When Vivien Brown got her start as a family doctor in Toronto 35 years ago, medicine treated women like small men. For drug prescriptions, the rule of thumb was to give a woman two-thirds of a man's dose, with little awareness of how her hormones and metabolism might interact with medications. For chronic illnesses such as hypertension and diabetes, women received screening and treatment recommendations based on studies conducted on men, even though women often have different symptoms and risk factors.
Fortunately, medical science is catching up with the physiological differences that can affect a woman's chances of developing a range of age-related diseases, Brown says. Women tend to outlive men, but they're at greater risk for dementia, breast cancer and osteoporosis. More men have heart attacks, but women are more likely to die from them, in part because the symptoms may be more subtle in women.
To protect themselves as they age, patients with two X chromosomes need health information tailored for them, says Brown, author of A Woman's Guide to Healthy Aging: 7 Proven Ways to Keep You Vibrant, Happy and Strong (in book stores Sept. 23).
Don't expect the usual "look slim in your 60s" tips. Instead, Brown offers evidence-based advice that could change how women feel about osteoporosis treatments, hormone therapy and vaccinations later in life.
Lifestyle changes alone cannot prevent chronic diseases, since genetics and environmental factors also play a role, Brown told The Globe and Mail. But here are five of the seven ways, Brown says, that can help older women thrive (the other two are diet and exercise, but you knew that already).
Mind your grey matter
Women are more likely than men to suffer from depression, multiple sclerosis and brain diseases such as Alzheimer's, of which 70 per cent of new cases are women – and not just because women live longer. Scientists do not know why women's brains are more vulnerable, but neuro-imaging studies have shown that men's and women's brains function differently when they're speaking, seeing, listening or just relaxing.
Women typically have stronger verbal skills, but this may increase their risk of falling through the cracks in screening tests for cognitive impairment, which tend to focus on verbal memory. Without early detection, women miss out on drugs that can slow the progression of cognitive decline if taken in the early stages. Brown urges women to talk to a doctor at the first sign of memory loss or confusion, because once they have progressed to Alzheimer's, "it's too late – you already have changes in your brain."
Long before that stage, women can protect brain health though aerobic exercise, linked to new brain-cell growth, and mindfulness meditation, which may increase brain density in an area associated with learning and memory in as little as eight weeks. The best "brain foods" include cruciferous vegetables (broccoli, cabbage, dark leafy greens), antioxidants from fruits such as blueberries and omega-3 fatty acids from fish. Brown also recommends the new MIND diet, a brain-boosting program combining aspects of the heart-healthy Mediterranean diet with the blood-pressure-lowering DASH diet.
Smoking, on the other hand, impairs brain function by restricting blood flow, while too much alcohol – more than one drink a night, occasionally two – has been linked to neurological damage.
Protect your heart
Breast cancer grabs headlines, but heart disease is the No. 1 cause of death in Canadian women. Too many die because doctors and patients have trouble recognizing heart-attack symptoms in women, Brown says. Instead of classic chest pain, women are more likely to experience discomfort in the neck, jaw, shoulder, upper back or abdomen, shortness of breath, nausea, light-headedness and fatigue. Brown urges women with these symptoms to be a "squeaky wheel" in the ER. Statistically, heart-attack outcomes are better for men than women, "because men get admitted earlier and they're treated more aggressively" with angiograms and bypasses, she says.
For prevention, Brown recommends asking a doctor about the Framingham Risk Score, which calculates cardiovascular risk based on factors such as smoking, cholesterol levels and family history. Once a patient knows her risk factors, she can go about lowering them through healthier eating, stress reduction, better sleep habits and exercise. In the early stages of heart disease, Brown says, "lifestyle changes may actually trump medications."
Osteoporosis, a dangerous deterioration of bone tissue, may not a sexy topic, Brown says, but one in four women will develop the disease, compared with one in eight men. After a hip fracture, more than 25 per cent of women will die within the first year.
Women can keep their bones strong by consuming three servings a day of dairy products, or calcium from other sources such as the bones in canned fish. Brown recommends vitamin D supplements (800 to 2,000 IU for women over 50) to help the body absorb calcium, and exercise to help maintain muscle tone and balance.
Women over 50 who fracture a wrist should ask for a bone-mineral density test to rule out bone loss. If a doctor prescribes osteoporosis drugs, "take them," Brown says, "because the reason for the medications is to decrease your risk of fracture." After one fracture, "we know that's the highest risk for another." New drugs for osteoporosis include Denosumab, delivered with a single injection every six months.
Rethink hormone therapy
Hormone-replacement therapy got a bad name after a large 2002 study found that synthetic estrogen after menopause increased the risk of heart attacks. However, at least half of the women in the study had underlying risk factors for heart disease, including smoking and obesity. Moreover, the study did not account for the timing of estrogen therapy: Many of the women started taking estrogen more than a decade after menopause.
Newer research has shown that adding estrogen around the time of menopause, between the ages of 50 and 55, does not increase heart-attack risk – and may in fact decrease it, since estrogen helps prevent plaque buildup in the arteries. Other studies suggest that women who take hormone therapy in early menopause may be less likely to develop dementia and bone loss. Some researchers have found a slight increased risk for breast cancer in women taking hormone therapy, but others have not.
Of note, hormone therapy no longer restores estrogen to replacement levels; it's equivalent to about a quarter-dose of a low-dose birth-control pill. For women in midlife, it's no longer a question of "pro- or anti-hormone," Brown says, but their age, health status and menopause symptoms: "It depends on the person."
Vaccinations aren't just for children; in older adults, they can prevent debilitating illness and premature death. Take shingles, for example. One in two Canadians who live to 80 will get this infection of the skin and nerves, caused by the chickenpox virus. In people over 50, the shingles vaccine can cut the risk of long-term nerve damage and nerve pain.
Meanwhile, pneumonia and flu vaccines can save your life. Pneumonia and flu combined are the sixth leading cause of death in Canada. But over the past 30 or 40 years, despite antibiotics, respirators and other hospital treatments, "we haven't reduced mortality rates," Brown says, noting that the majority of deaths are in patients over 65. Even if it doesn't kill you, pneumonia can lead to permanent lung damage, "so you may not go back to biking, hiking and all the things you like to do if you've had a bad case of pneumonia."
Sexually active women of any age should also consider the HPV vaccine to prevent cervical, anal and oral cancers from the human papillomavirus (which causes genital warts). While cervical cancer peaks in women in their 30s and 40s, researchers have documented a second peak in women in their 70s.