Ageism In Health Care Essay Samples
This story had been on my “to do soon” list just before my cancer diagnosis and now that my recovery is going so well, it's time to start catching up. Let me start with a couple of ageist profiling stories from Dr. Val Jones at the BetterHealth website:
”Take for example, the elderly woman who was leading an active life in retirement. She was the chairman of the board at a prestigious company, was an avid Pilates participant, and the caregiver for her disabled son.
“A new physician at her practice recommended a higher dose of diuretic (which she dutifully accepted), and several days later she became delirious from dehydration. She was admitted to the local hospital where it was presumed, due to her age, that she had advanced dementia. Hospice care was recommended at discharge. All she needed was IV fluids.
“I recently cared for an attorney in her 70’s who had a slow growing brain tumor that was causing speech difficulties. She too, was written off as having dementia until an MRI was performed to explore the reason for new left-eye blindness.
“The tumor was successfully removed, but she was denied brain rehabilitation services because of her 'history of dementia.'
“Of course, I recently wrote about my 80-year-old patient, Jack, who was presumed to be an alcoholic when he showed up to his local hospital with a stroke.”
These are not uncommon stories. One of the most serious side effects of ageism is inadequate health care. Another example from an important overview of ageism in healthcare was published in Generations, the journal of the American Society on Aging, in October 2015:
”The geriatrician and writer Dr. Louise Aronson (2015) describes a disturbing example of explicit ageism in which a surgeon asks the medical student observing his case what specialty she is thinking of pursuing.
“When she answers, 'Geriatrics,' the surgeon immediately begins mimicking an older adult complaining about constipation in a high-pitched whine. The attending surgeon had a reputation for being an outstanding teacher, yet repeats this parody throughout the surgical procedure.”
Let me pause here to say that the reason I was eager to get back to this topic is the excellent care I received at the Oregon Health & Science University (OHSU) hospital over nine days, which I wrote about here, that is in stark contrast to stories like those above which occur way too frequently.
When health care providers harbor implicit or explicit prejudice against older patients, the possibility of under- or over-treatment increases – and that often starts with poor communication.
As the authors report in the Generations article, in one study doctors were rated as “less patient, less engaged and less egalitarian with their older patients.”
”One way healthcare providers unknowingly patronize older adults,” they continue, “is to use 'elderspeak' - speaking slowly, with exaggerated intonation, elevated pitch and volume, greater repetitions, and simpler vocabulary and grammatical structure.
“Older adults perceive elderspeak as demeaning and studies show it can result in lower self-esteem, withdrawal from social interactions, and depression, which only reinforce dependency and increase social isolation (Williams, Kemper, and Hummert, 2005).”
The authors also note that it is not just the providers who “may harbor or exhibit ageist attitudes. Older adults themselves often possess very negative views of aging, not realizing the potential impact on their health.”
This may be changing, however, among baby boomers who are more likely to be comfortable questioning authority than many of their older counterparts.
Ageism in healthcare is, of course, only one area of prejudice against elders but as the stories above demonstrate, it can be deadly. If you encounter any healthcare professional who is behaving in a demeaning manner or dismissing your complaints, politely explain that you expect and deserve his/her full attention and care.
Or, you could just fire the doctor and find a new one as I did last October when my then-primary care physician dismissed my symptoms that eventually led to the pancreatic cancer diagnosis as nothing but a mild virus an antibiotic would take care of.
Whenever I have written about ageism lo these many years, inevitably there is a pushback in the comments. Invariably one or more will quote the “stick and stones...” adage, insisting that derogatory names can't hurt them. Others deny that ageism is on a par with sexism, racism, etc.
Really? It's not okay to denigrate, stereotype and discriminate against women and people of color but okay for old people? Really?
No, not really. Let me tell you why ageism – in all its manifestations – matters to me. It is about justice, justice for everyone including old people. And because if I don't keep insisting, it will change me in ways I won't like.
Q. What can a patient do about it?
A. Your default posture should be: Assume that information is going to get lost. Be the repository of your own medical information. And don't think that President Obama's push for electronic medical records (EMRs) will fix this.
Q. Why not? Isn't greater efficiency and transmission of your information among the promised benefits?
A. Someday that might be true, but we're not there yet. First, very few primary care practices have adopted EMRs because the cost of adoption is significant. Big, fabulous academic medical centers like the one where I work are very computerized; that's true. But if I care for you in my practice, and then you get chest pain and someone takes you to another medical center across town, guess what? The two offices don't speak to each other. So I tell patients to keep a "biggest hits" list with them. That includes your five or six major medical situations, such as diabetes or coronary artery disease. Obviously it's not practical to walk around with your entire medical record. But a few key pieces of paper can work.
Q. What would those be?
A. For my patients who have normal resting cardiograms, for example, I photocopy it and give it to them. It's a piece of paper the size of an index card, and it provides a baseline. As we get older we tend to accumulate not only conditions and diagnoses, but some abnormalities on medical tests, including x-rays, scans and stress tests. Also, keep a list of medications you're taking. A number of companies now, including Google Health and Microsoft HealthVault, have created tech-savvy online ways for patients to do this, depending on how you feel about medical privacy. You just never know where you're going to get sick or who's going to treat you.
Q. How does an older patient advocate appropriately for himself or herself, without overstepping the line?
A. That's the sweet spot, isn't it? You can advocate appropriately, and most physicians will respect that. Discuss your day-to-day activities with your doctor. Tell us how you move about, how you conduct your life, what you expect and hope to do in the future. The partnership is critical. But there is another issue here, and it has to do with the caregiver's role in the interaction. Very often, the caregiver accompanies the patient to the appointment.
Q. Right. So how should that be handled, ideally?
A. It's much more difficult, I think. On the one hand, you want to give the older patient space to have dignity. That person needs to be autonomous in the interaction. On the other hand, you're concerned. If you're like many boomers caring for older parents today, your parent comes back from the doctor, and you want to know how the visit went. You say, "Mom, Dad, what happened?" And like many people, they clam up. You can't figure out what went on in the visit.
Q. Why does that happen — what's at work here?
A. Boomers today are used to getting all kinds of things and all kinds of service, no matter where they go. Not true of their parents. I see many people in their 70s, 80s and 90s who are reverential to physicians to a fault. But we physicians are human beings. We're God's children, and we make mistakes.
Q. What do you suggest?
A. I tell the boomer child of an older parent to role-play with his or her parent before the visit. You might say, "OK, Dad, you're going to see Dr. Smith about your knee pain. He's probably going to ask you when the pain started, what makes it worse, and how about your other knee." This helps create a sense of what's going to happen at the visit. If the parent is willing to let the boomer child go with them on a visit, that's an opportunity to become a participant in the visit.