By Patricia Nicholson

One of the clear messages from the newly released POWER Study on older women is that aging is a women’s health issue.

The proportion of older adults in Canada’s population is expected to almost double in the 50-year period from 2005 to 2056, making care for older people a health-care priority. As the report makes clear, the older population is not only growing steadily, but is also predominantly female. Women still tend to live longer than men, so they make up a larger proportion of people over 65, and even more so in older age groups.

“As you get older, the majority of older people are in fact women, so it’s really important to think about their needs in particular because they are the group that are going to be driving the health-care system,” says Dr. Paula Rochon, vice-president, research at Women’s College Hospital, senior scientist at Women’s College Research Institute, and one of the investigators for the Older Women’s Health Report, the latest chapter of the POWER (Project for an Ontario Women’s Health Evidence-based Report) Study, a comprehensive study of women’s health in Ontario. 

High disability from chronic conditions

For example, the study found that older women are more likely to report disability or chronic pain than their male counterparts. In Ontario, 44 per cent of women ages 65 and over had some kind of limitation in their daily activities, compared to 28 per cent of men. More than one-quarter of older women (26 per cent) reported that pain limited their activities, compared to 18 per cent of men.

A high proportion of these disabilities were linked to chronic conditions such as heart disease, osteoarthritis, COPD and diabetes.

“We find that while women outlive men, they often live with more than one chronic condition,” Dr. Rochon says.

Some of the challenges this presents for health care are highlighted in the study, which links chronic conditions with high rates of hospital admissions that may have been avoidable. These hospitalizations were especially high in women, and increased with age.

“We need to find better ways of managing these conditions so that people are staying in their homes, which is where they tend to want to be. Because people often have more than one issue, we need to think about a system of care that isn’t fragmented,” Dr. Rochon says.

Changing issues require changing care

When patients have to go to different health-care facilities and different health-care providers for multiple chronic conditions, care can be difficult to manage. One of the POWER Study recommendations is to develop new, integrated models of care that can address complex needs. 

“When you recognize that people have multiple medical problems, people can come with their problem and help get it managed,” Dr. Rochon says, using the example of the Complex Care Clinic at the Centre for Ambulatory Care Education, which provides care for people with multiple chronic conditions.

A multidisciplinary team of different health-care professionals can also help people with complex needs. A team that combines physicians, dietitians and therapists can help patients manage their conditions in the community.

There is also a need to promote research that helps to build knowledge and expertise in these areas.

“We know a lot about how to manage heart failure. We know a lot about how to manage diabetes. But we know much less about how to manage people who have more than one condition, which is something that we see commonly in people as they get older – and particularly in older women,” Dr. Rochon says.

“From a research perspective I think there’s an opportunity to provide more information on how to best do that, and to evaluate the programs that we put in place to see what works.”

Inactivity common in older women

The study results also demonstrate that there are opportunities to try to address older women’s health at a number of different levels, including promoting healthier lifestyle choices in the population. The study found many older people may not be pursuing the types of behaviours that might improve their chances of having a healthy life.

“What was striking was that half of older adults reported that they were really inactive, and that this was something that was more common in women than men,” says Dr. Rochon. “There was also a problem across the board where people were not necessarily having the kind of healthy diet that we might recommend in terms of intakes of fruit and vegetables.”

The study found 60 per cent of older women and 48 per cent of older men were physically inactive, and both men and women had inadequate fruit and vegetable intake. However, fewer than half of older adults made changes geared toward improving their health in the past year.

Health in context

The POWER Study reports are designed to provide a comprehensive overview of women’s health in Ontario, including how health issues relate to factors such as income, ethnicity, education and geography.

The results suggest that socioeconomic factors may magnify health issues. For example, physical inactivity is more likely to affect older women in lower socioeconomic status groups compared to those in higher socioeconomic groups.

One issue that may be affected by economic factors is dental care. The study found that 45 per cent of older adults, and more than half of those ages 80 and older, had not seen a dentist in the last year.

“People don’t always jump to dental care as something that is top-of-mind,” Dr. Rochon says. “But one of the things we point out in this report is that if you don’t have good oral health, it reflects your ability to have good nutrition, which is one of the things that we’re concerned about. So it’s one of the prerequisites to good health.

“Close to half of older people didn’t get to a dentist in the past 12 months, which is a problem. And that also can be related to socioeconomic status because dental health, unlike a lot of the health-care services that we get as part of our universal health-care system, is not covered. So that can relate to the ability to pay, and older women may be disadvantaged in that regard.”

Future needs

In terms of addressing the health-care needs of older women, now and in the coming decades, the report highlights several issues. The first is related to human resources in health care.

“One of the things the report shows quite strikingly is, for example, there are very very few geriatricians,” Dr. Rochon says. “Despite the fact that we have an aging population, and one that’s projected to continue to age over time, we’re not really set up for it from a health-care professionals point of view.”

In addition to the low number of geriatricians, the report also demonstrates a need for further training for all health professionals in how to care for older people.

Another major issue highlighted in the POWER Study is the way health care is organized.

“We tend to have models that are focused around the acute care setting,” Dr. Rochon says. That means that many aspects of our health-care system tend to function around immediate treatment of illness or injuries in hospitals, often on an in-patient basis. This model is not well equipped to treat ongoing health issues of people living in the community, such as older people with chronic conditions like diabetes or osteoarthritis.

“We need to think about the fact that we have a lot of people who have chronic problems who don’t necessarily require hospitalization. The goal is how to keep them healthy in their homes, working with our community partners,” Dr. Rochon explains. “So there’s a big opportunity there for places like Women’s College – places that are ambulatory – to find ways to provide care that is interdisciplinary, that focuses on the patient and their needs to help keep them in the community.”

You can learn more about the Older Women’s Health Report at the POWER Study website.

Read more POWER study articles:

On C-section and hysterectomy rates in Ontario

On rising rates of diabetes in younger women

On musculoskeletal conditions

Read more on older women's health needs:

Caregivers' role in seniors' care