Bias against older people in health care settings is common and harmful : Shots

Dr. Louise Aronson, a geriatrician and author, speaks with a patient at UCSF’s Osher Center for Integrative Health in San Francisco.

/Julia Burns


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/Julia Burns


Dr. Louise Aronson, a geriatrician and author, speaks with a patient at UCSF’s Osher Center for Integrative Health in San Francisco.

/Julia Burns

A recent study found that older adults spend an average of 21 days per year on medical appointments. Kathleen Hayes can believe it.

Hayes lives in Chicago and has been spending a lot of time lately taking her parents, who are both in their 80s, to doctor appointments. Her father has Parkinson’s and her mother is recovering with difficulty from a severe attack of Covid-19. While sitting there, Hayes has noticed some caregivers talking to her parents at loud volumes, to the point, she says, “my dad told one of them, ‘I’m not deaf, you don’t have to yell.’ ”

While some doctors and nurses speak directly to her parents, others continue to look to Hayes herself.

“Their gaze is on me for so long it feels like we’re talking to my parents,” said Hayes, who lives a few hours north of her parents. “I had to emphasize, ‘I don’t want to speak for my mother. Please ask my mother that question.'”

Researchers and geriatricians say these types of cases involve ageism — discrimination based on a person’s age — and are surprisingly common in health care. It can lead to both overtreatment and undertreatment of older adults, says Dr. Louise Aronson, a geriatrician and professor of geriatrics at the University of California, San Francisco.

“We all see older people differently. Ageism is a cross-cultural reality,” says Aronson.

Ageism creeps in even when the intent is benign, says Aronson, who wrote the book: Elderly. “We all start young, and you think of yourself as young, but older people are different from the very beginning.”

That tendency to see older adults as “different” doesn’t just result in loud greetings, or being called “honey” while having your blood pressure taken, both of which can affect a person’s morale.

Aronson says the assumption that older people are one large, vulnerable, homogenous group can cause more serious problems. For example, when a patient does not receive the care he needs because the doctor sees a number, instead of an individual.

“You look at someone’s age and say, ‘Ah, you’re too old for this,’ instead of looking at their health, functioning and priorities, like a geriatrician does,” Aronson says.

She says the problem is that most doctors receive little education about older bodies and minds.

“At my medical school, we only get two weeks to teach about older adults in a four-year curriculum,” she says.

Aronson adds that overtreatment occurs when well-meaning doctors pile on medications and procedures. Older patients may suffer unnecessarily.

“There are things… that happen over and over again because we don’t teach [physicians] how to treat older people as fully human people, and when they get old enough to appreciate it, they’re already retired,” Aronson says.

Kris Geerken is co-director of Changing the Narrative, an organization that wants to end age discrimination. She says research shows that negative beliefs about aging – our own or those of others – are harmful to our health.

“It can accelerate cognitive decline, increase anxiety, it can increase depression. It can shorten our lifespan by as much as seven and a half years,” she says, adding that a 2020 study showed that discrimination against older people, negative age stereotypes and negative perceptions around one’s own age cost the healthcare system $63 billion a year.

Yet beliefs can change.

“If we have positive beliefs about age and aging, those things are all turned around,” says Geerken, and we tend to age better.

Geerken provides training against age discrimination, often via Zoom, including training for health professionals. She also advises older adults on how to push back if they feel like their medical concerns are being dismissed with comments like, “That’s to be expected at your age.”

Age-Friendly Health Systems are another initiative designed to curb ageism in healthcare.

Leslie Pelton is vice president of the Institute for Healthcare Improvement, which launched the concept of Age-Friendly Health Systems in 2018 with the John A. Hartford Foundation.

She describes the effort as one where every aspect of care, including mobility, mental health and medication, is focused on the needs and wants of the older adult.

Pelton says 3,700 locations in the U.S. — including clinics, hospitals and nursing homes — are now designated as age-friendly.

She describes the system as “a counterbalance to ageism because it requires a doctor to start asking and acting on what is important to the older adult, so that the older adult is seen and heard right away.”

That sounds great for Liz Schreier. Schreier is 87 and lives in Buffalo. She walks and does yoga regularly. She also has a heart condition and emphysema and spends a lot of time at the doctor’s office. She lives alone and says she has to be her own lawyer.

“What I find is a disinterest. I’m not very interesting to them,” she says. “And I’m one of many, you know, another one of those old people.”

She goes from specialist to specialist, hoping for help with the little things that keep popping up.

“I had a horrible experience with a gastroenterologist who said I was old, and he didn’t think he wanted to examine me, which was a bit insulting,” she says.

Later she found one of his colleagues who wanted to.

Schreier says it’s difficult to navigate the health care system as an 80-year-old. What she and her colleagues expect from health care workers, she says, is kindness and advice on how to stay active and functional, no matter how old they are.

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