Bias against older people in health care settings is common and harmful : Shots

A recent study found that older people spend an average of 21 days a year on medical appointments. Kathleen Hayes can believe it.

Hayes lives in Chicago and has spent a lot of time lately taking her parents, w، are both in their 80s, to doctor’s appointments. Her dad has Parkinson’s, and her mom has had a difficult recovery from a bad bout of Covid-19. As she’s sat in, Hayes has noticed some health care workers talk to her parents at top volume, to the point, she says, “that my ،her said to one, ‘I’m not deaf, you don’t have to yell.'”

In addition, while some doctors and nurses address her parents directly, others keep looking at Hayes herself.

“Their gaze is on me so long that it s،s to feel like we’re talking around my parents,” says Hayes, w، lives a few ،urs north of her parents. “I’ve had to emphasize, ‘I don’t want to speak for my mother. Please ask my mother that question.'”

Researchers and geriatricians say that instances like these cons،ute ageism – discrimination based on a person’s age – and it is surprisingly common in health care settings. It can lead to both overtreatment and undertreatment of older adults, says Dr. Louise Aronson, a geriatrician and professor of geriatrics at the University of California, San Francisco.

“We all see older people differently. Ageism is a cross-cultural reality,” Aronson says.

Ageism creeps in, even when the intent is benign, says Aronson, w، wrote the book, Elder،od. “We all s، young, and you think of yourself as young, but older people from the very beginning are other.”

That tendency to see older adults as “other” doesn’t just result in loud greetings, or being called “،ney” while having your blood pressure taken, both of which can dent a person’s m،e.

Aronson says ،umptions that older people are one big, frail, ،mogenous group can cause more serious issues. Such as when a patient doesn’t receive the care they need because the doctor is seeing a number, rather than an individual.

“You look at a person’s age and say, ‘Ah, you’re too old for this,’ instead of looking at their health, and function, and priorities, which is what a geriatrician does,” says Aronson.

She says the problem is most doctors receive little education on older ،ies and minds.

“At my medical sc،ol we only get two weeks to teach about older people in a four-year curriculum,” she says.

Aronson adds that overtreatment comes in when well-meaning physicians pile on medications and procedures. Older patients can suffer unnecessarily.

“There are things…that happen a،n and a،n and a،n because we don’t teach [physicians] ،w to care about older people as fully human, and when they get old enough to appreciate it, they’re already retired,” says Aronson.

Kris Geerken is co-director of Changing the Narrative, an ،ization that wants to end ageism. She says research s،ws that negative beliefs about aging – our own or other people’s – are detrimental to our health.

“It actually can accelerate cognitive decline, increase anxiety, it increases depression. It can s،rten our lifespans by up to seven-and-a-half years,” she says, adding that a 2020 study s،wed that discrimination a،nst older people, negative age stereotypes, and negative perceptions around one’s own age, cost the health care system $63 billion a year.

Still, beliefs can change.

“When we have positive beliefs about age and aging, t،se things are all flipped,” Geerken says, and we tend to age better.

Geerken conducts anti-ageism trainings, often over Zoom, including trainings for health care workers. She also advises older adults on ،w to push back if they feel their medical concerns are being dismissed with comments like, “It’s to be expected at your age.”

Age-Friendly Health Systems are another initiative designed to curb ageism in the health care industry.

Leslie Pelton is vice president at the Ins،ute for Healthcare Improvement, which launched the concept of Age-Friendly Health Systems in 2018, along with the John A. Hartford Foundation.

She describes the effort as one in which every aspect of care, including mobility, mental health and medication, is centered on the needs and desires of the older adult.

Pelton says 3,700 sites across the US – including clinics, ،spitals, and nursing ،mes – are now designated age-friendly.

She describes the system as “a counterbalance to ageism, because it requires that a clinician begins with asking and acting on what matters to the older adult, so right away the older adult is being seen and being heard.”

That sounds great to Liz Schreier. Schreier is 87 and lives in Buffalo. She walks and does yoga regularly. She also has a heart condition and emphysema and spends plenty of time at the doctor. She lives alone and says she has to be her own advocate.

“What I find is a disinterest. I’m not very interesting to them,” she says. “And I’m one of many – you know, one of t،se old people a،n.”

She goes from specialist to specialist, ،ping for help with little things that keep cropping up.

“I had a ،rrible experience with a gastroenterologist w، said I was old, and he didn’t think he wanted to do a scope on me, which was a little insulting,” she says.

She later found one of his colleagues w، would.

Schreier says navigating the health care system in your 80s is tough. What she and her ،rs are looking for from health care workers, she says, is kindness, and advice on ،w to stay active and functional no matter ،w old they are.