Ageism – Can It Really Hurt Us?
As I’ve traveled around to various conferences that are focused on older Americans there seems to always be a keynote speaker or panels or various classes on ageism. Each of these platforms comes at the topic from a different angle and they all try to show different ways it is manifested. There is certainly a basis for their concern. Speakers often blame different generations or institutions for perpetuating ageism, with good reason, it can hurt older people. Ageism is often defined as stereotyping, prejudice, or discrimination based on age. It is most often discussed as it relates to older adults, but it can apply to any age.
Since my blogs deal primarily with healthcare, I’m going to focus on how ageism can impact our health. I’ve talked many times about ways we need to personalize our healthcare and give us choices based on our own situation. I’ve chastised lawmakers for passing laws and regulations that put older people into “one size fits all” categories. Stereotyping, prejudice, and discrimination all attach categories before understanding an individual’s situation and will blur and inhibit an accurate diagnosis.
The world has never seen so many old people - 2/3 of the people that have ever lived to be 65 or older in all world history are alive today. Someone who reaches 65 can expect to live another 20 years. We can thank the advancements in medicines and care for this added longevity, but the world has no experience in caring for this many old people. We’re in uncharted territory and this is especially true for our healthcare.
Let’s start with the doctor’s office. I’ve witnessed ageism toward my mother-in-law when I was younger and went with her and my wife to the doctor. It seemed like my mother-in-law was a secondary part of the conversation. The doctor and the nurse would often look to my wife and myself for answers. I’m not a doctor but it seems that they would miss the body language and the manner in which a question is answered by not listening directly to the patient’s answers. I’m saddened to say I’ve also witnessed sexism when I’ve gone with my wife to the doctor and they would often look to me for some answers. Both of these “isms” get in the way of accurate diagnosis.
A very big concern of mine is how, over the years, ageism has creeped into the administration of our healthcare. I’ve railed against Quality-of-Life Years (QALY) as a determinate of care. It devalues the expected years remaining in an older person’s life. It is being used by other countries in their government-controlled healthcare, and I can see where it is trying to creep into our system too. It is almost the very definition of ageism. It really makes sense to me to almost eliminate the word age from any diagnosis. Now I understand there is a benefit for a doctor to know the age of the patient. There are doctors who are trained geriatricians, but I hope much of that training has to do with how to communicate with seniors, how to deal with multiple maladies and diminished recovery abilities. The difference in the physical health of two 65-year-old people can be huge, and the diagnosis should reflect those differences, not the fact that each of them are old. We shouldn’t have to settle for the “you’re just getting older” diagnosis.
Another way ageism has instilled itself into our healthcare is the lack of older people in medical trials. It would seem that it would be of primary importance to do medical trials on the primary user of most of the medicines, procedures, and medical devices. Some national guidelines, like screening cutoffs, are based on limited evidence because older adults are excluded from trials. For instance, Mammogram recommendations differ between the U.S. Preventive Services Task Force (USPSTF) - a nationally recognized, scientifically independent panel of experts that issues evidence‑based recommendations on screenings - and the American Cancer Society (ACS). This has created confusion leading many clinicians to assume screening after age 75 is not worthwhile, even though the ACS recommends continued mammograms. Some of the blame can be put on us – we need to make ourselves available for these trials. Next time you see one of those posters urging people to join a trial, look into it. Ask your doctor if there are some trials that you would qualify for.
It’s up to us to push for personal evaluations, rather than age related assumptions about our health. “You’re just getting old” isn’t a diagnosis. If some aspect of your health has deteriorated, it’s because something isn’t working right. It should be analyzed and treated like any health problem is dealt with.
Seniors in America are quickly learning to use technology. One of the fears of lawmakers during the debate on adding a prescription drug benefit to Medicare was the fear that older Americans would become confused and wouldn’t be able to choose the plan that fit them best. Seniors have proven over the last 20 years that they were very successful in either choosing the best plan for themselves or finding someone they trusted to help them make the choice.
Ageism can influence how people think about age, how they feel about age, and how they act toward others or themselves. It has no place in our healthcare, and our lawmakers need to be vigilant to weed out the ageism that exists today and ensure it isn’t a part of our healthcare in the future.
Best, Thair