Dismissal of Treatable Symptoms as “Normal Aging”
One of the most insidious and widely witnessed examples of ageism in healthcare is the tendency for medical professionals to dismiss treatable symptoms by attributing them to "just old age". Instead of conducting a thorough investigation, a doctor may tell an older patient that their joint pain, fatigue, or cognitive changes are an unavoidable part of getting older. This bias, whether conscious or not, has serious consequences, leading to missed or delayed diagnoses for serious conditions that are actually treatable.
The Real-World Impact of Dismissed Symptoms
Imagine an older adult reporting persistent fatigue and shortness of breath. An ageist healthcare provider might write this off as a natural decline in energy. However, these are classic symptoms of conditions like heart disease or anemia, which are treatable. By not investigating further, the provider misses a crucial opportunity for intervention, allowing the condition to progress and potentially become life-threatening. Similarly, memory issues might be quickly labeled as a "senior moment" rather than being properly evaluated for early-stage dementia or other cognitive impairments.
Elderspeak: A Common Form of Ageist Communication
Another example of ageism seen in healthcare is condescending communication known as "elderspeak." This is when a healthcare provider or caregiver speaks to an older adult in a patronizing, oversimplified, or high-pitched tone, often using terms of endearment like "sweetie" or "honey". While some may believe this is helpful, it is incredibly demeaning and can undermine the patient's dignity and self-esteem. Elderspeak infantilizes older adults, creating an unequal power dynamic and potentially causing them to be more resistant or withdrawn during care.
Common elements of elderspeak include:
- Using a singsong, exaggerated tone of voice.
- Referring to patients by their first name without permission.
- Using oversimplified vocabulary.
- Directing conversations to family members or caregivers rather than the patient themselves.
- Making assumptions about the patient's cognitive abilities based on age.
Exclusion from Clinical Trials
On a systemic level, ageism is clearly demonstrated by the historical and ongoing exclusion of older adults from clinical trials. For years, many clinical research studies, including those for new medications and treatments, have had an upper age limit. This practice is harmful because it means that data on a drug's safety and effectiveness in older populations is limited, even though older adults are often the primary users of many medications. This underrepresentation can lead to a lack of evidence for the safe and effective use of certain interventions in this patient group. The consequences were particularly stark during the COVID-19 pandemic, where some vaccine trials initially excluded older participants, despite their heightened vulnerability to the virus.
Unequal Treatment and Allocation of Resources
In addition to the implicit biases, explicit ageism has been witnessed, particularly during times of crisis. During the height of the COVID-19 pandemic, some states developed "crisis standards of care" that, in practice, led to the prioritization of younger patients for scarce medical resources like ventilators over older patients. These guidelines were based on the ageist assumption that a younger life is more valuable or has more years of life remaining. Such policies are a stark reminder of how deeply embedded ageist biases can be within the healthcare system, leading to discriminatory practices with devastating consequences.
Comparison of Ageist vs. Age-Friendly Healthcare
| Scenario | Ageist Healthcare Approach | Age-Friendly Healthcare Approach |
|---|---|---|
| Symptom Reporting | Attributing a patient's chronic pain to normal aging and offering minimal pain management. | Investigating the root cause of the pain, offering multiple treatment options, and involving the patient in the care plan. |
| Communication | Speaking loudly and slowly to an older patient, or only addressing their family members. | Engaging the patient directly in a normal tone, explaining treatment options clearly, and ensuring they feel heard. |
| Clinical Decisions | Providing less aggressive treatment for a serious condition based solely on the patient's chronological age. | Basing treatment decisions on the patient's individual health status, goals, and personal preferences, regardless of age. |
| Technology Adoption | Assuming an older patient cannot or will not use telehealth or a patient portal. | Offering training and support to help older patients navigate technology, improving their access to care. |
What You Can Do to Combat Ageism
Recognizing ageism is the first step toward combating it. Healthcare providers can engage in self-reflection and continuing education to challenge their own biases. Patients and their families can play an active role in their own advocacy by preparing for appointments and speaking up if they feel their concerns are being dismissed. Seeking a second opinion, especially from a geriatric specialist, can also be a vital step to ensure proper care. Creating a supportive environment where patients feel heard and respected is essential for improving health outcomes and fostering trust between older adults and their healthcare providers. For more information on age-friendly care and resources, see the Gerontological Society of America's initiatives.
Conclusion
From the subtle indignity of elderspeak to the life-altering consequences of misdiagnosis and exclusion from clinical trials, examples of ageism are unfortunately widespread in healthcare. These instances, whether overt or unintentional, demonstrate a deep-seated bias that negatively impacts the well-being of older adults. By raising awareness, promoting patient advocacy, and requiring ongoing education for healthcare professionals, we can work towards a more equitable and respectful healthcare system for all ages. It is a collective effort that benefits not only older adults but society as a whole by ensuring that care is based on individual needs and health, not on age-based assumptions.
