Dr. Patricia Farrell on Medika Life

Too Old to Live? The Scourge of Ageism in Medicine Cannot Be Denied

Insidious, calculated disregard for our older patients is not acceptable, and it should be called out for what it is — ageism in all its ugliness.

Too long and too often, older adults, a.k.a. senior citizens, are treated as though they have no value or little value left in them. Patients are pushed aside, and their medical conditions are regarded as simply the results of aging, not to be treated, not to be considered significant, and pushed off. What happened to the medical specialties of gerontology or psychogerontology?

And this deadly disrespect isn’t confined to any one country. The World Health Organization has found it is a global problem where age is not revered but dismissed. Their 2021 report: calls out ageism for what it is: a socially-acceptable form of discrimination that impacts older people’s livelihoods, health, and even survival.

How long are we supposed to abide by these restrictions, a.k.a. biases, in medicine? The time has come to stop it and demand respect and appropriate care rather than resigning older patients to sit in a rocking chair and wait for the Grim Reaper to arrive to collect them.

I recall doing a Google search and seeing a reference to a 2013 statement by a country official who said the elderly should hurry up and die. I suppose that would solve what problem? What about the loss of experience and intellectual capacity, or was consumer product sales the only consideration? A shameful statement at best.

A 2020 report by the United National General Assembly noted that in their report, the independent experts stress(es) the lack of comprehensive and integrated international legal instrument for the promotion and protection of the rights and dignity of older persons has significant practical implications given that a) existing regulations do not cohere, let alone conceptualize regulatory principles to guide public action and the policies of government; b) general human rights standards do not consider the recognition of rights in favor of older persons; c) it is difficult to clarify the obligations of states with respect to older persons; d) procedures for monitoring human rights treaties generally ignore older persons; and e) current instruments do not make the issues of aging visible enough, which preclude the education of the population and with it, the effective integration of older persons.

If the world’s populations are not sufficiently educated regarding the rights and dignity of older persons, doesn’t it follow that it has worked its way into the practice of medicine? Undoubtedly, anyone older than 65 or 70 has faced that ignorance, bias, or whatever you want to call it when receiving medical care. It is not-so-hidden dismissive behavior.

Publications have indicated a disturbing occurrence related to elderly patients who leave hospitals sicker than when they were admitted. Research shows that about one-third of patients over 70 years old and more than half of patients over 85 leave the hospital more disabled than when they arrived.

One paper outlined reasons for improper or poor care of elderly patients (they failed to mention bias), which read: Poor management of the complex problems of the frail elderly can be summarized as follows:(1)inappropriate (2) incomplete medical diagnosis, (3) poor coordination of community support services, (4) overprescription of medications, and (5) underutilization of rehabilitation. The question of beliefs in medicine was addressed in another publication. Succinctly, it stated that positive beliefs=better outcomes.

I don’t care how many “training sessions” on experiencing the difficulties of the elderly are run in schools. Putting on padding, gloves, or special glasses is a momentary thing that doesn’t necessarily carry over to overt beliefs and behaviors with the elderly. It’s a lark for the attendees, not a change of view.

I’ve heard physicians remark how “old patients have a certain smell, don’t they?” Smell? Well, I suppose they can’t afford your cologne, after-shave, or taking their clothes weekly to the dry cleaners, doc.

A word to the elderly patients: Learn to dress for success, even if you can’t afford it and have to skimp on meals or medicine. Better-dressed patients are perceived as more worthy of care. Yes, I am being facetious, but it’s a fact.

I recall standing in a major New York City hospital hallway while a quite elderly man in a hospital gown was seated on a gurney waiting for a procedure. He was entirely alone in the room and without glasses.

A quite young staffer approached, pushed a clipboard and pen in his direction, and asked him to sign a release to participate in a research protocol. The man was confused and wanted to know what it was for, and the staffer, in a state of annoyance, told him he needed to sign it. Signing without knowing what he agreed to seems unethical to me. In “good patient” mode, the man signed on the dotted line, not knowing in what research he would participate.

The hospital, undoubtedly, makes a great deal of money and produces many professional papers, so getting subjects for clinical trials is of paramount importance. Forget about the patients; get them to sign.

Other older patients with Medicare coverage regularly are told, “Well, Medicare won’t cover this procedure, so if you want it, you’ll have to pay.” The “pay” part isn’t usually provided, and the patient must produce a credit card before leaving. Where’s the medical empathy about the issue? It’s missing.

Most of the time, the procedure might be “cosmetic,” like an ugly mole, an enormous cyst, or distressing marks. I suppose that means elderly patients shouldn’t care how they look and how it might affect both their self-respect and how they are treated? Thank you, Dr. Pimple Popper, but who pays your fees? Is it Medicare or Medicaid or the TV show’s producers?

We know that Medicare won’t pay for more than ONE hearing aid. How many people need only ONE hearing aid? Do they pay for more than ONE lens in eyeglasses?

Medicare is just as biased as those providing the services. And Medicare won’t pay for dental care, and we know that can play a role in various illnesses, including cardiac disorders. Are all the elderly on their own here, and should they let all their teeth fall out?

Are we reaching the point where the elderly patient in medical care no longer expects respect? Should they begin committing suicide, as has been reported happening in Japan during the lockdowns and loneliness of the pandemic?

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Pat Farrell PhDhttps://medium.com/@drpatfarrell
I'm a licensed psychologist in NJ/FL and have been in the field for over 30 years serving in most areas of mental health, psychiatry research, consulting, teaching (post-grad), private practice, consultant to WebMD and writing self-help books. Currently, I am concentrating on writing articles and books.

DR PATRICIA FARRELL

Medika Editor: Mental Health

I'm a licensed psychologist in NJ/FL and have been in the field for over 30 years serving in most areas of mental health, psychiatry research, consulting, teaching (post-grad), private practice, consultant to WebMD and writing self-help books. Currently, I am concentrating on writing articles and books.

Patricia also acts in an editorial capacity for Medika's mental health articles, providing invaluable input on a wide range of mental health issues.

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