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Fighting Ageism and Unfair Treatment in Health Care

Among the problems: doctors who view depression and anxiety in older adults as 'normal'


Part of the Transforming Life as We Age Special Report

(Next Avenue invited all our 2016 Influencers in Aging to write essays about the one thing they would like to change about aging in America. This is one of the essays.)

Everyone deserves equal treatment — in the broader society and in our health care system. Today, older people are often not treated fairly and do not get the care they deserve, simply because of their age. While one of our great success stories in the 20th century was the stunning gain in human longevity, recent research from The Frameworks Institute, funded by my group, The John A. Hartford Foundation, and others, has found that the majority of us still don’t recognize ageism or its deleterious effects. They call it a “cognitive hole,” a mental blind spot.

As 10,000 of us turn 65 each day, it is critical that we shine a bright light on this insidious prejudice. It is a matter of simple fairness and justice. It is a way to honor the priceless and irreplaceable contributions that older adults make every day to enrich our society and culture. And for those of us at The John A. Hartford Foundation, it is critical to the broader effort to improve care for older people.

The Dangers of Ageism

Research during the last two decades has implicated ageism in the under- and over-treatment of older patients, as too many clinicians mischaracterize organic medical conditions as normal aging. Others ignore pain, anxiety and depression as unavoidable as we get older or unconsciously view older people as less worthy or less important than their younger counterparts.

Though nearly four in 10 older people take five or more medications, clinical trials generally exclude older patients with multiple chronic conditions.

A classic example is the underdetection of elder mistreatment, when, for example, clinicians ascribe bruises to anticoagulants instead of making an effort to ensure there is no family violence. Another — the assumption that all older people become confused and forgetful, when, instead, a brain tumor may be the real problem.

These negative and inaccurate views of older people consistently hamper our ability to recruit nurses, doctors and other health professionals into geriatrics and gerontology. The result: our health care workforce often lacks the knowledge and experience to treat a group of patients who make up 35 percent of all hospital stays and 27 percent of all doctor’s office visits. And though nearly four in 10 older people take five or more medications, clinical trials generally exclude older patients with multiple chronic conditions, so we may misjudge drugs’ efficacy (and even dangers) with this important patient population.

Even our own views of aging can have important influences on health and well-being. Researchers note people with more positive expectations about aging live longer, experience less stress and have a greater willingness to exercise and eat better. Conversely, negative perceptions of aging — inadvertently supported by unhelpful and negative stereotypes in popular culture and the media — can reinforce self-defeating behaviors that make us more vulnerable to disease and disability.

Developing an Age-Friendly Health System

During the last century, our health care system has consistently demonstrated an impressive ability to adapt and to find innovative solutions to challenging problems. Looking ahead, we need an intensive effort to create an age-friendly health system where all older adults and their families feel that the care they receive is the care they want and that they feel respected in the process.

We need health care suffused with aging expertise, devoted to person- and family-centered care, and able to provide coordinated services in the hospital, clinic and the community. This work is neither simple nor easy. Raising awareness about, and addressing, ageism throughout the health care system — and throughout our society — will be critical to delivering the care all of us want and deserve as we get older.

By Terry Fulmer
Terry Fulmer, PhD, RN, FAAN, is the president of The John A Hartford Foundation in New York City, a private, nonpartisan foundation dedicated to improving the care of older adults. She previously served as distinguished professor and dean of the Bouvé College of Health Sciences at Northeastern University and prior as the founding dean of the New York University College of Nursing. Dr. Fulmer, an elected member of the National Academy of Medicine, is internationally recognized as a leading expert in geriatrics and is best known for her research on the topic of elder abuse and neglect.

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