Medical research has failed women for decades. This is especially true for older women, leaving doctors without crucial information about how to best manage their health.
Late last year, the Biden administration pledged to tackle this problem with a new effort, the White House Initiative on Women’s Health Research. That raises a compelling question: What priorities should be on the initiative’s list when it comes to older women?
Subscribe to The Post Most newsletter for the most important and interesting stories from The Washington Post.
Stephanie Faubion, director of the Mayo Clinic’s Center for Women’s Health, expressed criticism when I asked about the current state of research on older women’s health. “It’s completely inadequate,” she told me.
One example: Many medications widely prescribed to older adults, including statins for high cholesterol, have been studied primarily in men, with the results extrapolated to women.
“There is an assumption that women’s biology doesn’t matter and that pre- and post-menopausal women respond similarly,” Faubion said.
“This must stop: The FDA must require that clinical trial data be reported by gender and age so we can determine whether drugs work the same, better, or less well in women,” she added.
Consider the Alzheimer’s drug Leqembi, which was 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 Leqembi study published in the New England Journal of Medicine found that the sex differences were substantial – a 12 percent slowdown for women, compared to a 43 percent slowdown for men – raising questions about effectiveness of the drug for women.
This is especially important because nearly two-thirds of older adults with Alzheimer’s disease are women. According to dozens of studies, older women are also more likely than older men to have multiple medical conditions, disabilities, autoimmune diseases, depression and anxiety, uncontrolled high blood pressure and osteoarthritis.
Yet women in the United States are resilient and outlive men by more than five years. As people age into their 70s and 80s, women significantly outnumber men. If we are concerned about the health of the older population, we should also be concerned about the health of older women.
As for research priorities, here are some suggestions from doctors and medical researchers:
– – –
Heart disease
Why is it that women with heart disease, which is much more common after menopause and kills more women than any other condition, receive less recommended care than men?
“We are noticeably less aggressive in treating women,” says 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 blood thinners to the same extent. We don’t perform procedures like aortic valve replacements very often. We are not adequately addressing hypertension.
“We need to figure out why these biases exist in healthcare and how we can eliminate them.”
Gulati also noted that older women are less likely than their male peers to have obstructive coronary artery disease (blockages in large blood vessels) and are more likely to have damage to smaller blood vessels that goes unnoticed. When undergoing procedures such as cardiac catheterizations, women have more bleeding and complications.
What are the best treatments for older women given these problems? “We have very limited data. This should be a focus,” Gulati said.
– – –
Brain health
How can women reduce the risk of cognitive decline and dementia as they 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 investigator for the Women’s Hospital. Health Initiative, the largest study of women’s health in the United States.
Numerous factors influence women’s brain health, including stress (dealing with sexism, caregiving responsibilities, and financial pressures) that can fuel inflammation. Women experience the loss of estrogen, a hormone important for brain health, during menopause. They also have a higher incidence of conditions that seriously affect the brain, such as multiple sclerosis and stroke.
“Alzheimer’s disease doesn’t start until age 75 or 80,” says Gillian Einstein, the Wilfred and Joyce Posluns professor of brain health and aging in women at the University of Toronto. “Let’s take a life course approach and try to understand how what happens earlier in women’s lives predisposes them to Alzheimer’s disease.”
– – –
Mental health
What explains older women’s greater vulnerability to anxiety and depression?
Studies suggest a variety of factors, including hormonal changes and the cumulative impact of stress. Writing in the journal Nature Aging, Paula Rochon, a professor of geriatrics at the University of Toronto, also criticizes “gender 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 former president of the American Association for Geriatric Psychiatry, suggests several topics in need of further research. How does the menopausal transition affect mood and stress-related disorders? What non-pharmaceutical interventions can promote psychological resilience in older women and help them recover from stress and trauma? (Consider yoga, meditation, music therapy, tai chi, sleep therapy and other options.) What combination of interventions is likely to be most effective?
– – –
Cancer
How can cancer screening and treatment recommendations for older women be improved?
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 for older women, broken down by health status. Currently, women aged 75 and over are lumped together, even though some are remarkably healthy and others remarkably vulnerable.
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 aged 75 years or older,” leaving clinicians without clear guidance. “Right now, I think we’re under-screening fit older women and over-screening vulnerable older women,” says Mohile.
She also wants more research into effective and safe treatments for lung cancer in older women, many of whom have multiple medical conditions and functional limitations.
“For this population, it is the decisions about who can tolerate treatment based on health status and whether there are gender differences in tolerability for older men and women that need to be explored,” Mohile said.
– – –
Bone health, functional health and frailty
How can older women maintain their mobility and ability to care for themselves?
Osteoporosis, which causes bones to weaken and become brittle, is more common in older women than in older men, increasing the risk of dangerous fractures and falls. Again the loss of estrogen is involved during menopause.
“This is extremely important to the quality of life and longevity of older women, but it is an overlooked area that is understudied,” says Brigham and Women’s Manson.
Jane Cauley, a distinguished professor at the University of Pittsburgh School of Public Health who researches bone health, would like to see more data on osteoporosis in older black, Asian and Hispanic women, who are undertreated for the condition. She would also like to see better drugs with fewer side effects.
Marcia Stefanick, a 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 exploring 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 learning what can be done to prevent it is essential,” she said.
– – –
KFF Health News is a national newsroom that produces in-depth journalism on health issues and is one of the core operating programs at KFF.
related content
This is what the Christian Right wants from a second Trump term
