Since American psychiatrist Robert N. Butler first coined the term in 1969, “ageism” has become one of the greatest impediments to modern medicine. Defined as the systematic stereotyping and discrimination against people because they are old, ageism is ubiquitous in Canadian healthcare.
In 2017, seniors were the fastest-growing age group with an estimated 6.2 million people 65 and older. With just over 300 geriatricians in Canada, experts say another 500 are needed to provide effective medical care to the elderly.
Even when seniors get to see a healthcare provider (HCP), they may be subjected to ageist attitudes behind closed doors such as a physician failing to differentiate age-related changes from pathognomonic findings. In some cases, the physician may avoid treating certain pathology by labelling it as a feature of “old age.” This lack of heterogeneity may result in under-treatment and, in some cases, medical negligence. If HCPs solely attribute these symptoms to increasing age, conditions such as pain, anxiety, depression and cognitive impairment may go unnoticed.
Ageism is starkly apparent in encounters between patients and physicians. On average, Canadian seniors spend less time talking to their HCPs than any other age group. As well, elderly patients are usually accompanied by a companion to their medical visit. Doctors often take advantage of this by directly communicating with the family member even if the patient in question is fully competent. While having a third person in the room can be beneficial, it may also affect the group dynamic. Seniors accompanied to their medical visits raise fewer topics with their doctors and are less assertive. If patients do not disclose underlying concerns to their HCP, it may lead to an inaccurate diagnosis, ultimately compromising the quality of care.
Ageism in healthcare exists across multiple levels. Combating ageism requires addressing ageist attitudes amongst care providers and elderly patients by developing an awareness of the inequalities that persist between age groups and appreciating that heterogeneity exists among the elderly. Older adults are diverse and differ in health and functional status, educational background and cultural upbringing. Labelling older adults with descriptions such as disease, disability and decline reinforces discriminatory perceptions of what aging embodies. According to Ashton Applewhite, a revered author and activist, it is essential that we reshape negative thoughts about aging to build a society that does not isolate older adults and allows them to continue to contribute.
Better education is part of the solution. Those who work with the elderly in healthcare settings should receive training that dispels negative assumptions and increases awareness of how to appropriately respond to the aging process. Improved training for doctors and other first responders who work directly with older persons is a necessary starting point. With aging of the population and longer life expectancies, HCPs need to become more familiar with the aging process and the needs of older adults. Currently, Ontario medical schools allocate a minimal percentage of their curriculum to aging. Since family physicians are often the first point of entry into the healthcare system, it is important that they receive more in-depth training than is currently offered.
Education must also be aimed at older persons so that they can identify if and when they are experiencing age-based discrimination and know what recourses are available to address it. Keeping the elderly informed about ageist practices empowers them to take part in the process of reforming current healthcare practices. An additional necessary step is to foster intergenerational collaboration. Interaction between HCPs and older adults is imperative in changing our current misconception that older individuals are dependent and frail. Communication in any healthcare setting with the elderly should elicit individualized treatment plans that enable patients to remain independent, healthy and outside of hospital settings. Healthcare outcomes depend on the physical health of a patient in addition to the HCP’s ability to attend to their patient’s psychosocial and biomedical needs. Effective patient-physician communication not only facilitates the exchange of health information but also builds interpersonal relationships that encourage decision making and patient satisfaction. By changing the way health practitioners engage with older adults, patients will be empowered to use their skills and confidence to take responsibility for their health and wellness.
Becoming advocates for older adults means that we need to choose our words with care. Avoiding stereotypes and discrimination associated with age will allow us to positively affect both implicit attitudes and explicit actions. It is imperative to train qualified individuals who may be interested in providing care to the elderly. With the aging population growing rapidly, addressing the shortage of providers with geriatric knowledge will aid our healthcare system in supporting the later stages of life.
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Excellent – I completely concur.
Bravo!
Sandi Berwick, RD, MA FSGN
MSVU
Co-chair, NS Dietitians’ Continuing Care Action Group’
Associate: Eden Philosophy of Care
Excellent article. Thank you for contributing this piece. I have had the misfortune to witness ageism in healthcare on a number of occasions when accompanying elderly family members to hospital or to physician appointments. In regard to the idea that “Seniors accompanied to their medical visits raise fewer topics with their doctors and are less assertive.” I would say that although that can occur, it would depend on the nature of the relationship between the caregiver/companion and the patient. Some seniors are far less assertive when alone, more tense, and they will often tend to forget to mention relevant information. It may help to have the caregiver/companion present for at least part of an appointment.
Dear Paul,
Thank you for reading our article. You raise an excellent point, which we agree is valid amongst seniors.
Regards,
Neel and Co.
I understand the point of this piece… and as a ‘geezer’ in my 8th decade, I agree that we don’t want to add yet another “-ism” to the many that are protesting discriminatory (and even criminal) detrimental treatment from ‘systems’ and ‘authorities’ and members of certain professions.
I am pleased that these four ‘young’ authors have documented/footnoted their key points… and I like the recommendation for more effective and durable education for those proceeding towards becoming HCPs.
I would also recommend that what used to be called a “Quality Standard” (QS) of practise with/for older patients could be developed… and then each already practising HCP could be periodically assessed against such a standard.
As well, patients and their advocates could use the guidance within the QS to support their interactions with their personal HCP. I have also found that being informed and prepared for consultations/appointments puts one on a more level playing field with one’s HCPs… irrespective of the clinical setting.
Finally, it has been my experience that younger HCPs are less problematic to work with as a patient (and as an advocate)… the most difficulty I have encountered was with older (nearing retirement …if that’s not too “ageist”) GPs who are the most dismissive/superior or who ‘act like they’re god’.
Thank you.
Hi Toby,
Thank you so much for your wonderful comments. We are truly humbled. You’ve raised many interesting points here. While we’re happy to hear that younger HCPs are cognizant of this issue (and therefore, easier to work with), it’s unfortunate to hear that there are other GPs who are indifferent to this. We hope that our work reaches as many people as possible, in an earnest effort to alleviate prevailing ageist attitudes among HCPs, both young and old.
Regards,
Neel and Co.
As a 84 yr old very active senior I tottaly agree with the comments in this article. The age number is only a numerical reference as I have friends in their 60s & 70s who have a physical age of someone in thier 80s. As humans we all age at different rates based on our genes, culutural and mental outlook on life. I believe in a positve outlook on life, maintaining a healthy diet and remaining active as long as I have the ability to do so.
Dear Flora,
Thank you for reading our piece. We agree with what you have to say, and are delighted to hear about your positive outlook on life. Wishing you good health ahead.
Regards,
Neel and Co.
Good comments. A big issue is what defines elderly or senior? At 60 I did aerobic classes at my gym with 25 year olds, my mother is 91 and walks a km most days. Yet, others are already very ill. Much like with those 0 to 18 years old age, I wonder if we need new ways to segment those 55 to 95.
Hi Ed,
You’ve raised an excellent point here. Unfortunately, our society defines “elderly” or “senior” based on a numerical value; however, as you rightly mentioned, it is far from that. This might be a topic for future discussion. We’re glad that you, and your mother, are keeping healthy during this unprecedented time.
Take care,
Neel and Co.