Ageism a barrier to healthcare for seniors
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.
Neel Mistry is a medical student at the University of Ottawa. He is passionate about medical education, public policy and health management.
Paul Rooprai is a medical student at the University of Ottawa. He is passionate about public health, clinical research and patient safety.
Kim Rooprai is a fourth year dental student at NYU College of Dentistry. She is interested in global and public health, healthcare management, and providing quality patient care.
Shubham Mistry is a PharmD candidate at the University of Toronto’s Leslie Dan Faculty of Pharmacy. He is passionate about rational prescribing and high-quality patient care.