Senior Spectrum
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Sept 2008
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Adding Life to Years
Are you being shortchanged medically because of your age?
Your 85-year-old spouse comes home from a visit to the doctor with bad news: cancer.
The doctor says there's really no point in doing anything because at your spouse's age, the tumor is likely to be slow-growing. In other words, your spouse will likely die of something else long before the cancer has a chance to finish its work. Even if that weren't the case, the doctor tells you, someone of your spouse's advanced age would not be able to tolerate radiation or chemotherapy or want to go through that suffering.
Does this scenario sound familiar? If you're over 65 or have known someone who is, it probably does. It's an example of how ageist attitudes shape the medical care older adults receive in this country.
I've written in this column before about how ageism affects hiring practices and how an overwhelming majority of people, including many older adults, have negative views of elders and treat them differently. It may be hard to believe, but those same sentiments extend to medical and other health professionals as well.
According to a report in the AARP Bulletin, people 65 and older account for more than half of all days in Intensive Care Units (ICUs), and patients 75 and older account for seven times more ICU days than those 65 and younger. Yet a study by the Vanderbilt University Medical Center found that older patients typically receive less-aggressive care than younger patients.
Or consider this: a survey done at Johns Hopkins University presented medical students with hypothetical patient cases and asked what treatments the students would recommend. More than 80 percent said they would admit a 10-year-old girl with pneumonia to intensive care and treat her aggressively, but just 56 percent said they would do the same for an 85-year-old woman.
There are at least two likely causes for this discrimination. One is the notion that older people cannot handle aggressive treatments like chemotherapy, which is false. Yes, chemotherapy might kill a frail elder, but not all elders are frail, so age alone should never determine treatment options. Evidence has existed for decades that older people can tolerate powerful drugs and interventions to treat cancers and other diseases, says geriatrician Robert N. Butler, the Pulitzer Prize-winning author who coined the term ageism in 1969.
Why don't more doctors understand this? Because of another phenomenon I've written about in this column: the lack of training in geriatrics. By one estimate, only about 10 percent of U.S. medical schools require any course work in geriatrics. The Nevada Geriatric Education Center, affiliated with the Sanford Center or Aging and University of Nevada School of Medicine, offers continuing-education courses in elder health care issues, but no law requires doctors, nurses or other medical professionals to be knowledgeable about geriatric medicine.
Another problem is that doctors, like the rest of us, have misperceptions about changes people experience as they age. Everything isn't just because you're “getting old.” Conditions like incontinence and depression are symptoms of diseases. They can - and should - be treated, not learned to live with.
Another reason elders don't always receive the care they should is economics. Older patients often have multiple chronic medical conditions, so it takes longer for a doctor to see the typical older patient. Reimbursement rates for both private and public health insurance plans today force physicians to see as many patients as possible in a day to make ends meet. No wonder so few doctors want to specialize in geriatrics. The patients are too time-consuming. There's another, more sinister side to the economics issue. Some people who would like to shape health-care policies nationally, like noted bioethicist Daniel Callahan, argue that society should explicitly limit the amount of medical care made available to elders. His view is that there are only so many medical resources to go around. If too many are allocated to extending the life of older patients (who are only going to die eventually) fewer resources will be left for children.
Callahan's argument resonates with many who are dismayed with the rocketing health care costs and looming deficits in Medicare as the Baby Boomers gray. But his analysis ignores the fundamental flaw in our health care system: that it's geared to acute care, treating sick people. Scant attention is paid, and few resources are devoted, to preventive care, even though in the long run keeping people healthy is much cheaper than trying to cure them.
Here again, ageism holds dire consequences for older adults. According to a report by the Alliance for Aging Research, seniors are less likely than younger people to receive preventive care such as vaccines or to be screened for certain diseases. For example, it's believed that influenza vaccinations could prevent up to 80 percent of all deaths from flurelated complications such as pneumonia. But two-thirds of older Americans don't get flu shots. The same report also notes that even though elderly people account for 70 percent of smoking- related deaths, Medicare does not cover smoking cessation programs. Again, the attitude seems to be, “These people are going to die soon anyway, why go to the effort?”
What can you do to combat ageism in health care? Educate yourself about treatment options, and know the difference between aging and disease. You have the right to same quality of care as people of any other age. The sad reality, though, is that because of ageist attitudes, you probably won't get it unless you demand it.
(Lawrence J. Weiss, Ph.D. is director of the University of Nevada, Reno Sanford Center for Aging and an adjunct associate professor of medicine. He welcomes your comments on this column. Write to him at weisslj@unr.edu or c/o Sanford Center for Aging, Mail Stop 146, Reno, NV 89557-0146.)