“Seventy percent or more of the people we looked after were women and through that process, I started to notice potential gaps that were there in terms of our ability to care for these women … to issues related to not necessarily having the evidence that we needed to tailor the care to this group of people.”
- Dr. Paula Rochon, founding director of Women's Age Lab, Women's College Hospital, Professor of Medicine and Public Health and RTO/ERO Chair, University of Toronto
Hello, and welcome to Matters Beyond Wealth with your host, Leanne Kaufman, president and CEO of RBC Royal Trust. For most of us, talking about subjects like aging, late life, and estate planning isn't easy. That's why we're going to help get the conversation started on this podcast while benefiting from the insights and expertise of some of the country's top experts. We want to bring you information today that will help to protect you and your family in the future. Now, here's your host, Leanne.
In our rapidly aging society, women continue to make up the majority of the older adult population and live longer than their male counterparts. Despite this, health research, healthcare, and public policy have largely ignored the gendered realities of aging in Canada and the specific impact on women. The Women's Age Lab at Women's College Hospital in Toronto is out to change that. Dedicated to addressing the health inequities faced by older women, the Women's Age Lab is the first and only centre of its kind in the world. Its aim is to improve the lives of older women, ultimately driving health system and societal change through science.
Hello, I'm Leanne Kaufman, and welcome to RBC Wealth Management Canada's Matters Beyond Wealth. My esteemed guest today is Dr. Paula Rochon, Founding Director of the world's first Women's Age Lab. She's also a Senior Scientist at Women's College Research Institute, Professor at the Department of Medicine and Institute of Health Policy Management and Evaluation, and the RTO/ERO Chair in Geriatric Medicine at the University of Toronto.
As a geriatrician, her career focus has been on promoting the health and wellbeing of older adults, particularly women, and finding new ways to improve their lives through leading national and international research. Dr. Rochon is creating a space for collaboration on science driven health and societal change that will improve the lives of older adults, in particular women. And I'm proud to say that RBC Wealth Management has entered into a partnership with Women's Age Lab as we recognize and support the important work being done by Dr. Rochon and her colleagues. Dr. Rochon, thanks for joining me here today to discuss the importance of gender-based research and how this matters beyond wealth.
Dr. Paula Rochon:
Well, thank you so much for the introduction and a pleasure to be here.
Let's start out by hearing a little bit more about the Women's Age Lab and why you created it.
Dr. Paula Rochon:
Well, I think Women's Age Lab was really kind of a natural progression for me of the work I was doing. I mean, I'm a geriatrician, so trained clinically to care for older people, and also a researcher, and right from the start of my career, I was looking after a lot of women, a lot of women who were older. I started off in long-term care, and in long-term care as a geriatrician providing consultations, I looked after many women. In fact, in that context, 70 percent or more of the people we looked after were women. And through that process, I started to notice potential gaps that were there in terms of our ability to care for these women. And that related to issues related to not necessarily having the evidence that we needed to tailor the care to this group of people. So, Women's Age Lab really came out of that kind of years of experience.
Like most great ideas, comes out of lived experience and identifying needs. What are the key areas that the lab is focused on when it comes to gendered based research on aging?
Dr. Paula Rochon:
Well, when we were developing the concept we talked to many people. We had ideas about what [was] important, but there were so many things to think about. Because when you go from the idea of thinking about aging and studying that to thinking about women, you're already kind of narrowing things down. But you can imagine that that pretty well impacts everything too. It's huge. So, we had to figure out where we wanted to focus.
We have identified four areas of focus. We call them pillars. One of them is addressing gendered ageism, which is something I know we're going to talk about a little bit further. Something that maybe years ago I wouldn't have thought was quite as important as I think it is now. But that's an important piece. We're also looking at re-imagining long-term care and aging in place. That's such an important issue now where we have such a population that's aging. And most people, 93 percent or so, are actually living in their homes and living well, and they want to find out how best to maintain that. So that's our second area of focus.
The third area is around optimizing medications, optimizing therapies. Because I think just about everyone takes some sort of a medication, and we need to figure out what are the best ways to take those medications, especially for women to minimize potential problems like adverse events that don't necessarily need to happen.
And the last area that we focus on is around promoting social connections and reducing things like loneliness. I think, as you can imagine, that's an issue that's important to women—women making up the majority of older people—but I think it's an issue that we can all really relate to, especially during this whole COVID experience, what that means. And it's something that really does also impact health, even though people don't really think of it that way.
We've identified these four areas of focus, our four pillars, and the approach that we've taken is a little bit different than traditional research. We're focusing on, of course the science—and everything we're doing is based on science—but we're taking a “know, do, act” approach. We're taking that knowledge, how can we put it into practice, the doing piece, and then how can we really talk about it like we're doing today so that people are more aware and can really help advocate for the kinds of changes that we need going forward.
Well, I think you've picked four really important pillars, and each of which will resonate with our audience, I think, or at least one of which will resonate with our audience no question. Why did you think it was so important to consider the differences between women and men in these four areas?
Dr. Paula Rochon:
Well, I think we have this sort of tendency to take a one size fits all approach when we're thinking about older people. For example, they're often considered a group. We talk about older people per se, even though depending on what you call older, which is a whole other story, some people around the world say that maybe 50 is the age that we should be thinking about. Other people say 60. Some people say 65 because it's a retirement age.
I think my experience going through this process and talking to lots of people has been that older is often older than whatever you are, so it doesn't really matter what the age is, but that's older. But what people tend to do is say they lump these groups altogether as if they're all the same, and clearly there's differences by age group. But, also there's differences between women and men that need to be considered that we don't always think about.
For example, women may be more likely to experience certain kinds of conditions. For example, conditions like thyroid disease may be more common in women than men. Women tend to live longer. They live longer often than men, but they also develop, not just maybe a single chronic condition, but often multiple chronic conditions and that requires maybe not just one, but often several kinds of drug therapies. So, it's important to think of age groups where things differ, but it's also important to think about the intersection and obviously with differences between women and men, because that's important too.
I think a lot of women would be very surprised to hear that research is not done specifically on women when it comes to things like drugs, for example. And how prolific is that, that research is done either on men or just not specifically targeted on gendered point of view at all?
Dr. Paula Rochon:
Well, I think it's interesting to think that when you look at, for example, the United States, where a lot of research has come out of, and a lot of the federally funded research, it wasn't until many years ago that it was important or it was required that you needed to include women in clinical trials of drug therapies. And to me, that's amazing because I think we've sort of just mentioned that people like women, for example, may be more likely to have chronic conditions, may need particular medications and are also more likely to develop adverse drug events. And so, if those are the people that are eventually going to be using the drug therapies, you want to be sure to make sure that you're studying them, including them in clinical trials.
But the piece I found even more interesting was that it wasn't until just a couple of years ago that those same federally funded studies in the United States had to also include older people; and so you would miss women out sort of in both contexts. You miss them out from because they weren't included, but also from an age perspective; you miss out on that intersection of what we need to know about older women. That's changing, and I think we're doing a lot better in that regard. But I think it's important to think about, if you're going to be treating people in certain ways, you need to be thinking about studying them.
The other gap that I see, which I think is huge and does continue, is when people do research, whatever it is, they often, again, present information about older people—say it's over the age of 65—don't always present differences between even women or men. But it misses out on so much information about women who are of different age groups or men who are of different age groups where there may be differences that would be important to see. So, we miss out a lot of opportunity, even with data that we currently have.
Yeah, it's something that not enough of us probably are aware of, and it's so important that we're looking at this through the lens that you're speaking of, because clearly there's got to be a difference. It can't be that older female bodies react the same way to young men's bodies, but in any event, I'm not a scientist. Let's go back for a minute and talk about gendered ageism, the first pillar you spoke of. What do you mean by that term? Or what does Women's Age Lab mean by that term?
Dr. Paula Rochon:
Well, there's been a lot of talk about ageism. I think you've been hearing about that more recently, which is basically discrimination based on age. And that was a term that was developed a number of years ago actually by a geriatrician named Robert Butler. And it came out of the idea of a distaste for aging, basically. That's where that term came from.
But it wasn't until much more recently that the term gendered ageism came about, which is basically discrimination, not only based on age, but also based on your sex. And the interesting thing for women is that they face both of those, right? Older women face discrimination based on not only their age but on their sex.
And one of the things we notice is that even when people talk about ageism, they don't necessarily specifically mention this gendered ageism piece, which is that sort of dual kinds of discrimination—which I think is really important to think about. And it's not just important because it's something that happens commonly and is unpleasant, I would say, but it also is important because it's like sort of those social determinants of health things like, for example, poverty. Things that impact your health and wellbeing that are maybe not necessarily considered medical factors, but ageism and gendered aging is like a social determinant of health. It does impact your health. And so it's really important that we start talking about this and thinking about it, and raising awareness about it and finding ways to really address it.
I know you co-authored an article for the OECD specifically on that poverty question, or the financial implications of gendered ageism. Can you tell us a little bit about your thesis in that article?
Dr. Paula Rochon:
Yes. There has been a lot of interest in ageism lately, and there have been a number of national initiative and international initiatives that have been launched to start addressing this, which I think is something that's really, really good. But as I've said, often we don't necessarily think about specifically what it means for groups like women. It's also interesting to note that when we talk about ageism, or at least in our context today, we're talking about it as how it affects older women, but it also affects younger people as well too. You can understand sort of conversations around things like, oh, you're too young to have this job, or you don't have the right kind of experience. You should wait later or whatever. Happens actually at both ends of the spectrum.
But one of the things that we think about in terms of gendered ageism when we're thinking about older people is what this means and maybe how it all comes about and how it eventually impacts your health. For example, if you think about older women today, and you go back to when they were younger and perhaps going into the workforce, those women, first off, may well not have gone into the workforce because there was a lot of, I don't know if the word is pressure, but at that time, it wasn't really as socially accepted for women necessarily to go into the workforce. And if they did go into the workforce, they often needed to take time off for caregiving responsibilities or for having children, which is something that many people would want to do. And other circumstances, women actually had to do that because they weren't able to necessarily work and be pregnant or things like that.
So, women, as a result of that, would end up with less time in the workforce. Also, women traditionally earned less and maybe have been less likely to have actually been promoted. And they may not only have taken time off for caregiving for children, but as we know, women tend to be more likely to be caregivers, and that may have also impacted a need to care for other family members, relatives, or older relatives as well.
Basically in the end, when people go to retire, women have accumulated less work time and income during that time, and their pensions are less. And so this phenomena actually is one that really happens around the world. And it results, they say, in women having pensions that are more than a quarter less than a pension that a man would have. And that's not great. But then you start to think about how does that impact people later on? Because we also know that women tend to live longer than men. So, in essence, a woman is living longer with less.
But those things go on to impact your health in ways that people may not necessarily think about. And it's maybe everything from being able to afford foods that might be preferred for them for their health, or perhaps it's being able to be more engaged in activities that maybe require income that might be beneficial for their health. Or maybe it's things that you have to pay for that are not covered even by plans that we might have that are available, for example, in countries where they support people in older age.
Things like, for example, hearing aids can be super expensive. And if you don't have one and you can't hear properly, that impacts your ability to engage in conversations. It leads to isolation and further causes problems. These things that are related to gender related differences, and this idea of maybe how things like gendered ageism kind of shows up, really, really are important, not only for the way people eventually feel, but also it directly impacts their health. So, it's really, really important.
And like you mentioned earlier, not just something that people who currently might consider themselves [as] older Canadians need to worry about. Women at all stages of their career need to be mindful of the choices that they're making and that their family's making today, and what that impact could be in their aging future. A lot to consider.
Dr. Paula Rochon:
Well, I think that's very true, and I think people don't necessarily think about that. They don't necessarily think about their future. And I mean, I think that's something that employers want to also think about, but also people don't necessarily think of themselves as being people that will eventually be old. Although if all things go well, people will live long lives and will live lives well, and so we want to be able to think about that.
Exactly. Now, I mentioned at the top in the introduction, your Women's Age Lab is run out of Women's College Hospital in Toronto, but you really are aiming to be global in scope. And the UN has recognized the decade of healthy aging at a global level. Are the issues that you and the Women's Age Lab are tackling fairly universal across the globe, or are these unique to Canada?
Dr. Paula Rochon:
No, these are universal issues. They're issues that we all need to think about. For example, as you mentioned, this is now the decade of healthy aging, the 20s, which is good. I mean, at an international level, people are thinking about the importance of aging and how do we promote health and wellbeing with aging? That's something that's really important. There's also an initiative right now around addressing ageism. Ageism has also come out on the world stage because this is something that impacts people of all ages, but particularly older people—and I would argue particularly women across the world. Maybe the circumstances are different, but it's very similar kinds of things that you're seeing.
And also there's an initiative right now about medications without harm, which also specifically looks at some of the issues for optimizing the way we prescribe for older people. And again, I would argue more emphasis needed on what do we need to think about for women who may have particular issues. But this is being picked up at an international level. And I know that from our research program perspective, we're working with people in different countries, and they're all experiencing the same kinds of issues. Maybe different, as I say, different kinds of circumstances that they may be dealing with, but the issues are often very similar.
You recently released your first anniversary and impact report. Congratulations on your first anniversary.
Dr. Paula Rochon:
One or two highlights from the first year of Women's Age Lab do you think our listeners would be interested or should know about?
Dr. Paula Rochon:
Well, I think one of the first things was it's exciting to actually be launched. And as you said, to our knowledge, maybe something that's interesting and I find kind of shocking, is that we're the first research center focusing on older women exclusively that we're aware of. And we've said that in a lot of places, and nobody's really challenged us, and we haven't seen another place that has the same focus. I think that's one thing that really comes to note. This is something that's long overdue, so we're really delighted to be doing this.
Of all the things that we've done in this past year, and it has been a bit of a whirlwind, and we've done a lot, we've had so many people come forward saying, "How can we help you? How can we be engaged? What can I do?" For example, I was on the phone yesterday, phone/Zoom, with a lot of different people from different sectors just coming forward, how can we help, how we work together? These issues are so important. So that's been really interesting.
But one of the projects that I'm really excited about that we're just launching is one that's in the sphere of reimagining aging in place. And as I said, we often talk about, as people get old and aging, you often think about frailty and people who require care, but let's remember that the vast majority of people are living in their homes, more than 93 percent, and are living well and want to stay there. And so we're very interested in how do we help support people to stay where they want to be in their homes?
And we are looking at naturally occurring retirement communities, which are basically apartment buildings or condos where lots of people live. And particularly where 30 percent or more of the residents are actually older people, often women. And they have particular things that would help to enhance their ability to stay there. So, some of the issues that people may experience are related to loneliness and lack of social connections, but people are living in a building where there's lots of people. So how do we bring in supports and resources to help facilitate people getting together and creating connections that maybe they're not so easy always to make? Let's be honest. It's not always difficult to meet people in those sorts of circumstances.
And how do you encourage people to be more active? Opportunities for things that range from walking groups to whatever it is that people want to do in those buildings to help bring, not only people together, but to encourage physical activity, which is also good for health. And to help encourage people to think of what are the opportunities with aging, which is so important for people to think. We're excited to be working in this area, and doing it actually not only just in Toronto, but working with Toronto, but also working with the city of Barrie to sort of figure out how we can do this better, and how we can then help other cities think about how they might do these kinds of initiatives that will be hugely beneficial to the many older people right now, especially women, who want to find ways to continue to live lives to the fullest.
This is such a big issue. As you know, we're about to be what we call a super age society, where soon 20 percent of our population will be 65 years of age and older. And this group has so much to offer, and we need to find ways to help them do what they want to do.
And I'm sure those naturally occurring retirement communities, the work that you're doing there will just continue to grow as the need grows, as you said, not just because of the growing numbers of people over the age of 65, but all those other things you've talked about and the knock-on effects of things like social isolation and the downstream impact to healthcare and things like that. These are all such critical issues that are also closely intertwined, and I'm just so excited for the work that you're doing to recognize that in a holistic way. Well, thank you so much, Dr. Rochon, for joining us today to talk about some of these gender differences and the realities around aging, the lack of research, and the work that recognizes these differences and why all of this matters beyond wealth.
Dr. Paula Rochon:
Well, thank you so much. It's been lovely to have the opportunity to talk with you today. Thank you.
You can find out more about Dr. Paula Rochon on LinkedIn
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