Recognizing Ageism in Healthcare
Ageism in healthcare can take many forms, from overt discrimination to more subtle, unconscious bias. For older patients, the consequences can be severe, including missed diagnoses, less aggressive treatment, and poorer health outcomes. Understanding what constitutes ageism is the first step toward addressing it effectively.
Forms of Ageist Bias
Ageist bias manifests in communication, diagnosis, and treatment protocols. Healthcare providers may use patronizing language, known as "elderspeak," which involves speaking slowly or using terms of endearment like "honey" or "dear". This communication style can make older patients feel disrespected and can reduce the quality of communication. Providers might also interrupt older patients more frequently or direct questions and decisions toward a family member rather than the patient themselves.
During diagnostic procedures, ageism may lead to age-based rationing of care. For instance, a doctor might attribute a treatable symptom, such as fatigue or pain, to a "normal" part of aging and therefore dismiss it without a full investigation. This can lead to delayed or incorrect diagnoses. Furthermore, older adults are often excluded from clinical trials, meaning new treatments and therapies may not be tested on the very population that stands to benefit most.
Consequences of Ageism
The effects of ageism extend beyond the doctor's office, impacting an older person's overall quality of life and health trajectory. The dismissal of symptoms can lead to preventable complications, increased hospitalizations, and higher healthcare costs. In 2020, the cost of ageism in the U.S. healthcare system was estimated at $63 billion. Prolonged exposure to ageist attitudes can also lead to internalized ageism, where older individuals begin to believe that their health problems are an unavoidable consequence of age, leading to decreased motivation for self-care and preventive behaviors.
Advocating for Yourself and Your Loved Ones
Empowering yourself and your family is key to navigating potential ageism in the healthcare system. Patient advocacy can ensure that older adults receive the high-quality, respectful, and individualized care they deserve.
Strategies for Effective Advocacy
- Prepare a list of concerns: Before your appointment, write down all your symptoms, questions, and concerns. This ensures all important points are addressed, especially if the appointment feels rushed.
- Bring a companion: A trusted family member or friend can help take notes, remember questions, and provide a second perspective during the appointment. They can also help speak up on your behalf if necessary.
- Request copies of records: Under HIPAA, patients have a right to their medical records. Having copies allows you to review information and ensure it accurately reflects your conditions and treatment plan.
- Communicate your preferences: If a provider uses condescending language, address it directly. A polite but firm statement, such as "I would prefer you call me by my name, not 'dear,'" can be effective.
- Be informed: Understanding your conditions and treatment options empowers you to make informed decisions. Don't be afraid to ask for clarifications in plain language.
When to Consider a Geriatric Specialist
For older adults with complex health needs, a geriatrician or other geriatric specialist can be a powerful ally. These providers have specialized training in caring for older adults and are more attuned to age-related health issues. A geriatrician focuses on the unique physiological changes associated with aging and is skilled at managing multiple chronic conditions and complex medication regimens.
If you or a loved one are taking multiple medications, experiencing significant mobility or cognitive issues, or managing several chronic diseases, a geriatric specialist may offer more personalized and holistic care.
Comparison of Geriatrician vs. General Practitioner
| Feature | Geriatrician | General Practitioner (GP) |
|---|---|---|
| Specialization | Specialized training in age-related diseases and complexities. | Broad medical training covering all age groups. |
| Focus | Holistic, patient-centered care for older adults, considering functional status and quality of life. | General health maintenance, managing acute illnesses, and preventative care across all ages. |
| Approach to Medication | Highly attuned to polypharmacy and potential drug interactions in older adults. | Manages medications but may not have advanced expertise in complex geriatric pharmacology. |
| Cognitive Assessment | Trained to identify and manage cognitive decline, dementia, and delirium. | May address cognitive issues but may lack the specialized training of a geriatrician. |
| Patient Involvement | Emphasizes shared decision-making, ensuring patient and family are central to the care plan. | Approach varies; may not always be as focused on extensive patient-centered collaboration for older adults. |
How the System Can Improve
Beyond individual action, systemic changes are necessary to address ageism in healthcare. Several institutions and organizations are working to promote age-friendly healthcare practices.
Numbered list on improving the system:
- Enhanced Geriatric Training: Integrating more robust geriatric training into medical school curricula and residency programs is crucial to equip future healthcare professionals with the skills needed to care for older adults effectively.
- Age-Inclusive Clinical Research: Policies that ensure the inclusion of older adults in clinical trials would lead to more evidence-based and effective treatments for this population.
- Institutional Policies: Healthcare institutions can adopt and enforce policies that explicitly combat ageism, such as mandating training on unconscious bias and implementing patient feedback mechanisms.
- Promoting Age-Friendly Health Systems: The Age-Friendly Health Systems initiative, an approach co-created by the Institute for Healthcare Improvement, the American Hospital Association, and others, focuses on four key areas: What Matters, Medication, Mentation, and Mobility. The initiative promotes patient-centered care and provides frameworks for institutions to follow.
- Encouraging Patient Rights: Informing patients of their rights, including the right to be treated with respect and to be involved in care decisions, is a critical step. Organizations can provide clear, accessible materials outlining these rights.
For more information on patient rights and resources, consider visiting the National Institute on Aging website.
Conclusion
While the presence of ageism in healthcare is a serious concern, it is not an insurmountable one. By recognizing the various forms age bias can take, empowering ourselves with effective advocacy strategies, and supporting systemic improvements, we can create a more equitable and respectful healthcare environment for older adults. Every patient, regardless of age, deserves to be treated with dignity, listened to, and provided with care that addresses their unique needs and priorities.
