Staying Strong

Generally speaking, how does aging differ in men and women?

Women experience some unique biological transitions, particularly menopause, which can affect bone density, body composition, and cardiovascular risk. But women also experience aging through a social lens: caregiving responsibilities, work, relationships, and financial circumstances all influence health. I think the most useful approach is to see aging as both biologic and deeply contextual.

Do all people experience cognitive decline as they age? What can women do to protect brain health?

Some cognitive changes are normal—for example, it may take a little longer to retrieve a name or learn something new—but significant cognitive decline is not an inevitable part of aging. Based on high-quality research into Alzheimer’s and vascular dementia, we know the fundamentals really matter: regular exercise, restorative sleep, managing blood pressure and other cardiovascular risks, staying socially connected, and continuing to challenge the brain with meaningful, engaging activities.

In the past decade, many assumptions about women’s health—particularly menopause and hormone therapy—have changed. Why are menopausal and post-menopausal women getting more attention now, and what findings are most important?

For many years, menopause was both understudied and undertreated. We now have a much more nuanced understanding of hormone therapy: For appropriately selected women, particularly those who are younger and closer to the onset of menopause, it can be a very effective treatment for symptoms, with benefits and risks that need to be individualized. What excites me most is the broader shift toward taking women’s health seriously and thinking proactively about bone, cardiovascular, metabolic, and cognitive health during this transition.

You practice yoga. How important is exercise for women as they age? Is cardiovascular exercise or strength training more important?

Both are essential. Cardiovascular exercise supports the heart, brain, and metabolic health, while strength training becomes increasingly important for maintaining muscle, bone, and functional independence. I also love yoga because it incorporates strength, mobility, balance, and mind-body awareness. Yoga offers some benefits for stress management, but it probably doesn’t progress strength as much as we need, compared to weightlifting. The best exercise program is varied—and, importantly, one you actually enjoy enough to sustain.

Women tend to outlive men. Is that biological or cultural?

It’s likely both. Biology appears to play a role, but health behaviors, occupational exposures, social relationships, and use of preventive healthcare also differ between men and women. Longevity isn’t simply about how many years we live; what matters is maintaining health, function, independence, and connection throughout those years.

There’s growing interest in older women living together for companionship. What do you think of this trend?

I think it reflects something very important: Social connection is a health need, not a luxury. For some women, shared living can provide companionship, practical support, and a sense of community while preserving independence. We should be thinking much more creatively about housing and community as people age. For women, older age can also offer a unique time of freedom from caregiving and work responsibilities.

Women are often caregivers for both children and aging parents in midlife. How can this affect health?

The “sandwich generation” can carry an enormous invisible workload. Women may put their own sleep, exercise, medical care, and relationships in last place for years. Part of my job as a physician is helping women recognize that protecting their own health isn’t separate from caring for their families—it’s what allows them to continue doing so, and reminds them their health and personhood matter too.

What’s your best advice for women who want to stay healthy and happy in midlife and beyond?

Start earlier than you think you need to, but also know that it is never too late. My research in aging and frailty continually reinforces how much lifestyle matters. Build muscle, move regularly, eat well, sleep, maintain strong relationships, address risk factors early, and stay engaged in things that give your life meaning. Healthy aging isn’t one intervention—it’s the accumulation of small, consistent choices over decades.