How Ageism in Health Care is Affecting Society

Experts say it starts with changing the way society thinks about aging. Despite the advances in medicine giving humanity longevity, our fate of living longer lives remain riddled with discrimination and prejudice. Ideally, we consider ourselves equal regardless of our race, income, gender, or age. But the reality is, today's society treats older people unfairly often lumping all aged 65 and up into a group of old, frail, decrepit, forgetful and sickly beings separate from the rest of society.

Ageism or age discrimination has deeply permeated our culture, mindsets and attitudes. People are so afraid of aging that they consider older people others. Experts call this the “us versus them” mentality. It is so common that even the healthcare system which is supposed to be responsible for providing care older people deserve continues to belittle the dangers of ageism.

According to a study published in the Journal of General Internal Medicine, one out of five older adults experiences ageism in health care settings and those who frequently experience it have a higher risk of developing a new disability or worsening existing ones. Every day, around 10,000 Americans turn 65 and the numbers are expected to rise as mortality rates decline. More and more experts believe that it is high time for ageism in health care to be put in the limelight.

Most Americans including older adults are not aware of ageism

A new research published by The Frameworks Institute (FI) found that most Americans are not aware of the dangers of ageism. The researchers call this the “cognitive hole” or the people's way of individualizing aging problems and not recognizing ageism as a ubiquitous problem for all. The FI's Gauging Aging: Mapping the Gaps between Expert and Public Understanding of Aging in America report was made to understand how people think about aging and use the results to identify challenging misperceptions that need to be changed by the whole society. In spite of the reality that older Americans continue to be ostracized from participating in socio-civic activities and opportunities such as employment, recreational activities, housing, business and others, the concept of ageism remain absent from the public's perception of what growing old means. Some older adults even accept that the discrimination they face is just a normal part of being in the last stage of living.

In the report, aging should be considered by society as “both a personal and a shared resource and opportunity”. This rethinking makes us view older Americans are as “central rather than marginal participants in our collective life as a nation.” The study recommends developing information tools and ways to help society “reframe” or change their understanding and perception of the aging process. This reframing, they say, can lead to changing policy for the betterment of older generations.

To fight ageism, experts suggest starting changing the way we perceive aging. We should know how ageism manifests and be able to recognize ageist situation, especially within the healthcare system.

The Dangers of Ageism in Health Care

Experts say that older patients comprise around 27 percent of all doctor's visits and 35 percent of all hospital stays. Negative views about them can bring unnecessary stigma that weakens the healthcare system's capability to treat one of their major clientele. It also hinders from adding more capable medical practitioners to the workforce. Ageism among medical providers is either done obviously or unconsciously and causes real damage to the patient. In Dr. Karin Ouchida and Dr. Mark Lams' article on Ageism in Healthcare, they enumerated several manifestations of ageism in our health care system.

1. Practitioners Belittling Geriatrics and Gerontology as a Profession. Obvious ageist comments proliferating among medical practitioners are clearly depicted in the story of a surgeon asking a medical student what specialty she's planning to pursue. She replied, “Geriatrics.” The professor immediately acted like a whiny high-pitched frail old man complaining about aching muscles and constipation. A lot of doctors also make jokes about their old patients. Humoring older adults' predicaments isn't just offensive but also unethical.Because of these kinds' ageist comments, geriatrics as a profession is stigmatized as a frustrating and less rewarding specialization, making doctors in training adamant in pursuing the career. The negative thinking of medical practitioners towards older adults hinder in recruiting more medical professionals to practice gerontology.
2. Under-Treating Older Patients. “It's normal to be depressed because you're old.” This doctor's advice is one of the examples hindering medical providers from treating the real cause of an older adult's ailment. Lumping all aches and pains of an older patient into a pack labeled “normal signs of aging” is downright ageist. This means, they do not get the proper treatment they could have had. Patients are forced to convince themselves that what they're feeling is just part of aging.Another popular example of under treatment is ignoring other causes of complaints such as lifestyle, relationships and home situation. A doctor attributed the bruises on an older patient's arm as normal effects of anticoagulants to an aging body, without inquiring further if there is violence in the family. Another patient complains of frequent headaches, memory loss and confusion but the doctor just assumes it normal for all older people to experience that and not conducting tests that may rule out brain tumor. There were also a lot of cases wherein doctors just assume that their patients are sexually inactive because of their age and fail to treat ailments such as erectile dysfunction, sexually transmitted disease and HIV.
3. Over-treating older patients. Ageism also becomes harmful when medical providers over-treat older patients with ill-advised health endorsements and medications based only on their age while excluding their preferences, abilities, and functionality. An example of this is the US health care system's program to give universal prostate cancer screening for older adults. While seemingly good, experts have found that these screenings resulted to exaggerated diagnosis of harmless tumors, and unwarranted treatment requiring surgery, that can lead to complications needing intensive care. Other examples include giving high dosage of diabetes medication which can trigger hypoglycemia and prescribing antibiotics for urinary tract problems without clinical signs or symptoms of infectionTo policy makers and economists, the overtreatment widely given to older adults is a complete waste of public funds. According to their estimate, one-third of the budget for health is spent on waste. Overtreatment waste in the past cost the country around $158 to $226 billion.
4. Ageist Talk in the Healthcare setting. One of the causes of under and over treatments is the lack of effective communication between the doctor and the older patient. Experts have pointed out complaints from older adults on how most medical practitioners do not talk straight to them. Instead they do the “elder speak” – a way of speaking similar to baby talk, with high pitch, exaggerated tones and volumes. Some even automatically shout near their ears without even knowing if they have hearing problems. They just assume all old people are deaf. For the record, all older adults, especially those who still can, hate elder speak. Like everybody else, they do not like to be talked down to.Doctors talking about older patient's condition to a third party instead of directly to them is also a hindrance in developing a good doctor-patient relationship. Sometimes they tend to leave out the patients in the conversation about their own health. There are also times when nurses and other staff talk about their older patients in front of them as if they are not there.Multiple studies have shown that these ageist acts are disrespectful, demeaning and can cause lower self-esteem and depression among older patients.
5. Ageism innate to older adults. Even older adults have ageist views about their own aging process that can greatly affect their health. Experts have found that older adults who accept that depression, fatigue, chronic pain, low libido, and dependency are just normal parts of aging, do not usually seek medical attention, get less care. They also tend to refrain from participating in physical activities, exercising, using protective gears and eating a balanced diet.
6. Institutionalized Ageism. In their article, Dr. Ouchida and Lam argue that the US healthcare system is prejudiced against older adults because of the following:
   • Lack of support to increase the number of doctors specializing in geriatrics and lack of action to reverse its declining number.
   • More doctors are opting not to treat Medicare patients; which supports most of older adults.
   • Clinical Practice guidelines, which were studied based on adult populations, are not applicable when it comes to older patients with multiple chronic illness. As a result, physicians try to mix treatments for these diseases, which put older patients at risk of the adverse effect of multiple drugs combined.

How to Address Ageism

For Dr. Ouchida and Lam, getting rid of Ageist Attitudes in Our health System requires medical practitioners to “recognize and appreciate the heterogeneity of older adults” through effective integration and exposure with them outside the hospital setting. Heterogeneity means, like any age group, older adults also differ in their functional status, health, and financial situation. Some older people are still strong, active, and sharp in their 80s while some may be weaker than others. And when it comes to race, income, gender, education, class and social status, disparities also apply to them as well as these apply to anyone.

We should all start changing our unpleasant perceptions about aging and embrace aging for what it is – a normal process of living that doesn't necessarily mean disability, disease, and decline. According to the Framework Institute's research, reshaping our negative thinking towards older people entails making adjustments in ensuring that older people are not isolated from the rest society and still contribute to it. This includes making better age-friendly policies increasing their opportunities for employment, transportation, HealthCare, community development and housing. “Our retirement culture were just not designed to support an aging society,” one expert from the study said. “We need to reengineer [our] institutions if we are going to be able to have a productive, secure, cohesive society.” Fighting ageism in the health care system isn't just about changing individual mindsets but also applying positive attitudes on aging to change policies and systems. Based on their research; Framework Institute recommends the following systematic changes to achieve a truly age-friendly society;

• Start by addressing institutionalized ageism to remove barriers prohibiting older people to engage fully in civic and economic activities as part of the community. This can be done through education and information campaigns or trainings among health care providers on the dangers of ageism.
• Giving more opportunities for them to be involved in the community through civic and social activities such as volunteer work, mentoring, and continuing their education.
• Changing our perception of work and retirement.  Older adults prefer to work past their retirement age due to economic and personal reasons. To address this, flexible policies should be made to avoid age discrimination and forced early retirement to older adults still capable of working.
• Spending public funds efficiently to avoid the humongous cost of health care programs
• Increasing the healthcare workforce trained in geriatrics.
• Finding solution to the growing demand for long-term care.
• Developing more efficient policy solutions to ensure income security in retirement.
• Giving institutional and social support to caregivers providing unpaid care to their loved ones. Social security credits should still be given to those who leave work to take care of their ailing family.
• Investing in research on the persistent problems of the aging population to provide more basis to institutional changes needed for older adults to age well in our society.

Fighting ageism is simply a matter of defending equality and justice. Changing our minds on aging and fostering a future free from discrimination is in a way, giving respect and honor to the contributions older adults made for our society. If we start crushing the pillars of ageism now, the one who would greatly benefit from the downfall is not just our generation, but also the next.