Should we expect more from healthcare?

On the other hand, do we expect too much?

Photo by National Cancer Institute on Unsplash

Just 10 years ago, there were 43.1 million Americans aged 65 and older. By 2050, according to the U.S. Census Bureau, that number will balloon to 83.7 million.

Our so-called healthcare system, functioning with all the efficacy and efficiency of a rocket cobbled together from spare parts, is not up to the challenge currently and unlikely to be up to the challenge in the coming decades. Healthcare workers are in short supply; older patients are not.

Little wonder, then, that when older adults present their symptoms, many harried and overworked physicians are inclined to respond with comments like, “What do you expect at your age?”

One thing we expect is to be taken seriously. Given the fact that more than one-third of total healthcare spending goes to caring for adults aged 65 and up, doesn’t it seem reasonable to expect healthcare professionals to listen and provide appropriate treatment?

One might think so. Yet it seems hard for many physicians to do. In a survey of older adults conducted by Age Wave and the John A. Hartford Foundation, only 11% gave an “A” grade to the health system overall, and only 23% were satisfied with how much choice and control they have over the care they receive.

The 4 Ms

While we wait for the emergence of the political will to design a more rational healthcare system, some thinkers are tinkering around the edges of the present one by promoting “Age-Friendly Health Systems.” The initiative is driven by the John A. Hartford Foundation and the Institute for Healthcare Improvement, in partnership with the American Hospital Association and Catholic Health Association of the United States.

To be recognized as age-friendly institutions, hospitals and other care facilities agree to the “4M Framework” in dealing with older adults:

• What Matters: Align care with the patient’s outcome goals and care preferences.

• Mentation: Prevent, identify, treat, and manage dementia, depression, and delirium across care settings.

• Mobility: Ensure patients move safely every day to maintain function and do What Matters

• Medication: Only use medication that does not interfere with the other 3Ms.

So far, nearly 5,000 facilities have either developed a plan for meeting the 4M framework (Level 1) or collected three months of data on older patients (Level 2). The Level 2 institutions get a badge and a public relations kit for announcing their age-friendly status. While there doesn’t appear to be any accountability to ensure performance on these measures, the age-friendly movement deserves credit for making healthcare institutions aware of their ageism problem and recognizing good intentions to address it.

Ageism Cuts Both Ways

But there is also a case to be made that some older adults expect too much of the healthcare system. To be specific, some expect modern medicine to grant them perpetual youth, if not eternal life.

This is also a problem of ageism, but in reverse. The expectations are driven by internalized ageism – the belief that looking and feeling old are catastrophic and must be forestalled at whatever cost. You’ll recognize this as the foundational belief that undergirds hair coloring, the cosmetics industry, the fitness and wellness industry, and plastic surgery. In other words, stoking fear of aging is big business.

Robert Kramer, an outspoken thought leader in the senior living industry, says that a doctor’s response of “what do you expect at your age” is a cop-out, but “it’s also a cop-out for an older adult to deny that their bodies are getting older and expect simple, no-effort solutions.” Expecting “a pill or a procedure to instantly fix problems and make you feel 20 or 30 years younger isn’t realistic.”

The late author and social critic Barbara Ehrenreich, in her 2018 book Natural Causes: An Epidemic of Wellness, the Certainty of Dying, and Killing Ourselves to Live Longer, skewers the illusion that right doctors, right exercise, and right mindset can allow us to outrun aging. Denial of our own aging may be an understandable reaction to a youth-worshipping culture, but it is not a particularly healthy approach to what is, in fact, a natural and inevitable process. Denial is also a clear sign that we have swallowed the poison – believing the ageist tropes that only youth are worthy of respect and admiration.

“We would all like to live longer and healthier lives,” Ehrenreich wrote. “The question is how much of our lives should be devoted to this project, when we all, or at least most of us, have other, often more consequential things to do.” The idea that we have much control over our cells, she argues, is an illusion.

Should we expect respect from healthcare professionals? Hell yes! But let’s remember that no amount of exercise, diet, meditation, or medicine can deny the inevitable forever. The sooner we accept our own aging as a natural stage of life, the sooner we can experience the pleasures and rewards that come with being chronologically gifted.