The perception of older Americans as frail, dependent, and isolated may be a self-fulfilling prophecy. Ageism, this prejudice that subtly dehumanizes older people and influences the way they are treated by society, is the subject of a revealing new report published by the Alliance for Aging Research.

In Ageism: How Healthcare Fails the Elderly, the Alliance cites mounting evidence of the ways in which ageism pervades our healthcare system and prevents older people from receiving optimal healthcare. This in turn leads to their increased dependence on family and public resources, increased disability and mortality, and depression and isolation.

A crisis of training

The Alliance report concludes that the healthcare workforce does not receive nearly enough geriatric training to adequately care for the aging population. Despite the projection that elderly people will make up 20 percent of the American population by the year 2030, only about 1 in 10 medical schools in the country even requires coursework or rotation in geriatric medicine.

Turn that statistic around to see the frightening reality: medical students can conceivably graduate from a whopping 90 percent of this country's medical schools with absolutely no formal training in caring for older people. Granted, geriatrics courses may be offered as electives at a far greater rate, but an annual survey by the American Association of Medical Colleges, cited by the Alliance report, says that fewer than 3 percent of medical school graduates choose them.

The geriatrics programs that do exist are woefully under supported. More than half of geriatric program directors indicated that their programs faced an uphill battle, lacking the necessary research, faculty, trainees, and financial support to develop suitably. Despite a 1991 Institute of Medicine recommendation that geriatrics programs have at least nine faculty members, nearly three-fourths of reporting programs today have fewer than that. More than half of those programs have fewer than six faculty members.

Knowledge gap extends beyond doctors' offices

The training deficit doesn't stop at physicians. It extends to other professionals involved in providing healthcare to the elderly, including the country's 200,000 pharmacists, only 720 of whom have geriatric certifications--this despite the fact that people over 65 comprise 25 percent of those who use prescriptions and over-the-counter drugs.

Also alarming, considering older Americans' dominance of the pharmaceutical market, is the fact that people over 65 are overwhelmingly underrepresented in clinical trials to test the safety and effectiveness of those drugs. Failure to test the drugs on the people who will ultimately use them results in adverse reactions and inappropriate dosages that should be preventable.

In just one example, a study in the New England Journal of Medicine reported that older people make up nearly two-thirds of cancer patients but only one-fourth of the patients included in clinical trials for cancer treatments. The study found that reasons for low enrollment rates in clinical trials among the elderly include patient and provider misconceptions about the benefit of such treatments for older patients. Additional reasons include coexisting medical problems which can conflict with trial eligibility or make trial participation cumbersome for older patients and logistical barriers such as problems with transportation including distance and cost.

However, without an understanding of how a drug will behave in the human body, the likelihood of administering an improper dosage or producing adverse drug reactions, spike to unacceptable levels.

Lack of knowledge translates into insufficient care

Failure to adequately study the effects of treatments on older people and train their healthcare providers only helps to perpetuate the destructive myths that poor health and dependence are just a part of growing older, and prevents providers from seeking interventions that could genuinely improve older patients' quality of life.

As a result of this inadequate knowledge base, not nearly enough doctors have a thorough or even a passing understanding of the unique health issues of the elderly. Proper geriatric care requires understanding not only how to treat specific problems, but ways in which older people are truly capable of living healthy, active lives.

In the next issue of Living Longer and Loving It!, we'll talk about how ageist attitudes affect older people's relationships with their physicians.