Date: October 1st, 2003
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 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.
In the last issue of Living Longer and Loving It! we talked about how the healthcare workforce is sadly lacking geriatric training. From physicians to pharmacists, the providers with whom elderly patients have regular contact and in whom they place their trust are unprepared to deal with the unique health issues these patients face.
But what does this mean for the elderly patient? Unfortunately, it translates into a vast chasm between physician and patient that often results in improper health care. It means a fundamental lack of understanding that leads to poor preventive care and poor access to appropriate treatment.
An ounce of prevention remains worth a pound of cure
hysicians often make the mistaken assumption that pervades our society: that serious medical conditions are simply an inevitable part of getting older. The truth is, they are not. Known preventive treatments would go a long way in keeping older patients healthy and enhancing their quality of life. Yet studies show that they often do not receive them.
"Healthy Aging for Older Adults," a 2003 report published by the CDC, stated that nearly all-90 percent-of adults over 65 do not receive the appropriate screenings, despite the fact that they are the victims of more than three-fourths of fatal heart attacks and more than half of all cancer deaths. The people in most need of screening are the ones most often going without.
Many lifestyle-related preventive measures that are aggressively touted by physicians to younger patients are virtually ignored for patients over 65 as well. Despite societal perceptions, elderly people remain at risk from sexual activity and illicit drug use, yet their doctors rarely discuss these issues with them.
Even when patients have symptoms that would typically alert a physician to substance abuse issues or HIV or other sexually transmitted diseases, those symptoms often go overlooked. As a result, older HIV patients are often diagnosed in later stages than younger patients. Dependency on pain medication and antidepressants can lead to their own unique set of problems in older patients, interacting with other medications and exacerbating other medical problems.
Patients over 65 are rarely counseled on healthy lifestyle issues such as smoking cessation and regular exercise. Physicians do not realize to what extent older patients can still benefit from making these lifestyle changes, despite substantial proof that it's never too late to start living a healthier life.
Ill health is not an inevitable consequence of growing older
Once an elderly patient encounters a health problem, studies show that physicians often use the person's age, not his or her functional status, as a factor in determining the appropriate treatment. This means too few older patients are receiving life-saving interventions.
One recent study showed that the use of intensive therapies such as mechanical ventilation and pulmonary artery catheters decreased progressively as patients got older. This despite the fact that studies support eliminating age as a primary factor in making these decisions. Surgery for older patients is often ruled out even though a Mayo Foundation study showed that people as old as 100 and older can undergo surgery. Their functional health, not their age, remains the determining factor when deciding whether surgery is appropriate.
Clearly the ageist bias infiltrates physicians' offices and affects treatment decisions inappropriately. But can't older patients speak up and demand better treatment? Unfortunately, they too have fallen prey to the mistaken notion that their ill health is just a part of aging. Multiple studies report that older patients often fail to discuss their health problems with their providers.
More education is necessary across the board if physicians are going to provide their older patients with the proper care and older patients are going to take charge of their own health. People over 65 do not have to resign themselves to living their remaining years with a declining quality of life. Proper knowledge can extend lives and make them happier and healthier as well.