Recognizing Ageism

Confession: I used to be ageist, so I know I don’t like being stereotyped in the way I previously did others. Previous to what, you ask? Previous to becoming certifiably old, myself! It’s by my considerable experience in being old that I’ve discovered I’m the same person as my younger self inside. I have the same passions and enthusiasm for life I had decades ago. Yet what I evidently don’t have in this decade is the same possibility of quality healthcare. I say “possibility” because in my case I had excellent physicians who were not ageist. However, statistics show I was in the fortunate minority.

Many factors contribute to a disparity in treatment for the elderly. A report from the Alliance for Aging Research cites five ways that ageist bias is revealed in US healthcare. (1) A lack of training in geriatrics to healthcare professionals. (2) Older patients are less likely than younger people to receive preventive care. (3) Older patients are less likely to be tested or screened for diseases and other health problems. (4) Proven medical interventions for older patients are often ignored, leading to inappropriate treatment. (5) Older people are consistently excluded from clinical trials, even though they are the largest users of approved drugs.* Not only healthcare professionals are guilty of ignoring symptoms in the aged. Some older adults have false beliefs about aging causing them to ignore their own symptoms. Many think their fatigue or pain is to be expected at their age. Therefore, they don’t even seek healthcare in the first place. 

Federal law prohibits discrimination based on age. However, that law was crafted to apply to employment (ADEA). What about age discrimination related to patient care? There are guidelines in place only if the healthcare program is receiving federal financial assistance.* Unfortunately, those regulations are not often being followed from what I’ve learned when I mentor cancer patients and what I now know from my research.

What does ageism look like? It can take many forms. Doctors may not be aware they are behaving differently toward older patients. For instance, when communicating, doctors may unconsciously address the younger person in the room rather than directing comments at the older patient. On the other hand, medical staff may exhibit more overt behavior if they’ve stereotyped the elderly as a group, instead of taking into account the actual physical state of the patient in front of them. Some may dismiss symptoms in an older patient, thinking they are simply due to aging. Even more egregious, many older adults have been denied medical treatment due to being a certain age. I am the administrator of an online cancer support group where I often read about inequality in healthcare.

 For example, one lady in my support group related her experience of telling her doctor for a year that “something was wrong.” She thinks her doctor didn’t actively pursue scans because she was “too old.” Her age? 67! Finally, she went to a different physician who found she had appendiceal cancer. By then, it had metastasized to several places and she was stage 4. She regrets waiting and she resents the fact her first doctor did not listen to her concerns.  She said she can’t prove the delay allowed the cancer to spread, but common sense indicates it was the reason.

Personally, I know of a 72 year old woman who requested a mammogram. Her primary physician said she didn’t need one at her age. She went elsewhere and found she had stage 1 breast cancer. She underwent a lumpectomy with a positive outcome.  Since she was physically fit, her recovery time was comparable to a middle-aged person. She deserved quality healthcare the same as anyone else with a more recent birthday!

 In America, even with a focus on eliminating prejudice, the elderly are still often discriminated against. Fortunately, the situation is changing. Previously, physicians had little or no specific training in the physiology and special conditions of old age. Ironically so, since old people are usually the ones most in need of medical care. Now, at least, there are social conversations around aging. The health care system is taking note. For example, “surgeons are thinking more about evaluating and preparing older adults before surgery and they are aware of the different kind of care they may need afterward. Anesthesiologists are thinking more about delirium, which has short-term and long-term impact on older adults’ brains.”* Hopefully, the trend will continue so people of all ages will have access to the healthcare they need and deserve.

*“Alliance Exposes Widespread Ageism in U.S. Healthcare at

www.agingresearch.org/press-release/alliance-exposes-widespread-ageism-in-u-s-healthcare/

**Called Section 1557 of the Patient Protection and Affordable Care Act which provides that an individual shall not be denied benefits due to age. 

*Judith Graham. A Doctor Speaks Out About Ageism In Medicine. 30 May 2019. https://khn.org/news/navigating-aging-a-doctor-speaks-out-about-ageism-in-medicine/