Suzanne is the Director of SHW Health Ltd, a health policy consultancy, and is an Advisor to ILC-UK. She has led projects in health policy across Europe on a number of issues including mental health, hepatitis, diabetes, cardiovascular disease in women, integrated care, ageing and health literacy and has published widely on these topics. She is a Trustee of the European Nutrition for Health Alliance and a former Senior Research Associate of the School of Public Policy at UCL.
adverse drug reaction is giving the wrong dose – women tend to have lower body weight than men and dosing regimens may only have been tested on men in clinical trial settings, so that dosing may be inappropriate for women’s body weight and metabolism. One could turn to research in the hope that evidence is emerging on how different treatments and interventions fare in older women, so that doctors can make informed choices when treating their older female patients. Unfortunately, very little research exists on how to tailor medication strategies by sex in older people, and this may be due in great part to the fact that women are still underrepresented in clinical trials, and older women that much more so.5,6 The fact that older women tend to have multiple
conditions may automatically exclude their participation from many clinical trials, but there may be other barriers to older women’s participation in clinical trials as well, be they financial, physical, cultural or psychological. Of course it is important to note that older men are also poorly represented in clinical trials: the average age of all cancer patients is 63, yet the average age of participants in clinical trials is approximately 32.7
So we are faced with a situation where the number of clinical trials is exploding (there are currently more 75 trials published every day!)8, yet our understanding of how treatments may work
and what risks they may entail in older women lags far behind. Health authorities such as the U.S. Food and Drug Administration (FDA) have called for greater inclusion of women, and of older people, in clinical trials since the late 80s. And efforts are being made by the research community, be it academia- or industry- based, to change the situation. But the requirements of clinical trial design are often difficult to match with the characteristics of the populations in which medicines will be used. As a result, the evidence base for the effectiveness of many interventions remains weak in older women, which may lead some physicians to hesitate to prescribe evidence-based drugs in older women and favour older, less effective drugs instead – even if newer agents could be safe and effective if used appropriately.
The situation is similar for the use of surgical procedures, diagnostic tests and equipment in older women. Cardiovascular disease is the most common disease in older women, however fewer women than men with suspected symptoms of acute heart
attack are referred to non-invasive testing, and fewer women than men who test positive for heart disease are referred for further testing and treatment.9,10
In conclusion, there are still important gaps to be filled in the way we deliver care, and the evidence upon which it is based, to meet the needs of older women. Closing these gaps should be considered an urgent priority is we are to offer older women an integrated response to their health care needs.
1 Wait S, Harding E. The state of health and ageing in Europe. International Longevity Centre, 2006. (http://www.ilcuk.org.uk/files/pdf_pdf_4.pdf)
2 Colley CA, Lucas LM. Polypharmacy: the cure becomes the disease. J Gen Intern
Med 1993; 8: 278-283.
3 Hofer-Duckelmann C. Gender and polypharmacotherapy in the elderly: a clinical
challenge. In: Regitz-Zagrosek (ed.). Sex and Gender Differences in Pharmacology, Handbook of Experimental Pharmacology 214: 169-182.
4 Schuler J, Duckermann C, Beindl W, Prinz E, Michalski T, Pichler M. Polypharmacy and inappropriate prescribing in elderly internal-medicine patients in Austria. Wien Klin Wochenschr 2008; 120: 733-741.
5 Schwartz JB. The current state of knowledge on age, sex and their interactions on clinical pharmacology. Clin Pharmacol Ther 2007; 82: 87-96.
6 Kim AM, Tingen CM, Woodruff TK. Sex bias in trials and treatment must end. Nature
2010; 465: 688-9.
7 Society for Women’s Health Research. Barriers to women’s participation in clinical trials and SWHR proposals solutions. http://www.womenshealthresearch.org/site/ PageServer?pagename=policy_issues_clintrials_barriersandreccommendations (accessed 22 Feb 2013)
8 Bastian H, Glasziou P, Chalmers I. Seventy-Five Trials and Eleven Systematic Reviews a Day: How Will We Ever Keep Up? PLoS Med 2010; 7(9): e1000326. doi:10.1371/journal.pmed.1000326
9 Arber S, McKinlay J, Adams, J, et al. Patient characteristics and inequalities in doctors’ diagnostic and management strategies relating to CHF: A video-simulation experience. Social Science and Medicine 2006; 62: 103-115.
10 Bird CE, Freemond AM, Bierman AS, et al. Does quality of care for cardiovascular disease and diabetes differ by gender for enrollees in managed care plans? Women’s Health Issues 2007; 17(3): 131-8.
Many of us take for granted the ability to manage our day-to- day lives without pre-planning every potential bathroom visit. For others, especially older women, this is often not the case. Sufferers of bowel incontinence (also called faecal incontinence) may go to extreme measures when faced with a privy-less trip or opt not to venture out at all. Others resort to a pre-trip laxative binge, attempting to ‘purge’ their bowel so as to avoid accidents. Significantly, many persons with incontinence suffer in silence, without seeking help of family, friends or medical assistance due to the condition being considered a taboo topic. Individuals may also be affected by significant financial burden due to the direct and indirect effects of this condition, which can be devastating for the person’s confidence, close relationships, employment and family life – consequences that do not immediately spring to mind when considering the effects of incontinence.
The control of bowel motions is maintained principally by muscles called sphincters. The two types of bowel sphincter muscle act in a coordinated manner to provide voluntary and involuntary control. Damage or degeneration of these muscles, or their assisting components, frequently occurs as a result of childbirth, which itself is the major risk factor for bowel incontinence in women, although the majority of women develop the condition several years later due to cumulative effects of the initial damage, ageing and the menopause.1
Worldwide studies indicate the prevalence of bowel incontinence in community dwelling adults ranges between 0.4–18 %,2 but this
figure increases to 26 % of women aged over 50,3 mostly likely due