Gender Inequities in Medical Care
Women often receive very different medical care than men:
- Women suffering a stroke wait longer to go to an emergency room for treatment.
- Once at an ER, women wait longer to be seen by a physician.
- After a stroke, women are more likely than men to end up in a nursing home or other long-term care institution.
- Women often become the primary care-givers for disabled husbands, while it is much less common for men to play this role for disabled wives.
- As with heart disease, women with stroke may not be treated as aggressively as men with stroke.
The Role of Estrogen
The value and risk of postmenopausal estrogen therapy is an unresolved and compelling question in need of further study:
- Animal research almost universally shows that estrogen therapy at low doses protects the brain when stroke occurs.
- However, important evidence from a recent NIH clinical trial suggests that estrogen therapy does not prevent recurrent stroke in women and can worsen outcome when stroke does strike.
- The effects of estrogen on carotid artery disease progression and on blood coagulation processes that may increase stroke risk are also unclear.
Many experts argue that "ageism" plays a significant role in whether or not older women with stroke receive optimal care:
- The medical community may be more willing and likely to aggressively treat a younger person, who is seen to have many productive years ahead, than an older person.
- Ageism also neglects the important goal of maintaining functionality and independence in the elderly.