No one wants to be spoken to as though they are children, unable to understand and to have conversations directed to others, not to them. It is demeaning, disrespectful, and apparent bias and the older patient gets it in spades from healthcare workers.
Too often, assumptions are made once a wrinkled face or sun-blotched, loose skin is seen, and the patient’s age screams out from an intake form. Is it any wonder people don’t want to tell anyone their age? Or that they avoid medical care? Would you gladly subject yourself to this boorish behavior?
A 63-year-old woman in a skilled nursing facility summed it up as she said she feels like “I’m invisible” and like she’s seen as “a slug in a bed, not a real person.” Only one nurse regularly talks to her and makes her feel she cares about (her) well-being….”Just because I’m not walking and doing anything for myself doesn’t mean I’m not alive. I’m dying inside, but I’m still alive.”
Healthcare discrimination can be seen in “one out of five adults over the age of 50 years (who) experience discrimination in healthcare settings. One in 17 experience frequent healthcare discrimination, and this is associated with
new or worsened disability…”
Discrimination is associated with age, financial status, and gender, and the longer the person is in the facility, the worse the discrimination becomes, especially for those with ADL disabilities.
I saw an older woman in an upscale residential nursing facility years ago. The woman was walking up and down the hallway, mumbling to herself. When I stopped to talk to her, the words she uttered were gibberish, and I wondered if there might be a problem with treatment.
She was well-educated, had been a nursing supervisor in a major university hospital, and now she was seen as beyond treatment for her mental decline. The treatment they used was exclusively antipsychotics. I didn’t think sufficient exploration had been initiated, and I found a geriatrician to whom I referred her family.
Within days of a medication change, she was verbal, going out to dinner with her family and helping other residents as any nurse would. The house physician (a resident from a local hospital) and the staff had written her off before this new treatment regime.
Where might the bias be in terms of the elderly and other groups receiving reinforcement? Perhaps one source is in medical residency programs. Do older women wish to be referred to as “cute, little old ladies?” What are the equivalent terms used for men?
Unlike racism or sexism about which there is considerable contemporary discourse related to diminishing bias and stigma, ageism has not been widely recognized as an area of social concern…Ageism is prevalent in medical education clinical settings and in the “hidden curriculum.”
AI Is Not Rooting Out Bias
Medical bias exists and persists and is being incorporated into AI databases where it will reside and infect other software platforms. Demographic healthcare inequalities continue to persist worldwide and the impact of medical biases on different patient groups is still being uncovered by the research community.
Who checks these current or future artificial intelligence databases to ensure that they do not contain bias against the elderly or other groups? Realistically, they may not be able to go back and find the initial programs that were tainted by bias; it’s a soup of programs.
Even the programmers may not realize where the code sits in the thousands of lines of code produced for one program and then another formed from that code. What might be needed?
Instead of seeking bias in current AI code, there may be a need to write whole new programs to address the bias. In addition to code, what else is needed now?
Webinars can be a potent source of information if healthcare professionals tune in to one like “Confronting Ageism in Health Care: A Conversation for Patients, Caregivers, and Clinicians.”
How many healthcare professionals keep up with knowledge in this area? Who would know if they didn’t? Families are left believing that the treating physicians are knowledgeable, but they may not be, and therein lies the tragedy. Look at the example I provided at the beginning of this article.
One group where anyone can find qualified professionals as well as valuable information is the American Geriatrics Society. Any questions that may arise regarding an older patient may need to be referred to a specialist.
The body’s many systems change with age and may become more sensitive to side effects, including memory impairments, panic disorders, and liver and kidney changes. One slip of memory may be seen as an indication of dementia when all of us have these moments of memory lacks without being demented. One woman I knew was malnourished, which affected her memory. Diet was the solution, not memory-enhancing drugs or antipsychotics.
The situation requires improvement, but it will only happen with self-awareness and there is a concerted effort by staff in medical schools and residencies to address it. If the “silver tsunami” is fast approaching, how will it be received? Life spans may be longer even with Covid-19, which brings a need for educated and unbiased attention to the physical and mental health needs of older adults.
There are at least a half-million people in the world over 100 in 2021. With improvements in medical research, that number will increase. How will they be treated and cared for in residences or their homes?