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Ageism in the Doctor’s Office

Stria Staff January 26, 2020

How does internalized ageism cloud providers’ judgment when treating older patients? And what does it mean for health outcomes?

All patients deserve quality care, regardless of their race, socioeconomic status or sexual orientation. But how does this ethical standard hold for older people? Can we trust that the concerns of older patients will not be dismissed when they visit their doctor’s office? 

Not surprisingly, the answer is no. Though the bias is likely unconscious, discriminatory behaviors toward older people in health care settings is an all too common experience. In addition to being an ethical transgression, ageism in the doctor’s office can be damaging and have lasting negative effects on an older person’s overall health. 

The following articles highlight growing concern about ageism in healthcare.

Headlines & Insights: Curated excerpts from thought-provoking articles

Doctors Are Ageist—and It’s Harming Older Patients
NBCNews.com  |  Liz Seegert

…deep-seated failings in the delivery of medicine to elderly patients are indicative of a larger problem in health care: ageism. We medicalize the natural process of aging, then look down on the patients who come seeking treatment while not adequately preparing the doctors they visit to address their particular needs. The U.S. population is getting older, and without a major change in the values, training and attitude of the mainstream health care community, more and more of us will be harmed when we seek care as senior citizens.

An analysis of National Health and Retirement study data found that 1 in 5 adults over 50 experiences age-related discrimination in heath care settings; 1 in 17 said they experience it frequently. This bias is associated with new or worsening disability, poorer mental and physical health, and use of fewer preventive health services.

Other studies found age-based discrimination to be common in diagnostic procedures and in the types of treatment offered to patients, especially in cardiology, oncology and stroke care. Compared with younger patients, older adults were less involved in their own health care decision-making and doctors were less tolerant, less respectful and less optimistic.

A Doctor Speaks Out About Ageism and Medicine
Kaiser Health News  |  Judith Graham

“Do you know the famous anecdote about the 97-year-old man with the painful left knee? He goes to a doctor who takes a history and does an exam. There’s no sign of trauma, and the doctor says, ‘Hey, the knee is 97 years old. What do you expect?’ And the patient says, “’But my right knee is 97 and it doesn’t hurt a bit.’

“That’s ageism: dismissing an older person’s concerns simply because the person is old. It happens all the time.

“On the research side, traditionally, older adults have been excluded from clinical trials, although that’s changing. In medical education, only a tiny part of the curriculum is devoted to older adults, although in hospitals and outpatient clinics they account for a very significant share of patients.

“The consequence is that most physicians have little or no specific training in the anatomy, physiology, pharmacology and special conditions and circumstances of old age—though we know that old people are the ones most likely to be harmed by hospital care and medications.” [from an interview with Dr. Louise Aronson, a geriatrician and professor of medicine at the University of California-San Francisco]

How Ageism Negatively Affects Older People’s Health
Time  |  Alice Park

The upsides to expressing gratitude are many. Studies have shown that gratitude has a uniquely powerful relationship with health and well-being, both our own and of those around us.

When people have higher levels of gratitude, they tend to have lower levels of depression, better sleep quality, and stronger biomarkers, such as higher rates of good cholesterol. In addition, they are better able to handle stress and are more socially connected.

By practicing gratitude over time, we can learn to notice and appreciate not only the positives, but also develop better attitudes about the negatives … the challenges, losses, and frustrations that we all face as we age. Adopting an attitude of gratitude means tackling the negative things and challenging ourselves to find ways to be grateful for them.

Perspectives on Bias in Medicine, Acknowledging Age Bias in Medicine
The Ohio State University College of Medicine  |  Laurie Belknap, DO and Camilla Curren, MD

Health care providers may further be predisposed to the development of ageism due to increased exposure to chronically ill or medically fragile patients at the end of life.

In fact, bias against the elderly may be the strongest and most socially acceptable bias.1 In one study, groups of nursing students and working nurses exhibited negative implicit attitudes towards older people, though nursing students had less implicit attitudinal bias than working nurses. In another study, evidence was found to suggest that mental health providers believed that mental illness was a normal part of aging and that older adults would not benefit from psychotherapy.  Medical care providers with more experience had decreased negativity in attitudes toward older patients, but this article also suggests that clinical experience and level of training are not predictive of a provider’s attitude toward the elderly.

Anti-aging bias among healthcare providers can affect decisions regarding the evaluation and treatment options that are offered to older adults and could result in disparities in health care for the elderly.

This story was created in partnership with students from the Department of Gerontology at Virginia Commonwealth University. Thanks to Shannon Arnette for contributing research for this piece.

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