Ageism and Today’s Healthcare Challenge

Author: Michael Wasserman MD

Originally published: Tuesday, November 4, 2014

Several years ago, one of my delightful and independent 93-year-old patients had chest pain while in my office. She had driven to her appointment, as she always did, but was taken across the street to the hospital by paramedics. She ended up in the hospital for a few days with what had turned out to be a small heart attack. When she was discharged, she told the nurses that her car was across the street at my office, and she asked whether could they help her get to it so that she could drive home. They smiled and said to her, “Of course you do, honey.” They didn’t believe that a 93-year-old woman had driven to her doctor’s office! Worse yet, they treated her patronizingly like a child and assumed that she was somehow confused. Even worse, they let her leave the hospital despite all this.

As she was about to cross the street to the parking lot outside my office, a nice gentleman saw her and asked whether she could use some assistance. She explained that she’d just had a heart attack, was discharged from the hospital, and was crossing the street to get her car. He graciously assisted her.

This incident led me to deliver a nursing grand rounds on the topic of ageism in our health care system. It is but the tip of a very important iceberg. There are a lot of preconceived notions about older adults in our society. This type of behavior is not unusual. The elderly are often treated like children. We see it in the supermarket, but it is rampant in emergency rooms, hospitals, and doctors’ offices. Instead of respecting an older person for their experience and wisdom, they are discounted and treated without respect.

Ironically, there are so many reasons that we should respect and pay closer attention to what an older individual tells us. Many older adults are functionally challenged on a daily basis. Arthritis, decreased mobility, and other physical maladies make everything that these people do more challenging. If they are out and about, it’s because they have a greater will and wherewithal than most younger people. They might be a little slower to respond to questions, but their answers are based on many years of experience and are in no way minimized by a slower response time.

These issues are heightened in the case of those suffering from Alzheimer’s disease or other forms of dementia. People with Alzheimer’s may not remember what happened 5 minutes ago, but at any given moment, they experience the world around them just like anyone else. Imagine waking up from a sound sleep and finding yourself strapped to the sides of your bed. For someone with dementia, this is how they perceive physical restraints, still utilized in hospitals and emergency rooms in order to make it easier on the staff to manage agitated patients. It only makes the agitation worse.

Aging sensitivity programs are available to help staff understand the challenges faced by older people. Dementia training is also available to help caregivers understand the best ways to approach someone with Alzheimer’s. Unfortunately, these types of programs are underutilized in many work environments that cater to older adults. No one wants to spend the money necessary to better prepare their staffs. Ironically, the overall costs of care are ultimately increased by the lack of sensitivity. Moreover, we are missing out on an ethical imperative that reflects on us as individuals and as a society.

What can we do about the ageism that exists in our health care system? We can start by doing a better job of educating students in medical, nursing, social work, and therapy schools. Understanding the psychological and social aspects of aging, in addition to physiology, is key. Practical learning experience with real older people is critical to the development of all health care providers and caregivers.

I believe that one of the biggest reasons that we don’t fight ageism the way that we do other “isms” is that we all fear getting older. Denial tends to take over, and as a society, we tend not to deal with this issue head on. It is a shame. Among our seniors are our parents and grandparents, our former soldiers and leaders, those who have spent their lives trying to help the next generation have things a little easier. The very least we can do for them is give them the respect that they deserve.