Combating Ageism in the Doctor's Office
Don't settle for 'these things happen with age' for medical concerns
With a bulge on my ankle and a painful bunion near my big toe, I limped into the office of my orthopedic physician. The building was bustling, home for 15 busy doctors working to remediate or rehabilitate any problem with bones or muscles. Despite my foot pain, I felt ready to move forward with a plan. That's why I was surprised when my doctor seemed to discourage a fix because of my age.

According to a cross-sectional study performed in partnership with the University of Michigan National Poll on Healthy Aging (NPHA), 93.4% of adults ages 50 to 80 surveyed in the study experienced everyday ageism. That's defined as a a short interaction, verbal or nonverbal, that indicates that a person is less valuable because of age. It's shocking that it is this common.
In our society, it's very common to refer to someone as having a "senior moment" or make jokes about memory and physical ability based on age.
Everyday ageism might take the form of stereotyping a person for their age or even directing hostility toward them as an older person. In our society, it's very common to refer to someone as having a "senior moment" or make jokes about memory and physical ability based on age. It may be usual and can even be funny, but in health care, ageism is associated with poor health outcomes.
My own doctor's reaction was surprising. I'd taken for granted that my foot would be a surgical fix, certainly not desirable but resulting in a less painful step. Our interaction was short and his demeanor impatient. He briskly told me "these things happen as you age." With some orders for physical therapy and a request to call if it got too bad, I was dismissed with the discomforting sense that he wasn't interested in pursuing treatment. At 52 years of age, fully insured and in good health, I wondered why.
The answer seemed to be ageism. There was an attitude that I'd just keep bearing through foot pain until it became too difficult to walk and only then would we be forced into a surgery. As someone who enjoyed many sports and activities, I strongly felt that was wrong. My doctor didn't listen.
There are organizations devoted to the fight against ageism. The Gray Panthers, a group of advocates for social and cultural change, define ageist behavior as discrimination that happens to both the young and the old. The group was created in the 1970s by Maggie Kuhn and a group of friends forced into retirement for age despite their objections.
Kuhn was a force in the group, harnessing both ends of the age spectrum to advocate for fair laws, a reduction in stereotypes and better nursing home environments, to name a few issues. At one point, she appeared and asked for a modern update to an older character on Johnny Carson's "The Tonight Show" and the Gray Panthers launched a nationwide task force to watch for ageism in television. Those findings were reported to the Federal Communications Commission (FCC) and Congress, causing change to existing standards.
In 1995, Kuhn passed away, but the Gray Panthers have continued her work with chapters across the United States. Karen Reside, president of the Long Beach Gray Panthers, remembered seeing Kuhn on Johnny Carson when she was in high school.
"I knew about the organization and really liked what they did and stood for," she says.
Awareness and Advocacy
By the time she reached her own retirement age, the Long Beach chapter's membership had dipped so low it was in danger of closing. Reside was asked to join by a colleague familiar with her work in the nonprofit sector and the first thing they did was recruit.
"We went from six members to 60 very quickly. It's our 50th year of service this year," she says.
"Put the younger people with technology knowledge and the older people with critical life experience [together] and work on solving issues."
The group works with interns from local colleges and members on projects that involve needed transportation, appropriate city services, housing and homelessness issues. They successfully advocated to get the city of Long Beach to declare Ageism Awareness Day every Oct. 9. Reside has experienced her own ageism in the health care environment.
"I'm 75 in March and I don't take medication," she says. "My friends are taking 13 medications. We are so overmedicated because of the Pharma industry. I told my doctor that I didn't want to take medication unless my life was at risk and had to argue with them to get them to finally agree."
According to Reside, everyone can benefit from a less ageist society.
"Ageism impacts us economically and causes seniors to be set aside," she says. "I testify a lot at city council on how we don't use our older adults. They can solve problems. Put the younger people with technology knowledge and the older people with critical life experience [together] and work on solving issues."
Ageism in Health Care
As for ageism in health care, those solutions are being tackled by the Institute for Healthcare Improvement (IHI), a not-for-profit health care organization that among other efforts, certifies major health institutions across the world to be "age friendly."
Alice Bonner is the senior adviser for aging at IHI. She sees a connection to ageism with any kind of discrimination.
"It's when someone — whether a physician, nurse, teacher or police, any human being — has preconceived notions about what it's like to be an older person or what it's like to age, similar to people who have preconceived notions based on race or based on sex," she says.
Her work at IHI offers a solution to people looking for an ageism-free environment. The institute offers digital tools and resources for any health care professional. A patient can refer a doctor to that source. The training stresses the need for anyone involved in caring for an older person to listen to their needs first before making judgement on care, and to consider the four M's: to consider the patient's mobility, review medications, focus on the mind and review what matters to the older patient.
One study shows the higher the incidences of ageism a patient experiences, the lower their opinion is of their mental and physical health.
"They should recommend different options and treatments based on what a patient tells them, that's person-directed care," she explains. "That means you are the one seeking care, telling a doctor what's important."
There's a definite risk for the patient with ageism. One study shows the higher the incidences of ageism a patient experiences, the lower their opinion is of their mental and physical health. Experiencing ageism almost convinces someone that they don't have strong bodies and minds. Only 34% of the adults in the University of Michigan study who experienced three or more incidents of ageism thought of themselves physically healthy, compared with 49% of respondents who had fewer examples of experiencing ageism.
On a positive note, the study also finds that most older adults have positive feelings as they age, including 88% of respondents who say they feel more comfortable about themselves and 65% who think their life is better than they thought it would be at this point. That's great news for the mental health of anyone heading into an advanced age. It's important that this confidence extend into the health care environment with communication prioritized on both sides.
Bonner says a relationship where the patient trusts their physician is important, allowing free conversation without intimidation.
"It isn't always easy and sometimes it's hard for people to talk," she says.
Open Communication
Bonner's suggestion to solve my own experience with ageism in health care was open communication; to better explain why I wanted the surgery and relief from my pain.
"For this doctor, you need to look him in the eye and say, 'I'm here because I'm an athlete. I care about continuing with the sports that I enjoy. I'd like to know my treatment options,'" she says.
I have an appointment with the same orthopedist in the new year. I'm going armed with a different attitude, one that starts less with my symptoms and more with my expectations that my foot isn't meeting.
Starting the conversation with a positive attitude about changes I'd like my doctor to help make in my pain level and gait might reframe his attitude about my aging and set a course for improvements in my health. With more communication and a positive outlook, we can all combat ageism when it arises.
