Ageing & Ignored: Why Are Older Women Invisible In Medical Research?

For decades, medical research has neglected women, particularly older women, leaving healthcare providers without critical data to manage their health effectively. In response, as per The Washington Post, the Biden administration launched the White House Initiative on Women’s Health Research, aiming to rectify these disparities. When it comes to setting priorities for the initiative focused on older women's health, what should be at the top of the list?

Stephanie Faubion, the director of the Mayo Clinic’s Center for Women’s Health, was quick to criticize the current state of research in this area when I spoke with her. “It’s completely inadequate,” she said. 

Heart Disease in Older Women

A striking example of this inadequacy is how many medications commonly prescribed to older adults, such as statins for high cholesterol, have been primarily studied in men, with the findings then applied to women. Heart disease, the leading cause of death among women, becomes increasingly prevalent after menopause. Yet, women receive less aggressive treatment than men. 

“It’s assumed that women’s biology doesn’t matter and that women who are perimenopausal and those who are postmenopausal respond similarly,” Faubion claimed. “This has got to stop: The FDA has to require that clinical trial data be reported by sex and age for us to tell if drugs work the same, better or not as well in women,” she added.

According to Martha Gulati, the director of preventive cardiology and associate director of the Barbra Streisand Women’s Heart Center at Cedars-Sinai in Los Angeles, “We’re notably less aggressive in treating women. We delay evaluations for chest pain, don’t administer blood thinners at the same rate, and perform fewer procedures, like aortic valve replacements. We’re not adequately addressing hypertension in women.”

Gulati stressed the need to understand and eliminate these biases in healthcare. She pointed out that older women are less likely to have obstructive coronary artery disease—blockages in large blood vessels—and more likely to have damage in smaller blood vessels that often go undetected. Additionally, women tend to experience more bleeding and complications when undergoing procedures such as cardiac catheterizations. Therefore, it is imperative to focus on tailored treatments for women’s unique cardiovascular profiles. 

Brain Health and Cognitive Decline

With nearly two-thirds of Alzheimer's patients being women, understanding how to mitigate cognitive decline is critical. Consider the Alzheimer's treatment Leqembi, which was approved by the Food and Treatment Administration last year after the maker reported a 27 percent reduction in cognitive deterioration in those who took the medication. A supplementary appendix to a Leqembi trial published in the New England Journal of Medicine indicated significant gender differences—a 12 percent slowdown for women vs. a 43 percent slowdown for men—rraising concerns about the drug's efficacy for women. 

Older women face a greater risk of dealing with multiple medical conditions compared to older men. Research shows that they are more likely to suffer from disabilities, autoimmune diseases, depression, anxiety, high blood pressure, and osteoarthritis, among other health issues.

"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, chief of the Division of Preventive Medicine at Brigham and Women's Hospital in Boston and a key researcher for the Women's Health Initiative, the largest study of women's health in the US.

Factors like stress from caregiving, financial strain, and menopause-related estrogen loss significantly impact women’s brain health.

Despite these challenges, women tend to be resilient and live longer than men, with an average lifespan exceeding that of men by more than five years in the United States. As people age into their 70s and 80s, the number of women surpasses the number of men significantly. Given these demographics, focusing on the health of older women is essential when considering the overall well-being of the ageing population.

Increased Vulnerability of Older Women to Anxiety and Depression

Older women are more susceptible to anxiety and depression due to a variety of factors, including hormonal changes and the cumulative impact of stress over their lifetimes. In the journal Nature Aging, Paula Rochon, a geriatrics professor at the University of Toronto, highlights “gendered ageism” as a significant contributor. This term refers to the combined effects of ageism and sexism, which often render older women invisible and marginalized in society.

Helen Lavretsky, a psychiatry professor at the University of California, Los Angeles, and former president of the American Association for Geriatric Psychiatry, points to several areas needing further research. One critical area is the impact of the menopausal transition on mood and stress-related disorders. Additionally, there is a need to explore nonpharmaceutical interventions that can enhance psychological resilience in older women. Practices such as yoga, meditation, music therapy, tai chi, and sleep therapy are potential avenues for promoting mental health and aiding recovery from stress and trauma.

The challenge lies in determining the most effective combination of these interventions to support the mental well-being of older women. 

Improving Cancer Screening and Treatment for Older Women

Cancer screening and treatment for older women need significant improvements, particularly in terms of personalised approaches based on health status. Supriya Gupta Mohile, director of the Geriatric Oncology Research Group at the Wilmot Cancer Institute, University of Rochester, highlights the necessity for better breast cancer screening guidelines tailored for women aged 75 and older. Currently, this age group is treated as a monolith, despite the vast differences in their health conditions, from those who are remarkably healthy to those who are notably frail.

The U.S. Preventive Services Task Force recently pointed out the lack of sufficient evidence to evaluate the benefits and harms of screening mammography for women aged 75 and older, leaving doctors without clear directives. “Right now, I think we’re underscreening fit older women and overscreening frail older women,” Mohile stresses.

Additionally, Mohile advises more research on safe and effective treatments for lung cancer in older women, many of whom deal with multiple health conditions and functional impairments. She also stresses the need for studies to determine who can tolerate treatments based on health status and whether there are sex-specific differences in treatment tolerability between older men and women.

Bone Health, Functional Health, and Frailty

In addition to cancer-related concerns, maintaining mobility and preserving independence are pivotal for older women's overall well-being. Osteoporosis, a condition more prevalent in older women due to the decline in estrogen post-menopause, significantly heightens the risk of fractures and falls. Jane Cauley, a distinguished professor at the University of Pittsburgh, stresses the importance of addressing osteoporosis in older black, Asian, and Hispanic women, who often receive inadequate treatment. She calls for enhanced research efforts to develop safer medications with fewer side effects for this demographic.

Marcia Stefanick, a professor at Stanford University, also stresses the need for studies that identify effective strategies to promote physical activity among older women. Preserving muscle mass, strength, and the ability to independently care for oneself are key components in mitigating frailty, a prevalent issue among ageing women.

“Frailty is one of the biggest problems for older women, and learning what can be done to prevent that is essential,” she claimed. 

The collective efforts of researchers like Mohile, Cauley, and Stefanick highlight the multidimensional challenges facing older women's health, advising tailored approaches in cancer screening, treatment protocols, bone health management, and overall mobility preservation.