Reclaiming the Narrative of Aging for Older Women with Dr. Paula Rochon
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Are older women seen and heard in healthcare? Why do drug therapies often fail to account for their specific needs?
ICES scientist Dr. Paula Rochon joins us to discuss the groundbreaking work of the Women’s Age Lab and tells us how her research tackles unique health challenges faced by older women, such as polypharmacy (taking more than five medications) and social isolation. Dr. Rochon also uncovers the gender gap in aging studies and advocates for a future where older women are not only visible but where their health and well-being are prioritized, paving the way for healthier and more fulfilling lives.
TRANSCRIPT
Misty Pratt
The fastest growing population in Canada is individuals 85 years or older, and over half of them are women. Older women are more likely to live longer, on average, four years longer than men, and they are also more likely to develop multiple chronic health issues and to live below the poverty line. At a time when menopause and other issues related to reproductive health are having a moment in science, media and pop culture, health issues that affect older women have gone unrecognized, but that is slowly changing. Thanks to the work of the Women’s Age Lab at Women’s College Hospital in Toronto, the lab is the first and only center of its kind in the world, and is a space for science-based research and collaboration that improves the lives of older women. Joining us today is Dr. Paula Rochon, Founding Director of Women’s Age Lab, and senior scientist at ICES. Dr. Rochon is focused on promoting the health and well being of older adults, particularly women, and finding new ways to improve their lives. She has published over 300 papers in peer-reviewed journals and is creating a space for collaboration on science driven health and social change that will improve the lives of older adults, specifically women.
Paula Rochon
Women, but particularly older women, often feel that they’re kind of invisible, that they’re not really recognized, they’re not really seen, and that their issues are not really given the attention that they need. And I guess one of the obvious things that we think about going forward is we want to make sure that women, and particular older women, are groups that are visible and we are thinking as we should, about the important issues that are important to improving their health and well being.
Misty Pratt
Welcome to In Our VoICES the podcast that takes you beyond the data to meet the people and hear the stories that help shape health and health care for all of us. I’m your host, Misty Pratt, and I’m one of the people behind the data who make the difference at ICES, a health research data and analytics institute based in Ontario, Canada. ICES staff, scientists and partners are on a mission to make healthcare better and people healthier. In this podcast, we share our stories in our voices. A note that the opinions expressed in this podcast don’t necessarily reflect those of ice. Dr Paula Rochon, welcome to In Our VoICES.
Paula Rochon
Thank you so much, Misty. Pleased to be here.
Misty Pratt
So first, I want to ask you if you could define what older woman means because I think if you ask different people, some would say 50 is older, and others might say 75 plus is older. So is there a consensus in the field?
Paula Rochon
No, I don’t think there’s a consensus. You know, in Canada, we often think of 65 because that’s sort of the traditional kind of age of retirement. When you think about that, in Canada, we have, you know, about 20% of our population that’s in that age range right now, mostly women. So it’s like over 7 million people. So a very big group. But if you look internationally, for example, the WHO is using an age range of about 60 when they’re looking at older people. And you think about that, I mean, there’s, like, a billion people in that category around the world right now, mostly women. But I think, you know, what we call old varies, and some people say it’s always older than where you were at. So lots of different ways of thinking about it.
Misty Pratt
Absolutely. What are older women telling you about their experience of aging, particularly in our culture?
Paula Rochon
Older women today are maybe perhaps different than older women in the past. And women are telling us that they really care about, you know, their health and their well being. And they want to know, what are the things that they can do to kind of help maintain their health, how to maintain their well being as they get older. They really want to know, you know, what are the things that they could potentially do? Because people are interested not just in living longer, but how to live longer well.
Misty Pratt
And is there information out there for them? Is there enough that they can go and find what they need to be able to live a longer, healthier life?
Paula Rochon
I don’t know that there is. I mean, the things that people care about is they want to be able to remain independent. You know, most people say they want to be able to age in their homes, and they want to find ways to be able to do that. They’re thinking about affordability, you know, as they sort of move into the retirement years, especially for women. You know, this is that big issue, often more of a challenge for women than it is for men. People want to think about these things and how do they maintain their social connections as they get older? Because it is about this whole idea of health and well being.
Misty Pratt
And so how are women getting left out of research? Health Research, specifically, because we know there’s a gender gap in research across the board, but it does appear to be a particular issue for older women.
Paula Rochon
Well, I always interested, sort of, if you go back historically, to think about how women got left out of research. So, you know, I always talk about, for example, in the United States, the NIH which has been their major funder of research. You know, it wasn’t until the 1990s that you had to have women included in research that was funded by the federal funding agencies. You know, that’s one thing to think about. But the other piece is that it wasn’t until just a couple of years ago that older people had to be included in research. So you could imagine research funded by the federal funding agency. So you can imagine that intersection of women who are older, you know, really kind of got missed out over a very long period of time, and that’s really only changed fairly recently. And so then you play out, you know, what are some of the things that have happened as a result of that? You can imagine, for example, drug therapies. We do a lot of work related to, how do you optimize use of drug therapies for older adults through what we do at ICES, for example. But you can imagine that, for example, drug therapies might have been designed sort of thinking of people who were younger and not necessarily women. But you know that, for example, doses need to be different. Often women require lower doses than men, or dosing may change with age. And if you haven’t considered those things, it means that in the end, people who are getting those therapies may not be getting exactly the right dose for them. So this sort of issue goes way back in terms of who was included in research, for example, and then it has implications for what we’re seeing now today.
Misty Pratt
And it sounds like if we’re lumping, you know, say 60 is the cutoff or 65 if we’re lumping all those groups together, perhaps somebody who’s 65 has a very different body than somebody who’s 85 so these drug therapies might be working differently for those both those groups. Is that true?
Paula Rochon
Well, that’s another piece that I think we really need to be much more thoughtful about. So for example, often you’ll see information presented about people over the age of 65 as a single group. And as you’ve just said, a 65 year old is different than an 85 year old. That’s a big span of age and women are different than men, so you have a lot of differences there. But for example, if you look at data reported sort of from places like Statistics Canada or places like that, often it’ll be a whole lot of age groups and then 65 plus. So whether you’re a male or female or you’re 65 or 85 you’re all grouped together in this one category. And we lose information. You know, one of the things that we really have been advocating for is, when you’re studying groups, to think about collecting information by, for example, five year age groups. So you can look at patterns that might evolve, and then also disaggregating by, at least by sex. So you’re looking at male and female and other intersecting factors. And as a result of that, you start to see patterns emerge that you might otherwise miss. People on our team, Joyce Lee and Robin Mason, have created a module, a learning module, to help people think about how you should incorporate this, for example, into the planning of your research and ideally the recording of the information, so that you can make it much more relevant to so many people who are in this older age range and are not all the same. You know, it also strikes me that when you think about what happens in the under age groups, you know you have infants and you have toddlers, and you have children, you know sort of people who are children, and you have teenagers, and then you have young adults, and then you have mature adults. You have all of these different groups. And it just doesn’t seem right that you have one group for everyone over the age of 65 so I think we have to think about how to break these things down a lot more so that we can get much more value out of the data that we potentially have.
Misty Pratt
One area that the women’s age lab focused on is social connectedness. What has your research found about older women and loneliness?
Paula Rochon
Well, this is work that’s been led by Rachel Savage in our group and people are now becoming much more interested in the idea of, first off, recognizing that there is a lot of loneliness, but also thinking about, how do you promote things like social connections to reduce loneliness? And loneliness is something that I think we all experience, doesn’t matter what age you are, probably during the COVID-19 experience, a lot of us particularly felt that when we weren’t able to connect with people that we normally would. So it’s an issue that really affects so many people, especially women. And one of the reasons why we’re focusing on this for women, and especially older women, is that they may feel this kind of disproportionately. You know, a lot of women are probably more likely than men to live alone, and about 40% of those who live alone say that they’re lonely. You can imagine when you’re thinking about women and aging, women tend to live longer than men. Often they marry individuals that are younger than them, and as a result of that, women may be more likely to end up in a circumstance where they are alone. So this is something that is a problem and common in something that we really need to think about – how to address it in so many different ways.
Misty Pratt
And given that we’ve been hearing about loneliness so much now in the media, is loneliness something that is worsening with time? Are there other social factors that are affecting the experience of loneliness?
Paula Rochon
I think it is something that maybe is perhaps more common than you might have thought about in the past. For example, think about how families are currently designed. You know, in the old days, it was the thought that families would live a bit closer, and there was a lot more thought around intergenerational living as an example. So you’d have, maybe it might be the grandparents living with the parents living with the children. So people were, you know, perhaps was more common to have that kind of experience. But now, if you think about our families often, you know, children are off living in Europe, living in, you know, different parts of the country. They’re not necessarily sort of in the vicinity of where you are. You lose maybe some of those connections that might have been perhaps more common in earlier days. So that’s one of the things that I think has perhaps changed now. I think you could also think about us here in Canada and the way, you know, we are in this huge country, and a lot of people live in houses that are maybe not close to each other, or they live in rural neighborhoods, unlike other countries, like for example, if you’re looking at places like Europe, where people are more likely to be living in very close proximity, where houses are all connected, where there’s sort of a lot more maybe walkability in some of these areas, and maybe access to sort of things closer at hand. So for example, shopping is really close to home, and you have a much, maybe much easier to have a sensor community. So I think those are things that are different than they were in the past, and maybe some things that are a little bit more unique to our environment.
Misty Pratt
Another issue that you’ve worked on is polypharmacy. Can you tell us what polypharmacy means and why it impacts older women more than other groups?
Paula Rochon
So we’ve talked a lot about drug therapies, and in particular the issue of polypharmacy, and not so much polypharmacy, but also potentially inappropriate polypharmacy. So generally, it’s defined well, it can be defined in many different ways. There’s many, many different definitions of polypharmacy, but probably the most common one is thinking about people who are on or using five or more medications. So multiple medications. Now this is an issue, especially for women, perhaps because women with age tend to have more chronic conditions than men. So you might imagine that they may need different medications to help manage those chronic medical conditions. We also know that women are more likely than men to experience adverse drug events, and so perhaps susceptible to some of maybe the adverse events that might be associated with some of these medications. So this idea of multiple medications is really important for all people to think about older younger people in terms of how to manage them. But they may be something that are particularly important for older women, because we need to think about, how do you make sure that they’re on the medications that are appropriate for them? And to you know, be watching out for potential adverse events that could be managed.
Misty Pratt
What are the questions they should be asking? Perhaps a family doctor?
Paula Rochon
Well, I think it’s really important for people to make sure that they keep a list of their medications, you know, so they should know what medications they’re on, and they should also know who started the medication and why it was started. Because even though people, you know, using electronic records have lists of the drug therapies, they don’t always have all of this information. And you know, often medications have been started, like, a long time ago, and so you forget kind of what. The whole rationale was so I think it’s important to have this information and to make sure that you’re aware of all these things. And then I think it’s also really important for people to make a point of having their medications reviewed on an ongoing basis, so it could be with the pharmacy, with the physician, somebody who has had the time to go through, what are these medications for, and then to determine if they’re still needed, they’re still needed the same dose, you know, what we should be doing with these medications. So it’s important, I think, for patients to ask about the medications. You know, do I still need this medication? Do I still need it the dose that is currently being prescribed? These are important things and important conversations to have on an ongoing basis.
Misty Pratt
So they might be prescribed by perhaps several different specialists, so that perhaps the family doctor isn’t even the one that prescribed them in the first place, and that’s why they’re needing to ask a single person to take a look at the whole picture.
Paula Rochon
People have primary care physicians, which is great, and they often see specialists, or they may end up being in hospital or going to emergency rooms, and so other medications may be added. So it’s just important that everyone has the same picture that they’re looking at and able to go back and reflect on who prescribed what and why those medications were were prescribed at that time. It can certainly lead to something we’ve talked a lot about in our work called prescribing cascades. And that’s where an individual gets a drug therapy, some time later, some new problem emergence looks like a new medical condition, and another drug therapy is prescribed to treat that new medical condition. So there’s lots of examples of these out there. So for example, one of the examples of a prescribing cascade is somebody is put on and on a diuretic, the medication for maybe it’s managing blood pressure or some other thing, and over time, they may start presenting with something that looks like gout, so they’re having a lot of pain and discomfort as a result of that, and put on a new medication to treat the gout as an example. But what we have learned is that sometimes diuretics, especially thiazide diuretics, can impact uric acid levels, which can predispose to gout. And the question would be, you know, rather than treating the gout, if you went back and looked at whether this diuretic was needed in the first place, you may not have those episodes. I remember a long time seeing a patient who I was asked to see about management of their gout. Very, very painful for this woman at the time, and then thinking about what arena prescribed to try to treat this. And it took a while before we realized that, you know, she had developed some swelling of her legs, some mild swelling, and the decision had been to put her on a diuretic to manage this relatively mild swelling. And then some time later, she would develop this episode of gout that was very painful for her, and would be looking at medications to treat that. But we realized that this swelling was quite mild and it could be managed with sort of non pharmacologic kind of approaches and some simple things like some leg elevation and acute things like that. And she didn’t really need to have the diuretic and was quite comfortable. And with that kind of intervention, we then didn’t need to she didn’t need to have those painful episodes and didn’t need to have the subsequent therapy. So it’s really important when you’re looking at medications, to think about whether these sequences could have occurred, because that can give you some different options in terms of how you might better manage the medication. So always something to keep in mind.
Misty Pratt
And does it affect more women prescribing cascades?
Paula Rochon
There’s a concern that it might in some cases, one of which is because women tend to perhaps use more medications. And man, although there’s a little bit of controversy about that, and women are perhaps more likely to experience some adverse events, so that could predispose them to having those more often.
Misty Pratt
And so moving on to the data that you’re using to look at these issues, which is held at ICES, how does that data support the work of the Women’s Age Lab?
Paula Rochon
Well, it’s very important to have data from places like ICES. I mean, ICES has population level data. It’s a wonderful resource, because for the work that we do, we have information about everyone who’s over the age of 65 living in the province of Ontario, and we’re able to look at males and females, and we’re able to look at all the different age groups, and we’re able to look at those various different intersections that we spoke about. So it’s an incredible resource. It’s also provides a wonderful opportunity to look at, for example, how drug therapies, as one example, are being used by older adults in the community, not just at the clinical trials that were used originally to evaluate these drugs, but how they’re actually being used in sort of what we might consider to be a real world or population level setting. And you know here are in Canada, where over the age of 65 older adults have their medications provided through the Ontario Drug Benefit Plan. It allows us to see all of these different things that are being used by older people, and to look at all of the various different circumstances you know, their issues, their providers. Look at if they have hospitalizations, emergency room visits. It just provides an incredible wealth of information. I think we’re so fortunate to have access to these data, and also, over time, ICES has built up incredible expertise at how to use these data, and so when you’re looking at complex problems, it’s just such a wonderful team to be able to work with so that we can get the kind of information that’s going to be most helpful.
Misty Pratt
How can we explore gender within the data?
Paula Rochon
Well, it’s interesting because, you know, for example, when you’re looking at you’re putting in a grant proposal, you know, CIHR, our federal funder, asks that you describe how you’re considering sex and gender in the work that you’re doing. And so there’s a section where you need to talk about these issues and clearly using ICES data, we’re able to get at whether people are male or female, because we have that information. We don’t have information about gender identity. So often I see when people write these sections, and they’re using administrative data, data like we have here in Ontario, they’ll say, I can report sex, but I can’t talk about gender. But that’s not really true, because there’s a whole piece of the sociocultural components of gender that are so important. So it might relate to differences where there is information potentially available in large databases. So for example, you could get pieces that relate to things like education. You know, in general, historically, older women have had less education than men in some databases, not ICES. You can get that kind of information at a population level. You can also get information about income to some extent, and again, that is related to gender. Women are more likely than men to have lower incomes. And that’s something that happens for a whole variety of reasons, but can impact, you know, health going forward. Now in ICES, we have the ability for older adults to look at people in the Ontario Drug Benefit Plan who maybe have lower income. So there’s that opportunity to look at income, or you can look at neighbourhoods where people are living, which is another opportunity to look at something that is a gender-related sociocultural factor. So I think even though some of these pieces of data are not obviously available in some of the databases, I think we have to think creatively about how we can explore these really important components that do impact health using the data that we have. And so I think there are opportunities with the ICES database, and there’s also opportunities with some of the larger population level databases as well.
Misty Pratt
Yeah, fascinating. Looking to the future. What do you hope will change when it comes to women in healthy aging?
Paula Rochon
I guess one of the things that we say and we feel is that women, but particularly older women, often feel that they’re kind of invisible, that they’re not really recognized, they’re not really seen, and that their issues are not really given the attention that they need. And I guess one of the obvious things that we think about going forward is we want to make sure that women, in particular, older women, are group that are visible, and we are thinking as we should about the important issues that are important to improving their health and well being. So we want to really make sure that this group is visible. And one of the other things that you know, you think about, as I said earlier in that conversation, that we’re about to become what they call a super age population. 20% of the population is over the age of 65 and the majority of them are women. And we need to have a strategy. How do you promote health and well being with aging, particularly thinking about women, not just everyone as a whole, but thinking about particular groups. And so I think this is something where there’s a big gap, and when you have it sort of as part of a strategy, then you know things sort of fall into place. So I think this is something really important for us to think about going forward. Something that’s kind of concrete and something that I think we we could really do. And then the other piece that we always say is, you know, we often forget the obvious thing when we talk about aging. You know, this is something that impacts all of us, and so it’s something that should matter to all of us. It’s not something that’s just out there in the future. You know, if we’re lucky, we’re all gonna we’ll get there, but it should be something on all of our agenda, so want to raise awareness about that.
Misty Pratt
Really appreciate you being here and telling us about your work.
Paula Rochon
Well, thank you so much. It’s a pleasure to be able to talk with you
Misty Pratt
To learn more about Dr. Paula Rochon research. We’ll link to the Women’s Age Lab in our show notes. You can also visit the ICES website ices.on.ca and search for Dr. Rochon in our scientists’ tab.
Misty Pratt
Thanks for joining me for this episode of In Our VoICES. Please be sure to follow and rate us on your favourite podcast app. If you have feedback or questions about anything you’ve heard on In Our VoICES, please email us at [email protected], and we’ll be sure to get back to you. We might even share your feedback on a future episode. I’m Misty Pratt and wishing you strong data and good health!
