintended effects.
Marcia Stefanick, a professor of drugs at Stanford University School of Medicine, desires to know what strategies are almost certainly to motivate older women to be physically lively. And she would really like to see more studies on how older women can best maintain their muscle mass, strength and self-care abilities.
“Frailty is one of the biggest problems facing older women and it is important to learn what can be done to prevent it,” she said.
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