A couple years ago, I was waiting in an exam room at my doctor’s office to discuss a problem with her. The problem was potentially serious and I was anxious about it. In walked a very bubbly, 20-something, medical assistant. She greeted me with “Hi honey, how are we feeling today?”. This girl was younger than my son. Now, I suppose some people would think nothing of it; just write it off to an overly perky young girl trying to be welcoming. I am not one of those people. I suddenly felt like a 3-year-old sitting on that table, rather than an adult who had worked in the medical field for longer than this girl had been alive. I smiled at her, even though I felt a twinge of anger inside, and replied firmly “You can call me Lori”. She got the message, dialed back the juvenile language, and proceeded with a bit more professionalism.
This is only one manifestation of something called ‘ageism’. Ageism occurs when older people meet prejudice, stereotypes or discrimination based solely on their age. Ageism also manifests in a reluctance to recognize and respect the needs of older people or in treating them less favorably than younger people. Ageism shows up when an older person is over- or undertreated (overtreated because doctors know Medicare will pay for it), when they are demeaned, when their symptoms are minimized (this is also called ‘medical gaslighting’), and in the form of communication used when speaking with them.
There is a type of communication referred to as “elderspeak”. It is how the young medical assistant greeted me that day in the office. It is characterized by using condescending, overly simple language, terms of endearment (honey, sweetie, dear, etc), and is often spoken in a high-pitched tone that is typically reserved mainly for young children or pets. Elderspeak from a doctor can leave a patient feeling devalued and disrespected. Personally, it left me feeling insulted.
Ageism is present when doctors assume that their older patients who talk more slowly are cognitively impaired and are unable to communicate their medical concerns. Have you ever gone to a medical appointment with a younger family member, a daughter or son perhaps, and the doctor speaks primarily to the other person, and not to you? These same assumptions can cause doctors to exclude older patients from involvement in their own medical care. The patient is bypassed entirely and younger family members are approached and involved in medical decision-making without any discussion with the patient. The patient is not asked for her medical history nor told about the treatment plan and prognosis. If you happen to be in a coma or otherwise unable to be involved in decision-making, then this would be appropriate. That’s why we should all assign a Healthcare Power of Attorney to someone we trust. But if you are not in that state, then this behavior is generally NOT ok.
Doctors and nurses often believe that asking questions of or explaining things to older adults takes patience and often requires having to speak slower or louder, and this is, of course, time consuming. Time is in short supply in the medical field these days. Why do you think they put a diaper on many older patients as soon as they are assigned a hospital bed? No one wants to deal with having to help these patients out of bed and into a bathroom. There is just no time for that, and typically, they are already understaffed.
Another form of implicit ageism is the assumption that older people are not resilient and can’t recover from illness or injury. It happens when doctors pursue less aggressive treatment options for older patients and instead, focus on just managing the disease instead of trying to cure it.
All of these behaviors deprive patients of their sense of dignity and autonomy.
Ageism within healthcare is a problem that has been around for a long time, but is getting a new look recently, especially during the Covid pandemic, which killed more than half a million Americans age 65 and older. Ageism leads to barriers in the access of healthcare services and treatments, in the form of denial of these services, with age becoming the primary factor, as was often evidenced during the pandemic. Rationing based on age alone is a widespread problem. A review of studies done by the World Health Organization in 2020 found that in 85% of the 149 studies that they looked at, age determined who received certain medical procedures or treatments.
The nonprofit group Alliance for Aging Research has highlighted the following 5 areas of age bias:
1) Healthcare providers lack the training in geriatrics required to give proper care to older patients.
2) Older people are consistently excluded from clinical trials.
3) Older patients are less likely to receive preventative care.
4) Older patients often receive inappropriate or incomplete treatment.
5) Older patients are less likely to be tested or screened for diseases and other health problems.
Let’s talk about some of these points. #1. They lack the necessary training. In their medical school education, doctors currently spend at least three times the amount of time studying pediatrics as they do geriatrics. The majority of medical students receive NO formal training in geriatrics at all. One size does NOT fit all.
#2. Older people are not included in clinical trials. Why? An older person’s life is valued less than the life of a 40-year-old simply because the 40-year-old has more potential years to live. It’s an ethical dilemma. Whose life should we save first? It’s a tough call, isn’t it? There are a lot of vibrant, active octogenarians out there living a full life who might have at least another 15-20 good years ahead of them. And there are some very frail and weak 80-year-olds who have numerous medical issues. Can you make a call on who gets what based SOLELY on a number?
#3. Older people are less likely to receive preventative care. My mother is a breast cancer survivor. She had cancer surgery at the age of 41. Last year, when she was 86, I asked her when her last mammogram was, knowing how important breast cancer screening is, especially for someone with a past history of it. She waved me off and said her doctor had told her two years prior that she didn’t have to have mammograms anymore because she was “too old” and it was unlikely that she would have breast cancer at her age. I wanted to scream. Having worked for years for a breast cancer specialist, I knew this was wrong. I did the research and found that approximately 14% of breast cancer diagnoses occur in women aged 75-84. 14% is still a lot of older women. The point of preventative care is to catch things earlier enough to treat them successfully. Shouldn’t an older person have the same right to this as any younger person?
What are we going to do about this problem of ageism? I believe that the first step is awareness. When the things that I’ve talked about here happen to you, recognize it for what it is.
Secondly, we need to empower longevity. Adults over 65 are the fastest-growing age group and the largest consumers of healthcare resources.
We need to advocate for ourselves. That means letting your healthcare providers know how you would like to be treated. And when you are not treated that way, do something about it. Make it clear you are not ashamed of being older. Fill out the patient survey in detail. Find a different doctor if necessary, and let the first doctor know why you are leaving. Consider filing a complaint with a regulatory agency such as your state’s Medical Board. The problem is that many patients are afraid to speak up when they’re treated poorly. They have incorrect assumptions about what they’re allowed to ask, which is just a form of internalized ageism. They’re intimidated by the doctor. Your doctor works for you, not the other way around. Rehearse with a friend if need be, but do speak with your physician if you feel you are being treated unfairly.
As this awareness of ageism in healthcare and its backlash grows in momentum, it will help to change things from the bottom up. It will force an increase in the education of healthcare providers in the field of geriatrics. It will increase inclusion of older people in clinical trials. It will advance appropriate screening and preventive measures for older adults. It will promote the opposite of ageism: A world where a doctor sees each patient, no matter their age, as an individual, listens carefully, avoids judgment, and does everything within their power to allow that person to be as healthy as possible for as long as possible.