Health care

Older women are severely underrepresented in medical research

Medical research has marginalized women for decades. This is especially true for older women, leaving doctors without the most important information on how to better manage their health.

Late last year, the Biden administration promised to address this problem with a new effort called the White House Initiative on Women’s Health Research. That prompts a serious question: What priorities should be on the agenda when it comes to older women?

Stephanie Faubion, director of the Mayo Clinic’s Center for Women’s Health, began to criticize when I asked about the current state of research on the health of older women. He told me: “It’s not enough at all.

One example: Many drugs prescribed to older adults, including statins for high cholesterol, were studied primarily in men, and the results were extrapolated to women.

“It’s thought that female biology doesn’t matter and that premenopausal and postmenopausal women respond the same way,” Faubion said.

“This must stop: the FDA must require clinical trial data to be reported by sex and age so we know whether drugs work the same, better or not in women,” he added.

Consider the Alzheimer’s drug Leqembi, which was approved by the Food and Drug Administration last year after the manufacturer reported a 27% slower rate of cognitive decline in people taking the drug. An appendix to Leqembi’s study published in the New England Journal of Medicine revealed that the sex difference was large – a 12 percent decrease in women, compared to a 43 percent decrease in men. – raising questions about the drug’s effectiveness in women.

This is especially important because almost two-thirds of adults with Alzheimer’s disease are women. 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, among others. of other issues, according to many research studies.

However, in the United States, women are more resilient and outlive men by more than five years. As people enter their 70s and 80s, women outnumber men by a large margin. If we are concerned about the health of older people, we should be concerned about the health of older women.

In terms of research priorities, here are some of what doctors and medical researchers have suggested:

Why are women with heart disease, which is so common after menopause and kills more women than any other condition—given so little attention? What is recommended more than men?

“We’re not necessarily aggressive when we treat women,” said Martha Gulati, director of heart disease prevention and executive director of the Barbra Streisand Women’s Heart Center at Cedars-Sinai in Los Angeles. “We delay screening for chest pain. We don’t give blood thinners at the same rate. We don’t do procedures like aortic valve replacement as often. We don’t treat high blood pressure with enough.

“We need to know why this attention bias exists and how we can get rid of it.”

Gulati also noted that older women are less likely than their peers to develop coronary artery disease – a blockage of the large blood vessels – and are more likely to have damage to the small blood vessels that goes undetected. When undergoing procedures such as cardiac catheterizations, women experience bleeding and complications.

What are the best treatments for older women with these issues? “We have very little data. This needs to be focused,” said Gulati.

How can women reduce their risk of cognitive decline and dementia as they age?

“This is an area where we really need to have clear messages for women and effective interventions that are feasible and accessible,” said JoAnn Manson, director of the Division of Preventive Medicine at Brigham and Women’s Hospital in Boston. and important researcher for Women. Health Initiative, the largest study of women’s health in the United States.

There are many factors that affect women’s brain health, including stress – dealing with sexism, caregiving responsibilities and financial stress – which can cause inflammation. Women lose estrogen, a hormone important for brain health, with menopause. They also have higher rates of adverse effects on the brain, such as multiple sclerosis and stroke.

“Alzheimer’s disease doesn’t 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 lifestyle approach and try to understand how what happens earlier in women’s lives puts them at risk for Alzheimer’s disease.”

What makes older women more vulnerable to anxiety and depression?

Studies suggest a variety of factors, including hormonal changes and the increased effects of stress. In the journal Nature Aging, Paula Rochon, a professor of epidemiology at the University of Toronto, also faults “sexism,” the unfortunate combination of aging and sexism that causes women to the older ones were “less visible.”

Helen Lavretsky, professor of psychiatry at the University of California Los Angeles and past president of the American Association for Geriatric Psychiatry, suggests several topics that require further research. How does menopause affect mood and stress-related problems? What non-pharmacological interventions can promote mental stability 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 would be most effective?

How can cancer screening and cancer treatment recommendations for older women be improved?

Supriya Gupta Mohile, director of the Geriatrics Clinical Research Group at the Wilmot Cancer Center at the University of Rochester, wants better guidance on screening for breast cancer in older women, affected by health conditions. Currently, women aged 75 and over are mixed although some are healthy and some are very frail.

Recently, the US Preventive Services Task Force noted that “current evidence is insufficient to evaluate the benefits and risks of screening mammography in women 75 years of age or older,” leaving doctors without clear guidance. “Right now, I think we’re overestimating older women enough and underestimating older women,” Mohile said.

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 problems.

“For this population, it’s the decisions about who can tolerate treatment based on health status and whether there are sex differences in tolerance in older men and women that need research,” Mohile said. .

Bone health, functional health and disability

How can older women maintain mobility and maintain their ability to care for themselves?

Osteoporosis, which causes bones to become weak and brittle, is more common in older women than in older men, increasing the risk of dangerous fractures and falls. Also, loss of estrogen through menopause is involved.

“This is very important to older women’s quality of life and longevity, but it’s a neglected and understudied area,” said Manson of Brigham and Women’s.

Jane Cauley, a professor emeritus at the University of Pittsburgh School of Public Health who studies bone health, would like to see more information on osteoporosis among older Black, Asian and Hispanic women, who untreated for this condition. He 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 what methods can motivate older women to be physically active. And she would like to do more research on how older women can maintain muscle, strength and self-care abilities.

He said: “Frailty is one of the biggest problems for older women, and it is important to learn what can be done to prevent it.

KFF Health News is a national newsroom that produces in-depth journalism on life issues and is one of the main programs operating on KFF.

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