I’m a daughter of immigrants, so I didn’t grow up with grandparents or older relatives. As a young child, I did see my father’s parents a few times, but it wasn’t enough to teach me about their generation. I have a few photos, but not many memories of those visits, here or in the Netherlands. I can pull up an image of my tall Opa standing in our backyard, towering over the sunflowers – which were enormous in my small child’s eyes. I remember my Oma unpacking her suitcase as she settled in and sitting with her to unravel a knitted sweater so the wool could be used again. But that’s about it. My exposure to people older than my parents was limited.
Years later, when I began my nursing program, I only saw older people when they were ill. In my first job, on a medical floor, we cared for some older long-term patients who occupied a few rooms at the end of the hall. It wasn’t a good place for them. They were treated as patients, not people who needed and deserved stimulation and activities. They were cared for (provided with food and drink, clothing changed, and bathed), but they had little quality of life in my opinion. They didn’t belong in that place, but there was nowhere else for them to go.
I only saw older people when they were ill.
Did my lack of early life experience with seniors and my early nursing experiences skew my view of older people? Did it lead to implicit bias, a form of automatic and unintentional bias that affects judgments, decisions, and behaviors? It’s possible.
On the other hand, my best friend grew up with older generations as a part of her everyday life. She saw the reality of how robust older people often were. So her view was different from mine. I admired that and, truth be told, I was always a bit envious of her ease around our older patients. Her caring touch often humbled me and I tried to learn from her. I like to think I did, especially as I grew as a person and met healthy, happy seniors who had so much to offer the world.
And that brings us to ageism in healthcare. I learned about working with older people, but many people haven’t.
Stereotypes abound
Some of the most common stereotypes associated with aging are that older people are:
Burdensome/dependent
Senile
Unable to contribute to society
Depressed
Anxious
These stereotypes prevent quality healthcare.
Picture an older patient who seems frail or confused. A quick assumption is that it’s probably due to old age. But what else could it be? How about an undiagnosed infection or illness? Malnutrition due to lack of access to healthy food or inability to prepare meals? An adverse reaction to a medication or the effect of a combination of drugs? Depression? Something else? If the frailty or confusion is treatable, that patient could regain a good quality of life rather than just existing.
What about tests and treatments? Should diagnostic tests or treatments be denied even though they would be options for younger patients? And why might they be denied? Because an illness hasn’t been considered? Because of cost and lack of insurance?
What about new treatments? Older people are certainly not represented in many clinical trials, often with a cut-off age of 65. So this means practitioners don’t know how new drugs or treatments will affect their older patients, further limiting treatment options.
If the frailty or confusion is treatable, that patient could regain a good quality of life rather than just existing.
What about how we address older patients, whether they seem confused or not? Some people treat older people in a child-like way, speaking in a sing-song voice, using juvenile language, or only addressing their companion, despite their ability to think and speak independently. This isn’t appropriate, is it?
Given all this, it’s not surprising that when older people see healthcare professionals, they feel they aren’t taken seriously. They feel devalued and dismissed when they might have an easily treatable condition allowing them to resume their previous quality of life.
Ageism and its effects start before people get old
Some misconceptions and beliefs about aging we hold from earlier in our own lives may catch up to us in a very real way.
I don’t usually refer to studies over a few years old, but I found this one from 2002 interesting. According to the abstract, “This research found that older individuals with more positive self-perceptions of aging, measured up to 23 years earlier, lived 7.5 years longer than those with less positive self-perceptions of aging. … The findings suggest that the self-perceptions of stigmatized groups can influence longevity.”
Similar findings were published seven years later by other authors. According to them, people having negative stereotypes and attitudes toward older adults when they themselves were younger were associated years later with increases in:
Cardiovascular disease
Memory impairment
Decreased capacity to recover from disability
Hearing loss
Diminished will to live
Lower participation in preventive activities
Lower perception of functional health
Poorer recovery after myocardial infarction
The authors wrote, “Furthermore, these problems individually or in combination may have increased the risk for all-cause hospitalization by 50%, and reduced longevity compared with people who harbored more positive explicit attitudes toward old age.”
Positive thinking about aging can also affect dementia, say researchers. A study published in 2018 found that positive age beliefs, even among people who carried the APOE gene, a strong risk factor for Alzheimer’s disease, were about 50% less likely to develop dementia than those with negative aging beliefs.
Ageism costs money – lots of it
If we don’t already feel strongly about ageism in healthcare, how about we look at how much it costs?
In 2018, a Yale School of Public Health study found that health costs related to ageism came in at about $63 billion per year in the U.S. And, according to the authors, “ageism was responsible for 17.04 million cases of the eight most expensive health conditions in one year among those 60 and older.”
Cardiovascular disease, like strokes or heart attacks, is the most expensive condition. This stands out because, as per the Centers for Disease Control and Prevention (CDC), about 80% of strokes are preventable – you read that right: 80%. And nearly 90% of heart disease, which can lead to heart attacks, is also preventable. Why are we not helping our seniors avoid these rather than accepting them as a fact of life?
So what can we do?
We didn’t care for older people properly when I graduated from nursing school and 40 years later, we still don’t. But it’s not complicated. It takes a change in mindset, starting with acknowledging that old age is not an illness or disease. We must stop buying into the stereotypes that all older people are frail and that illness is a given.
Other actions include making the system age-friendly. This means:
Make sure offices are physically accessible.
Provide alternate methods of communication if a patient is hard of hearing or has some other barrier to communication.
Extend appointment times so patients have time to discuss their health issues.
Provide preventative care, not just reactive care.
Improve home healthcare so people with limited mobility or no access to transportation can still see a medical professional.
Educate healthcare providers about aging and health issues, and work on wellness and prevention.
Increase the number of geriatric specialists in the system.
Include older people in new research.
Are some of these changes expensive? Yes, they are. But how about that annual $63 billion price tag we’re paying now? Isn’t that expensive?
What do you think? Please leave your thoughts and ideas below in the comment section, and let’s get a conversation going. And please subscribe if you haven’t yet, and share this newsletter with others who may be interested.
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Excellent article. Having worked as a primary care provider in an area with a very high geriatric population I agree much of this rings true. I agree with educating about preventative care and wellness, but thinks this should apply to patients as well as providers. Unless patients are familiar with preventive care at a younger age it is hard yo get them to buy into routine wellness visits.