Stephanie Faubion, director of the Mayo Clinic Center for Women’s Health, launched into a critique when I asked about the current state of research on older women’s health. “It’s completely insufficient,” she told me.
One example: Many medications widely prescribed to older adults, including statins for high cholesterol, have been studied primarily in men, with results extrapolated to women.
“It’s assumed that women’s biology doesn’t matter and that premenopausal and postmenopausal women react the same way,” Faubion said.
“This must stop: The FDA must require that clinical trial data be reported by sex and age so we can know whether drugs work the same, better or worse in women,” she said. added.
Consider the Alzheimer’s disease drug Leqembi, approved by the Food and Drug Administration last year after the manufacturer reported a 27 percent slower rate of cognitive decline in people taking the drug. An additional appendix to a study by Leqembi published in the New England Journal of Medicine found that gender differences were substantial – a 12 percent slowdown for women, compared to a 43 percent slowdown for men – raising questions questions about the effectiveness of the drug for women.
This is particularly important because almost two-thirds of older people with Alzheimer’s disease are women. Older women are also more likely than older men to suffer from multiple health problems, disabilities, autoimmune diseases, depression and anxiety, uncontrolled high blood pressure and osteoarthritis, among other problems, according to numerous research studies.
Despite this, women are resilient and outlive men by more than five years in the United States. As people reach 70 and 80, women significantly outnumber men. If we are concerned about the health of the older population, we must be concerned about the health of older women.
When it comes to research priorities, here are some of the suggestions from doctors and medical researchers:
Why do women with heart disease, which becomes much more common after menopause and kills more women than any other disease, receive less recommended care than men?
“We’re definitely less aggressive in treating women,” said Martha Gulati, director of preventive cardiology and associate director of the Barbra Streisand Women’s Heart Center at Cedars-Sinai in Los Angeles. “We are delaying evaluations for chest pain. We do not give anticoagulants at the same rate. We don’t perform procedures like aortic valve replacement as often. We are not addressing hypertension enough.
“We need to understand why these biases in care exist and how to eliminate them. »
Gulati also noted that older women are less likely than their male peers to suffer from obstructive coronary artery disease (blockage of large blood vessels) and more likely to experience damage to smaller blood vessels that goes undetected. When women undergo procedures such as cardiac catheterizations, they experience more bleeding and complications.
What are the best treatments for older women given these problems? “We have very limited data. This must be a priority,” Gulati said.
How can women reduce their risk of cognitive decline and dementia as they age?
“This is an area where we really need clear messages to women and interventions that are effective, actionable and accessible,” said JoAnn Manson, chief of the division of preventive medicine at Brigham and Women’s Hospital in Boston and key investigator for the Women’s Hospital. Health Initiative, the largest study of women’s health in the United States.
Many factors affect women’s brain health, including stress (dealing with sexism, caregiving responsibilities, and financial challenges) which can fuel inflammation. Women experience a loss of estrogen, an important hormone for brain health, with menopause. They also have a higher incidence of diseases with serious consequences for the brain, such as multiple sclerosis and stroke.
“Alzheimer’s disease doesn’t just start at age 75 or 80,” said Gillian Einstein, the Wilfred and Joyce Posluns Chair in Women’s Brain Health and Aging at the University of Toronto. “Let’s take a lifespan approach and try to understand how what happens earlier in women’s lives predisposes them to Alzheimer’s disease. »
What explains older women’s greater vulnerability to anxiety and depression?
Studies suggest various factors, including hormonal changes and the cumulative impact of stress. In the journal Nature Aging, Paula Rochon, professor of geriatrics at the University of Toronto, also denounces “gendered ageism,” an unfortunate combination of ageism and sexism that makes older women “largely invisible.”
Helen Lavretsky, professor of psychiatry at the University of California, Los Angeles and past president of the American Association of Geriatric Psychiatry, suggests several topics that need further investigation. What is the impact of the menopausal transition on mood and stress-related disorders? What non-pharmaceutical interventions can promote psychological resilience in older women and help them recover from stress and trauma? (Think yoga, meditation, music therapy, tai chi, sleep therapy, and other possibilities.) What combination of interventions is likely to be most effective?
How can we improve cancer screening recommendations and cancer treatments in older women?
Supriya Gupta Mohile, director of the Geriatric Oncology Research Group at the University of Rochester’s Wilmot Cancer Institute, wants better guidance on breast cancer screening in older women, broken down by health status. Currently, women aged 75 and over are grouped together, even if some are in remarkable health and others particularly fragile.
Recently, the U.S. Preventive Services Task Force noted that “current evidence is insufficient to assess the balance of benefits and harms of screening mammography in women 75 years of age or older,” leaving physicians without clear direction. “Right now, I think we are under-screening healthy older women and over-screening frail older women,” Mohile said.
She also wants more research into effective and safe treatments for lung cancer in older women, many of whom suffer from multiple health problems and functional impairments.
“For this population, it is the decisions about who can tolerate treatment based on their health status and whether there are gender differences in tolerability for older men and women that require investigation,” said Mohile.
Bone health, functional health and frailty
How can older women maintain their mobility and preserve their ability to care for themselves?
Osteoporosis, which weakens and weakens bones, is more common in older women than in older men, increasing the risk of fractures and dangerous falls. Again, menopause-related loss of estrogen is involved.
“It is extremely important to the quality of life and longevity of older women, but it is a neglected and understudied area,” said Manson of Brigham and Women’s.
Jane Cauley, a distinguished professor at the University of Pittsburgh School of Public Health who studies bone health, would like more data on osteoporosis in older black, Asian and Hispanic women, who are undertreated for this disease. She would also like to see better medications with fewer side effects.
Marcia Stefanick, professor of medicine at Stanford University School of Medicine, wants to know which strategies are most likely to motivate older women to be physically active. And she would like to see more studies investigating how older women can best preserve their muscle mass, strength and ability to care for themselves.
“Frailty is one of the biggest problems for older women, and it is essential to know what can be done to prevent this,” she said.
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