When an older patient goes to see his or her doctor, or when they find themselves in need of urgent or long-term care, these seniors have a right to expect to be treated with dignity and empathy. Yet for millions, that’s not the case, according to this recent Kaiser Health News report. Written by Judith Graham, the Kaiser article provides a damning indictment of traditional medicine and how the industry all too often treats seniors. Graham’s article also provides an excellent argument why seniors should follow the advice of Rajiv Nagaich and seek out a geriatrician as their primary care doctor.
A Well-Informed Patient Ignored in the ER
Graham begins her article with a story that seems almost unbelievable. An 84-year-old California woman named Joanne Whitney went to the emergency room with a painful urinary tract infection. The ER doctor wanted to prescribe a particular antibiotic that Whitney knew would not work on her particular ailment. The reason she was so certain? Whitney is a retired associate clinical professor of pharmacy at the University of California-San Francisco.
“He wouldn’t listen,” Graham writes, “even when she mentioned her professional credentials. She asked to see someone else, to no avail.” Whitney told Graham she felt completely ignored and finally gave up. Only later did a different outpatient clinic properly adjust the prescription.
But that wasn’t Whitney’s only experience with hospital ageism. “Earlier this year, Whitney landed in the same emergency room, screaming in pain,” says the Kaiser report, suffering with another urinary tract infection and other issues. “When she asked for Dilaudid, a powerful narcotic that had helped her before, a young physician told her, ‘We don’t give out opioids to people who seek them. Let’s just see what Tylenol does,’” said Graham. “Whitney said her pain continued unabated for eight hours.”
COVID-19 Pandemic Brings New Attention to Medical Ageism
According to Kaiser Health News, Whitney’s experiences of ageism in health care shines the spotlight on what Graham calls “a long-standing problem that’s getting new attention during the COVID-19 pandemic.” As a woman of 84, alone in the ER, Whitney was ignored, in spite of her obvious knowledge and experience. “When older people come in like that, they don’t get the same level of commitment to do something to rectify the situation,” Whitney told Graham. “It’s like ‘Oh, here’s an old person with pain. Well, that happens a lot to older people.’”
As Graham explains, ageism refers to the stereotypes, prejudice or discrimination seniors may experience because of their age. “The assumption that all older people are frail and helpless is a common, incorrect stereotype,” she writes. “Discrimination is evident when older adults’ needs aren’t recognized and respected or when they’re treated less favorably than younger people.” Poorly-trained staff may lack the skills to handle senior patients with empathy.
Age Bias: Explicit or Implicit
“In health care settings, ageism can be explicit,” Graham writes. As an example, she cites plans now being implemented in some hospitals for rationing medical care (referred to as “crisis standards of care”) that specify treating younger adults before older adults. “Embedded in these standards,” she goes on, “now being implemented by hospitals in Idaho and parts of Alaska and Montana, is a value judgment: Young peoples’ lives are worth more because they presumably have more years left to live.” Graham adds that Idaho’s regulations are the subject of a civil rights complaint by a group called Justice in Aging.
But even if there is no obvious age discrimination,ageism can implicit, says Graham. She spoke with Dr. Julie Silverstein of Oak Street Health, a clinic with more than 100 primary care centers in states, all of which serve low-income seniors. Silverstein told Kaiser Health News that doctors often assume that older patients who speak slowly are cognitively impaired, and therefore unable to relate their medical concerns. This bias can lead physicians to ignore the patient’s input and make the wrong medical decisions.
Report: 20 Percent of Seniors Have Experienced Medical Ageism
According to Graham’s research, this bias against seniors in the medical community is a major problem, not an isolated occurrence. “Nearly 20 percent of Americans age 50 and older say they have experienced discrimination in health care settings, which can result in inappropriate or inadequate care,” she writes, citing this 2015 study of 6,000 seniors. Graham said other studies peg the annual health cost of ageism in America – including misdiagnosis, over-treatment, and under-treatment – at $63 billion.
Sadly, the same pattern is common in nursing homes, Graham writes, where one in five residents has persistent pain – yet a significant number don’t get adequate treatment. One woman told Graham, “When I ask questions, they treat me like I’m old and stupid and they don’t answer. When I tell them what hurts, they just ignore it or tell me it’s not time for a pain pill.” Tragically, this woman is made to feel invisible. “Just because I’m not walking and doing anything for myself doesn’t mean I’m not alive,” she said.
Solutions: Hire a Geriatrician for the Right Health Care
One couple cited in the Kaiser report told Graham they found the answer to age discrimination by changing over to a so-called “concierge medicine” practice in their community. (Concierge medicine and its pros and cons are described in this 2019 article from AARP.) While that option can work for some, we find most seniors have a better overall medical experience with a geriatrician, also called a geriatric care physician.
As an example, Graham cites one 75-year-old woman named Nubia Escobar whose longtime cardiologist retired. Her new physician had trouble controlling her hypertension. But when the woman sought a second opinion, fearing that her too-low blood pressure might cause her to faint, the second cardiologist was impatient and rushed. “He didn’t ask many questions and he didn’t listen,” she related to Graham. The woman’s adult daughter, also at the appointment, described the cardiologist as abrupt and constantly interrupting her mother.
“Nubia Escobar has since seen a geriatrician who concluded she was overmedicated,” Graham writes. Escobar told Graham that her new doctor was patient and took plenty of time. “How can I put it? She gave me the feeling she was thinking all the time what could be better for me.”
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(originally reported at www.khn.org)