Aging Options

Age Bias in Health Care is More Common, More Damaging Than We Realize

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Most older patients have a high regard for their doctors. But does the medical profession return the favor? Sadly, research continues to show that age bias is rampant in the world of health care, putting senior patients at grave risk to their health. Many older patients are commonly marginalized and patronized, their health concerns dismissed as “just part of aging.” Others are diagnosed by physicians unfamiliar with their history and physiology, and are prescribed drugs and treatments that are inappropriate at best and dangerous at worst.

As we read about age bias in health care in this recent report from National Public Radio (NPR), we found ourselves growing increasingly angry. We think the NPR piece by reporter Ashley Milne-Tyte is a must-read for seniors and their families who deserve the best from their health care providers – but too often aren’t receiving it.

Age Bias in Health Care: Catering to Insulting Stereotypes

Milne-Tyte begins her article with the story of Kathleen Hayes, a resident of Chicago who can certainly relate to a recent study which found that older people spend an average of 21 days a year on medical appointments.

Hayes knows, because she is responsible for taking her parents—both in their 80s—to their respective doctor visits. Her father has Parkinson’s and her mother had a challenging recovery from COVID-19, and this has given Hayes quite the spectrum of experiences in various healthcare settings.

While sitting in on these appointments, Hayes has noticed certain behaviors, like healthcare workers speaking to her parents much louder than necessary, or some doctors and nurses not even addressing her parents directly, instead only speaking to Hayes herself. 

“Their gaze is on me so long that it starts to feel like we’re talking around my parents,” says Hayes. “I’ve had to emphasize, ‘I don’t want to speak for my mother. Please ask my mother that question.'”

Age Bias in Health Care Leads to Poor Care, Overtreatment

These common situations aren’t just inconsiderate. According to researchers and geriatricians, they constitute ageism, or discrimination based on a person’s age. The intent behind this behavior can even be benign. But, according to Dr. Louise Aronson, a geriatrician and professor in San Francisco, it can have deleterious effects, leading to both overtreatment and undertreatment of older adults.

“We all see older people differently. Ageism is a cross-cultural reality,” Aronson says. “We all start young, and you think of yourself as young, but older people from the very beginning are other.” This disassociation can trigger unconscious bias toward seniors.

Age Bias in Health Care: Stereotypes and Generalizations

Some of this perspective, seeing older adults as “other”, can manifest in simple (yet insulting) behaviors, like speaking too loudly or using inappropriate terms of endearment (like “honey”) during procedures. These are typically demoralizing, but not necessarily damaging.

However, Aronson warns that making assumptions about older people as being “one big, frail, homogenous group” can be more serious. She says that a patient can often not receive the care they need because the healthcare professional is seeing “a number, rather than an individual.”

Aronson adds, “You look at a person’s age and say, ‘Ah, you’re too old for this,’ instead of looking at their health, and function, and priorities, which is what a geriatrician does.”

Age Bias in Health Care Starts in Medical School

Aronson notes that a major limiting factor is medical education. Many doctors receive very little instruction about how to appropriately interact with older bodies and minds, noting that in her medical school they “only get two weeks to teach about older people in a four-year curriculum.”

This ignorance can lead to overtreatment, when well-intentioned doctors push medications and procedures without adequate discernment, leading to unnecessary suffering and side effects.

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

Attitude Toward Aging Can Shorten Lifespan Dramatically

Milne-Tyte turns next to Kris Geerken, the co-director of Changing the Narrative, which is an organization working to end ageism. Geerken explains that negative beliefs about aging are detrimental to our health, according to research.

“It actually can accelerate cognitive decline, increase anxiety, it increases depression. It can shorten our lifespans by up to seven-and-a-half years,” she says. She also adds that a 2020 study showed that discrimination against older people is expensive: “Negative age stereotypes, and negative perceptions around one’s own age, cost the health care system $63 billion a year.”

Age Bias Can be Overcome with Training, Patient Push-back

The good news? It doesn’t have to be this way, and beliefs can change.

“When we have positive beliefs about age and aging, those things are all flipped,” Geerken says. This also means that we tend to age better.

The answer is education. Geerken leads anti-ageism trainings both in person and over Zoom for various groups, including healthcare workers. “She also advises older adults on how to push back if they feel their medical concerns are being dismissed with comments like, ‘It’s to be expected at your age,’” Milne-Tyte writes.

One Answer: Age-Friendly Health Systems

There are other initiatives pushing against ageism in the healthcare industry, such as Age-Friendly Health Systems. The Institute for Healthcare Improvement launched this concept in 2018 in partnership with the John A. Hartford Foundation. The result is that 3,700 clinics, hospitals, nursing homes, and other sites across the US are now designated “age-friendly”.

Leslie Pelton, vice president of the Institute for Healthcare Improvement, describes the effort as “one in which every aspect of care, including mobility, mental health and medication, is centered on the needs and desires of the older adult.”

She adds that the system acts as “a counterbalance to ageism, because it requires that a clinician begins with asking and acting on what matters to the older adult, so right away the older adult is being seen and being heard.”

Age Bias in Health Care: Patients Find Doctors Disinterested

Milne-Tyte concludes with the story of Liz Schreier, 87, who lives in Buffalo. Schreier is very active, walking and doing yoga regularly. But she also has a heart condition and emphysema and is no stranger to spending plenty of time at the doctor’s office. Because she lives alone, she has learned to advocate for herself.

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

Schreier has gone from specialist to specialist, looking for help. “I had a horrible experience with a gastroenterologist who said I was old, and he didn’t think he wanted to do a scope on me, which was a little insulting,” she says. Thankfully, she eventually found one of his colleagues who would.

Milne-Tyte concludes, “Schreier says navigating the health care system in your 80s is tough. What she and her peers are looking for 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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(originally reported at www.npr.org

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