Ageism in Healthcare is Hurting Patients-The HSB Blog 4/25/22

Our Take:

As the adult population continues to increase in size, age-related discrimination, biases, beliefs, and stereotypes are becoming more prevalent. Ageism has been shown to have adverse effects on one’s health outcomes and influences the psychological, physiological, and behavioral health of the older population. Additionally, such ageist beliefs can promote negligent behavior by staff and lead to the further development of chronic diseases. However, the inclusion of geriatric-related clinical coursework can promote a change in how future healthcare professionals interact with and provide care to such populations. While the use of telehealth services has increased positive responses from elderly populations limited digital/technical knowledge has halted further success.

Key Takeaways:

Approximately 89% of elderly adults from previous studies have experienced some form of ageist behavior or discrimination.
Older individuals are less likely to be selected as organ transplant recipients in comparison to younger individuals.
Elderly populations are likely to visit their healthcare providers annually an average of 12 times.
Older adults with negative perceptions about ageing demonstrated poorer functional health, recovered from disease more slowly and had shorter average life spans.”

The Problem:

While older populations are regular consumers of medical services, they are more likely to face harsher treatment, poor attitudes, and poor bedside manner by staff. Oftentimes, healthcare professionals present will bypass the elderly patients and speak directly with their families showing a lack of regard for their input and undermining their decisions. For example, in the study “Physical Therapists’ Nonverbal Communication Predicts Geriatric Patients Health Outcomes” a series of videotaped interactions focused on capturing indifferent behaviors by physical therapists resulted in a negative “short- and long-term cognitive physical health outcomes for the patient”. Additionally, despite the growing need for geriatric physicians many medical students or residents entering the field find it to be frustrating and less rewarding. However, they fail to understand that the need to investigate and research sensory and cognitive impairments within elderly populations is an important aspect of formulating treatment options for future generations when they reach this stage.

The Backdrop:

Ageism in healthcare, while often not recognized, has been a long-standing issue in the proper treatment, communication and experiences of elderly patients. These negative views within the healthcare system are often influenced by clinician’s initial exposure to hospitalized elderly patients more so than in community-dwellings. For example, medical trainees’ exposure to geriatric patients within a healthcare facility led to misconceptions that stereotype them as frail, disoriented, or incurable solely due to age. In addition, as housing seniors in institutional settings has become more common and worker shortages have become more severe, the level of training and sophistication in serving the needs of the elderly has also declined. This has led to a lack recognition and ability to effectively treat and deal with geriatric-related conditions. As stated in the “Geriatrics Workforce by the Numbers,” “with this population growth, the demand for Geriatricians is expected to increase 45% by the year 2025, yet [the] emerging number of Geriatricians in America actually decreased from 10,270 in 200 to 8502 in 2010”. Furthermore, the lack of training and educational curriculums in the health workforce has led providers to apply age-based, group characteristics to most geriatric patients regardless of their individual health status.” Thus, treatment may be delivered regardless of health status. For example, according to an Ageism Survey conducted by Dr. Erdman Palmore, approximately 43% of elderly individuals between the ages of 60 – 93 stated their healthcare provider would associate their ailments as a direct factor of their age, with 9 percent of participants stating that they had been denied the opportunity to receive medical treatment due to their age.”

This was particularly evident in treatment guidelines established during the recent COVID pandemic, where many elderly individuals that were turned away from care and had been placed in a stereotypical age-related illness category despite their health status. Older adults were more often looked at in terms of the mortality rates as tables which were considered “normal” regardless of the state of the disease, comorbid conditions and overall physical health. According to “Ageism and COVID-19: what does our society’s response say about us?” in the United States a Ventilator Allocation Guideline has been put in place “whereby ‘age may be considered as a tie-breaking criterion”. Additionally, the creation of the ‘Vulnerable Person Registry’ has aided in supporting elderly populations to keep them socially engaged and provide the necessary resources needed during these tough times, the name itself is ageist. However, in terms of telehealth, the adoption of consult services with video-conferencing and post-discharge maintenance has been shown to have positive health outcomes among the limited number of individuals that actively use them.

Implications:

While elderly populations are not as familiar with technology or digital platforms it is not an impossible task to help them obtain technological literacy in order to use and get the maximum impact from digital tools. For example, when New York Presbyterian-Weill Cornell Emergency Department incorporated a geriatric emergency medicine, over 1, 000 patients were evaluated with most noted they had “high levels of satisfaction after receiving care,” This demonstrates that not only do elderly patients defy the stereotypes but also, they are capable and in fact eager to learn more about technological platforms/advancements available via digital platforms. However, many times digital tools do not incorporate the appropriate methods to train seniors how to make maximum use of the technology. Consequently, innovators, providers and payors should make sure to include this in all phases of their products using customer journey mapping to ensure products are available to seniors along all levels of the health continuum. In addition, as noted in Ageism as a Risk Factor in Chronic Disease, “older adults with negative perceptions about ageing demonstrated poorer functional health, recovered from disease more slowly and had shorter average life spans” Hence, as they note, given the burden of chronic disease in the aging population, better understanding and addressing ageism is a promising and largely unexplored strategy for decreasing morbidity and mortality in the United States.