Why Patients Should Be More Impatient

Ageism is baked into the health care system, and it’s dangerous.

Photo by National Cancer Institute on Unsplash

Ageism is prejudice against people on the basis of age. Like all prejudices, it’s stupid and regrettable, but so what? Can it really hurt you?

Unfortunately, yes. Yes it can. Nowhere is that more apparent than when it comes to your health care, where ageism can lead to years of suffering or premature death.

Whether conscious or unconscious, ageist beliefs can lead your health care providers to over-treat you, under-treat you, ignore your own experience, or make assumptions about your condition based on distorted ideas about old people. It may impel professionals who should know better to make judgments based on a stereotype of an age group rather than on your individual situation – and despite the fact that older patients are more different from one another than any other age group (because we’ve had longer to diverge from the herd).

A heap of evidence confirms how ageism impacts the treatment of older patients. A study released in 2015 found that one in five adults 50 or older experienced discrimination in health care based on their age. It’s not just an American problem, either. In a Polish study, 30 percent of older patients said they experienced discrimination, and 47 percent of health care students observed it taking place. In 2018, Dr. Becca Levy of Yale University pegged the cost of health care ageism at $63 billion annually.

In an article for Generations, the Journal of the American Society on Aging, Dr. Karin M. Ouchida and Dr. Mark S. Lachs delineated all the ways ageism finds expression day to day. Perhaps you’ve experienced one or more yourself:

1.       Under-treatment

  Health care providers disregard a patient’s symptoms as typical complaints of old people. Research has shown, for example, that pain in older patients is consistently under-treated because providers believe pain is “normal” for their age. Example: a woman in her 60s comes in with a swollen left knee, the result of a fall. The doctor says, “You’re just getting older.” She responds, “My other knee is just as old and it’s not swollen.” In a 2011 survey of physicians and nurse practitioners, two thirds agreed that “having more aches and pains is an accepted part of aging,” and 14% said it was normal to be depressed when you are old. (False! it is not normal. Truth is, we tend to be a lot happier than the middle-aged.)

2.       Over-treatment

By some estimates, one-third of all health care spending in the U.S. is waste. Much of the waste comes from tests and procedures that lack solid proof of benefit and may even cause harm. One example: universal prostate cancer screening for older adults. Although it sounds smart, screenings result in unnecessary surgeries (for non-cancerous tumors) that can lead to complications. Another is prescribing antibiotics for urinary tract issues when there are no clinical signs or symptoms of infection.

3.       Communication Disconnects

It’s not always easy to talk to older adults, who may have hearing or vision loss or cognitive impairment. But assuming that every older adult has these problems is ageism. And leaving out essential information about symptoms, test results, risks of procedures is dangerous.

This manifests in two primary ways. One is providers address older patients using “elderspeak,” a dialect similar to baby talk in which providers speak in a higher pitch, at a louder volume, at slower-than-normal speed and employing a fourth-grade vocabulary. For some reason, older patients find this condescending. The second comes when a younger family member or friend accompanies the patient and the provider speaks only to the third party, even talking about the patient as if he or she were not in the room. A friend told me when she accompanied her older male friend to an appointment, the doctor asked her how the man was feeling. “Why don’t you ask him?” she said. “He’s right here.” Here are other tips on talking to medical providers.

4.       Ageism Among the Aged

Sadly, older adults who buy into the prevailing myths about aging may assume that depression, low libido, chronic pain, low energy, and helplessness are just the way. They are less likely to seek medical care and consequently get less. They also tend to have little interest in physical activity or healthy eating.

Institutional Ageism

Beyond the actions of individual practitioners, ageism is baked into institutional practices in health care. Many physicians are opting out of treating Medicare patients, for example. Another is the clinical practice guidelines for each disease, which are based on broad adult populations and are not applicable to older patients. (There’s a reason for that: older patients are excluded from the trials that form the basis for the guidelines.) They also don’t account at all for patients – particularly older adults – who have more than one chronic condition. This often leads to patients receiving multiple prescriptions for different disorders that may conflict with one another.

Finally, in spite of the fact that one in five Americans will be 65 or older by 2030 – just eight short years – the medical establishment has made little or no effort to increase the number of geriatric specialists to treat this wave. Nor have medical training programs made much effort to include geriatric rotations for new doctors. But then, that should not be surprising, since instructors and other doctors cast aspersions on geriatrics as a lesser specialization that amounts to treating old men and women complaining of muscle aches and constipation.

Do Your Part

So what do you do with all this? Be alert on future encounters with the health care industry. Be ready to speak up for yourself as a patient, not a statistic. Counter ageist thinking wherever you find it. You can find more ideas in the great resources collected by Changing the Narrative for its campaign to reduce ageism in health care.

It’s fair to say your life is on the line.