Older women’s health woefully understudied

Medical research has shortchanged women for decades. This is particularly true of older women, leaving them without critically important information.

Many drugs widely prescribed to older adults were studied mostly in men, with results extrapolated to women. Consider the Alzheimer’s drug Leqembi, approved by the FDA last year after the manufacturer reported a 27% slower rate of cognitive decline in people who took the medication. A study in the New England Journal of Medicine revealed that sex differences were substantial: a 12% slowdown for women, compared with a 43% slowdown for men. And nearly two-thirds of older adults with Alzheimer’s are women.

“It’s assumed that women’s biology doesn’t matter and that women who are premenopausal and those who are postmenopausal respond similarly,” said Stephanie Faubion, director of the Mayo Clinic’s Center for Women’s Health. “This has got to stop.”

Older women are also more likely than older men to have multiple medical conditions, disabilities, difficulties with daily activities, autoimmune illness, depression and anxiety, uncontrolled high blood pressure and osteoarthritis, among other issues, according to scores of research studies.

Even so, women outlive men by more than five years in the U.S. Which means that older women outnumber older men by significant margins. If we’re concerned about the health of the older population, we need to be concerned about the health of older women.

Late last year, the Biden administration promised to address this problem with the new White House Initiative on Women’s Health Research. Which raises the question: What priorities should be on its list for older women?

Here’s what doctors and researchers suggested.

Heart disease

Women with heart disease, which becomes far more common after menopause and kills more women than any other condition, are given less care.

“We’re notably less aggressive,” said Martha Gulati, associate director of the Barbra Streisand Women’s Heart Center at Cedars-Sinai in Los Angeles. “We delay evaluations for chest pain. We don’t give blood thinners at the same rate. We don’t do procedures like aortic valve replacements as often. We’re not adequately addressing hypertension. We need to figure out why these biases in care exist and how to remove them.”

Older women are less likely than their male peers to have obstructive coronary artery disease and undetected damage to smaller blood vessels, Gulati said. When they get procedures such as cardiac catheterizations, women have more bleeding and complications.

What are the best treatments for older women given these issues? “We have very limited data. This needs to be a focus,” Gulati said.

Brain and mental health

How can women reduce their risk of cognitive decline and dementia as they age? “We really need to have clear messages for women and effective interventions that are feasible and accessible,” said JoAnn Manson, a key researcher for the Women’s Health Initiative, the largest study of women’s health in the U.S.

Numerous factors affect women’s brain health, including stress – sexism, caregiving responsibilities and financial strain. Older women lose estrogen, a hormone important to brain health. They have a higher incidence of conditions with serious brain impacts such as multiple sclerosis and stroke.

Older women are also more vulnerable to anxiety and depression. Studies suggest a variety of factors, including hormonal changes and cumulative stress. Paula Rochon, a professor of geriatrics at the University of Toronto, also faulted “gendered ageism” in an interview in Nature Aging.

Helen Lavretsky, past president of the American Association for Geriatric Psychiatry, named several topics that need further investigation. How does menopause impact mood and stress-related disorders? What nonpharmaceutical interventions can promote resilience in older women and help them recover? What combination of interventions is likely to be most effective?

Cancer screening and treatment

Supriya Gupta Mohile, director of the Geriatric Oncology Research Group at the University of Rochester, wants better guidance about breast cancer screening for older women.

“Right now, I think we’re underscreening fit older women and overscreening frail older women,” Mohile said.

The doctor also wants more research about effective, safe and tolerable treatments for lung cancer in older women, many of whom have multiple medical conditions and functional impairments. The age-sensitive condition kills more women than breast cancer.

Bone health and frailty

Osteoporosis is more common in older women than older men, increasing the risk of dangerous fractures and falls.

Jane Cauley, a professor at the University of Pittsburgh, wants more data about the condition among older Black, Asian and Hispanic women, who are undertreated. She also wants better drugs with fewer side effects.

Marcia Stefanick, a professor at Stanford University School of Medicine, wants to know which strategies are most likely to motivate older women to be physically active. And she’d like more studies investigating how older women can best preserve muscle mass, strength and the ability to care for themselves.