Ageism is defined as prejudice or discrimination against a particular age group, especially the elderly. The term was first used more than 30 years ago by Dr. Robert N. Butler, the founding Director of the National Institute on Aging, to describe discrimination against the elderly within our healthcare system. But has there been improvement in the healthcare system’s treatment of the elderly population in the last three decades?
Does our healthcare system discriminate against the age group that needs it the most?
Many believe that the lack of training in geriatric medicine is the root of the problem. Often healthcare professionals, because of lack of proper training, make mistaken assumptions or have incorrect beliefs about the type of treatment an elderly patient can endure. Moreover, many doctors feel intense pressure from Medicare, managed care plans, and insurance companies, and try to pack a maximum number of appointments into a day. They may not have the time and training to adequately assess the needs and problems of older patients.
To illustrate, a recent survey of students at John Hopkins University School of Medicine, one of the premier medical institutions in the country, showed that 80 percent would admit a 10-year-old girl with pneumonia to intensive care and treat her aggressively, but only 56 percent said they would do the same for an 85-year-old woman. Exacerbating the problem, of course, is that a lack of training in the special needs of elderly patients may be a matter of life and death in many cases.
Finally, many healthcare providers conclude that serious medical problems in elderly patients are simply a matter of getting old. That attitude may result in healthcare providers missing out on opportunities to prevent, treat and enhance the lives of many elderly patients.
This problem costs society greatly
By ignoring the medical needs of the elderly, society is impacted greatly. For example, experts say that poor medical attention received by many older Americans leads to premature dependency on government subsidies or on family members who are not prepared for these additional responsibilities. Certainly such discrimination leads to increased levels of mortality and disability, but equally important is the depression and isolation that many older Americans feel when they are deprived of their ability to work, act independently, and to simply enjoy their later years.
Future generations, however, will feel the impact of improper medical care for elderly patients today. For instance, when it is believed that nothing can be done for elderly patients, research is neglected; yet when one recognizes a medical problem, research is enhanced, which obviously has a positive effect in the future.
But an even more startling statistic should alert everyone to the problem: in 2011, the Baby Boom generation will begin to turn 65. While people over 65 made up only 13 percent of the population in 2000, it is projected that by 2030, 20 percent of the population will be age 65 or older. Moreover, the total population over 65 is expected to double in the next 30 years, growing to 70 million people. Obviously, unless attitudes change a large number of people will begin to be directly affected by ageism.
Discrimination starts on the preventative level
Discrimination starts on the preventative level. Often older people are denied the kind of preventative care routinely provided to others. Although lack of awareness on the part of both physicians and patients plays a significant role in the disparity of preventative screening measures administered to older patients, findings show that doctors are less aggressive when recommending preventative measures to the elderly. For example, despite the fact that 60 percent of all cancer deaths and 80 percent of all fatal heart attacks afflict men and women age 65 and older, nine out of every ten adults over the age of 65 go without the appropriate screenings according to a 2003 Centers for Disease Control report entitled “Healthy Aging for Older Adults.”
Other signs of discrimination
It appears that older people are less likely to be screened for life-threatening diseases than younger people. Studies show that a wide range of diseases and conditions often go unscreened and undetected, including glaucoma, basic cancer tests like pap smears or mammograms, osteoporosis, and even hearing loss. In addition, the mental health of the elderly is often overlooked. Primary care doctors often miss signs of clinical depression and suicidal thoughts in older people (despite the fact that people over 65 had the highest suicide rate of any age group).
Older people are improperly treated routinely by healthcare professionals who have little or no geriatric training. Without casting blame on the system, doctors, often out of ignorance or unconscious bias, may discount or misattribute certain problems to natural aging rather than disease.
In addition, proven medical interventions for older people are often ignored, leading to inappropriate or incomplete treatment. This problem is particularly true as it relates to chemotherapy to be given to elderly cancer patients. It is commonly believed that elderly patients cannot tolerate chemotherapy, yet recent studies show that they can. Finally, older people are consistently underrepresented in clinical trials, a particularly troubling situation because many of the drugs or procedures that are being tested will be used by elderly patients, who comprise the largest segment of the population getting the diseases.
Preventing discrimination:
Ask questions.
Come to the doctor with a list of questions and concerns on paper. Try to visit the doctor with another person so that two sets of ears will hear the responses to the questions. If you cannot attend with another person, tape record the conversation with your doctor so that you can listen to his or her answers later.
Give Complete Information.
Be sure to give your doctor or other healthcare professional complete information when you visit. Don’t hold back because you believe information is unimportant or trivial — let the doctor decide what’s important. Only with complete information can the doctor give a proper diagnosis and prescribe treatment or drugs to treat your problem.
Gather Information.
Get as much information as you can from your doctor. Try to understand what he or she believes your problem to be and how it will be treated. Also, don’t neglect the Internet, which can be a fertile source of medical information. Understand as much as you can about your problem so that you can assist in your treatment.
Contact Others.
Don’t neglect to contact nurses, pharmacists, social workers and dieticians. They are important to your understanding of the treatment or the drugs you are taking, what social systems are available to help you in your time of need, and how to plan meals that will best serve you while you are undergoing treatment.
Advocate with respect.
Healthcare professionals have the medical expertise, but the service, attention and quality of care required doesn’t always come automatically. You or your loved one must often take an active role in getting the best service possible — but you must advocate with respect. Remember that the doctor or nurse is often under a great deal of pressure and while your concerns are the most important to you, the doctor or nurse has the broader responsibility of attending to the care of many other patients.
Help is available:
AARP has a wealth of information on this subject. Contact the AARP at http://www.aarp.org/, or call 800-424-3410.
Contact the Alliance for Aging Research, which has studied these issues, at http://www.agingresearch.org/, or call 202-293-2856.
Contact the National Institute on Aging at http://www.nia.nih.gov/, or call 301-496-1752.
Alan Kopit is a consumer attorney with the firm Hahn Loeser and Parks LLP in Cleveland, Ohio and a regular contributor to “Today.”