Dr. Paula Rochon is a geriatrician who is recognized for her work to focusing on dementia management of older adults, especially women. She is a senior scientist and the vice-president of research at Women’s College Hospital. Dr. Rochon leads Women’s Xchange, a research and exchange centre focussing on improving women’s health. She is also a professor at the University of Toronto in the Department of Medicine and Institute of Health Policy Management and Evaluation.
We were fortunate to be able to interview Dr. Rochon about her work and ask her questions about her work.
1. What brought up the issue of a need for dementia management research for different sexes?
It is important to consider sex and gender dimensions in all research because these factors serve an important role in affecting a patient’s health, their risk factors, how they experience health care and how health-care professionals provide care. When research studies do not report differences between women and men, we are left with a less valuable view of best practices for proper prescribing techniques, effective treatment methods and outcomes. Research that incorporates and reports data reflective of the whole population benefits everyone. As the Lead of Women’s Xchange, a knowledge translation and exchange centre based at Women's College Hospital designed to promote the development of women's health research across the province, it is a priority for myself and my team to reinforce the need to integrate sex and gender into research. With regards to dementia specifically, it is a condition that disproportionately impacts women. The burden of caregiving also falls more heavily on women, who are more likely to provide care for a parent, relative or spouse with dementia.
2. How is the care for older women with dementia different from men? What are some ways to improve the quality of care of different sexes?
Some of the work that we have done suggests that women are prescribed slightly lower doses of dementia medications relative to men. This may be because women require a lower dose to reduce the development of adverse events. Women generally live longer than men, which means that more women are living alone and may not have someone to provide care for them. This may explain in part why there are substantially more women than men in long-term care homes.
3. How have you seen the treatment of older adults improve over the years?
Over the years, there has been a growing recognition surrounding the importance of sex and gender considerations in research. Having better evidence that is tailored to women and men will result in better treatment for all Canadians. The inclusion of a sex-and-gender lens in health research creates evidence-based, effective and appropriate health-care policies for all.
4. What is the most important factor in improving the care of older adults with dementia?
Many older adults want to remain in their homes. For this to happen, we need a lot more support in the community, particularly when it comes to caregivers. Caregiving has become increasingly taxing as many untrained people are providing medical and nursing care, assisting with daily living, and navigating the complexities of the health and long-term care system. As well, caregivers often provide financial support to their loved ones and may miss out on full-time employment, raises and other monetary benefits. Improving care for older adults with dementia starts with our caregivers.
5. What are prescribing cascades? What would you suggest doing to improve the issue of prescribing cascades?
Prescribing cascades occur when a drug therapy leads to an adverse event that is misinterpreted as a new medical condition. This leads to the prescribing of a new drug therapy that may not be required. Prescribing cascades are particularly common in older adults, in part because they are a group that have more medical conditions and therefore may be prescribed more drug therapies. Prescribing cascades have also been identified with the drug therapies that are frequently used to manage dementia. One example is cholinesterase inhibitors, leading to incontinence, leading to the new prescription for a urinary anticholinergic.
For more information on recognizing and managing prescribing cascades, you can access an article I co-wrote in the Lancet.
