2024-08-06 20:44:00
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A doctor is collecting data from a senior woman (symbolic image). © Oleksandr Latkun/Imago
Many medications prescribed to women have primarily been tested on men, and the results have been extrapolated to women. This is a problem.
Medical research has overlooked women for decades. This is particularly true for older women, leaving doctors without crucial information on how to best manage their health. At the end of last year, the Biden Administration promised to address this issue with a new White House initiative for women’s health research. This raises an interesting question: What priorities should be on the initiative’s list when it comes to older women?
Stephanie Faubion, director of the Center for Women’s Health at the Mayo Clinic, criticized the current state of research on older women’s health. “It is completely inadequate,” she told me. One example: many drugs commonly prescribed to older adults, including statins for high cholesterol, have primarily been tested on men, and the results have been applied to women.
“It is assumed that women’s biology does not matter and that women respond similarly before and after menopause,” Faubion said. “This has to stop: the FDA needs to require that clinical trial data be broken down by sex and age so that we can determine whether drugs work equally well, better, or worse in women,” she added.
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Alzheimer’s drug works differently for women than for men
One example is the Alzheimer’s medication Leqembi, which was approved by the Food and Drug Administration last year after the manufacturer reported that cognitive decline in people taking the medication was slowed by 27 percent. An additional appendix to the Leqembi study published in the New England Journal of Medicine demonstrated that the differences between the sexes were substantial – a 12 percent slowdown in women compared to a 43 percent slowdown in men – raising questions about the effectiveness of the drug for women.
This is particularly important because nearly two-thirds of older adults with Alzheimer’s disease are women. According to numerous research studies, older women are also more likely than older men to suffer from multiple diseases, disabilities, autoimmune diseases, depression and anxiety, uncontrolled hypertension, and arthritis, among other issues.
Nevertheless, women are resilient and outlive men in the United States by more than five years. In their 70s and 80s, women significantly outnumber men. If we care about the health of the older population, we must also care about the health of older women. Regarding research priorities, physicians and medical researchers have made the following suggestions:
Heart Disease
Why are women with heart disease, which occurs far more frequently after menopause and affects more women than any other disease, treated less aggressively than men? “We treat women significantly less aggressively,” says Martha Gulati, head of preventive cardiology and deputy director of the Barbra Streisand Women‘s Heart Center at Cedars-Sinai in Los Angeles.
“We delay evaluations for chest pain. We do not administer blood thinners at the same rate. We perform procedures like aortic valve replacements less frequently. Hypertension is not adequately treated. We need to find out why these disparities in care exist and how to eliminate them.”
Gulati also pointed out that older women suffer less frequently from obstructive coronary artery disease — blockages in large blood vessels — but tend to show damage to smaller blood vessels that often goes undetected. Women experience more bleeding and complications during procedures like cardiac catheterizations. Which treatments are best suited for older women given these issues? “We have very few data. This needs to be a focus,” Gulati said.
Brain Health
How can women reduce their risk of cognitive decline and dementia as they age? “This is an area where we really need clear messages for women and effective actions that are doable and accessible,” said JoAnn Manson, head of the Department of Preventive Medicine at Brigham and Women’s Hospital in Boston and one of the leading researchers on the Women’s Health Initiative, the largest study on women’s health in the United States.
Numerous factors affect women’s brain health, including stress — dealing with sexism, caregiving responsibilities, and financial burdens — which can promote inflammation. With menopause, women lose estrogen, a hormone crucial for brain health. Additionally, they are more likely to experience conditions with serious implications 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. “We should choose a lifelong approach and try to understand how what happens earlier in women’s lives predisposes them to Alzheimer’s.”
Mental Health
Why are older women more vulnerable to anxiety and depression? Studies point to a range of factors, including hormonal changes and the cumulative effects of stress. In the journal Nature Aging, Paula Rochon, a professor of geriatrics at the University of Toronto, also criticizes “gendered ageism,” an unfortunate combination of age discrimination and sexism that makes older women “largely invisible.”
Helen Lavretsky, a professor of psychiatry at the University of California, Los Angeles, and a former president of the American Association for Geriatric Psychiatry, proposes several topics for further investigation. How does the transition into menopause affect mood and stress disorders? What non-pharmaceutical interventions can promote the mental resilience of older women and help them recover from stress and trauma? (Think yoga, meditation, music therapy, tai chi, sleep therapy, and other options). What combination of interventions is likely to be most effective?
Cancer
How can the recommendations for cancer screening and treatment for older women be improved? Supriya Gupta Mohile, head of the geriatric oncology research group at the Wilmot Cancer Institute at the University of Rochester, wishes for better guidelines for breast cancer screening in older women, broken down by health status. Currently, women over 75 are grouped together, even though some are remarkably healthy while others are particularly frail.
Recently, the U.S. Preventive Services Task Force found that “the current evidence is insufficient to assess the balance of benefits and harms of mammography screening for women over 75 years, leaving doctors without clear guidance. “I believe we are currently screening fit older women too little and frail older women too much,” Mohile said.
She also wants more research on effective and safe treatments for lung cancer in older women, many of whom have multiple ailments and functional limitations. “For this population, decisions need to be made 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, where bones become weaker and more brittle, is more common in older women than in older men, increasing the risk of dangerous bone fractures and falls. Here too, the loss of estrogen during menopause plays a role. “This is enormously important for the quality of life and longevity of older women, yet it is an overlooked area that is not adequately researched,” said Manson from Brigham and Women’s.
Jane Cauley, a respected professor at the University of Pittsburgh School of Public Health who focuses on bone health, would like to see more data on osteoporosis in older Black, Asian, and Hispanic women who are under-treated. She also desires better medications with fewer side effects.
Marcia Stefanick, a professor of medicine at the Stanford University School of Medicine, wants to know which strategies are most likely to motivate older women to be physically active. And she calls for more studies to examine how older women can best maintain their muscle mass, strength, and ability to care for themselves.
“Frailty is one of the biggest issues for older women, and it is crucial to know what can be done to prevent it,” she said. KFF Health News is a national news service that produces in-depth journalism on health topics and is part of KFF’s core programs.
By Judith Graham
We are currently testing machine translations. This article has been automatically translated from English into German.
This article first appeared in English on June 16, 2024, at Washingtonpost.com – as part of a collaboration, it is now available in translation to readers of the IPPEN.MEDIA portals.
Future Trends in Women’s Health Research
The landscape of women’s health, particularly for older women, is on the brink of transformation as awareness grows regarding the unique challenges they face. Current medical research patterns, which have historically favored male subjects, are increasingly recognized as inadequate. This shift prompts a reevaluation of priorities in health care and research.
Gender-Specific Drug Research
Future trends are likely to emphasize gender-specific clinical studies. Advocacy for including more women in drug trials brings to light significant discrepancies in how treatments impact men and women differently. The need for the FDA to mandate the reporting of clinical data by sex and age could lead to more tailored therapies that genuinely address the needs of older women.
Heart Disease Awareness
With heart diseases becoming more prevalent in post-menopausal women, research is anticipated to focus on why treatments for women lag behind those for men. Advances in understanding the unique presentations of heart disease in women can lead to more effective and aggressive treatment protocols, ultimately improving outcomes for this vulnerable population.
Brain Health Initiatives
The relationship between hormonal changes and cognitive decline in women is another area ripe for exploration. As researchers look to combat dementia and Alzheimer’s—conditions that disproportionately affect older women—there could be a push for preventative guidelines based on life stages, integrating lifestyle changes that support brain health throughout a woman’s life.
Mental Health Research
Increasing recognition of the mental health challenges faced by older women, particularly concerning anxiety and depression, is likely to fuel further studies. There’s potential for the development of holistic care models that incorporate non-pharmaceutical interventions like mindfulness, yoga, and social support networks to enhance resilience and quality of life.
Cancer Screening Protocols
As discussions around tailored cancer prevention strategies gain traction, the focus might shift toward creating specific guidelines for older women. This could ensure that screenings are not overly generalized, taking into account individual health contexts rather than age alone, thereby improving early detection and treatment efficacy.
Osteoporosis and Functional Health
With osteoporosis posing a significant risk to the health of older women, emerging trends may prioritize research into effective prevention strategies and treatments that minimize side effects. This could encompass not only medication but also lifestyle interventions aimed at maintaining bone health and physical mobility.
Community-Based Health Initiatives
Future research may foster community-led initiatives that empower older women to engage more actively in their health care. By establishing local support systems and culturally competent health resources, these programs could address systemic disparities, promote preventive care, and enhance the overall well-being of older women.