Takeaway
To many, "aging" and "old" are considered dirty words. Clinicians should fight ageism.
Lifelong Learning in Clinical Excellence | November 19, 2019 | 2 min read
By Sharon Inouye, MD, Harvard University
The message arrived at the receiving hospitalist’s desk and was met with a tired groan: “90-year-old woman S/P fall with multiple fractures of pelvis and sacrum, admitted for pain control and rehab.”
It had been a grueling day. The hospitalist, Dr. K, saw the basic demographic details and immediately defaulted to an assumption—that this patient would be a complex, resource-heavy, and perhaps “inappropriate” admission for his service. He saw an age, not a person.
I requested a moment to speak with Dr. K. Introducing myself, I said, “The patient is my mother, and I’m a physician-daughter and a geriatrician.” I was met with thinly veiled hostility. He hadn’t yet met my mother, but he was quick to vent his frustration: this admission might not be appropriate, and he would have to look into her care further.
I had just experienced outright ageism: the instant bias and negative assumptions made about older adults.
Ageism
Ageism remains a pervasive and socially tolerated forms of prejudice in the United States. Countless surveys still equate “aging” and “old” with disease and decline. Terms meant to soften the reality—senior, elder, golden years—often fail to hide the underlying societal discomfort with the process of aging. Globally, many cultures revere their elders, but in the American healthcare setting, this influence is often pernicious.
The impact of ageism on patient care is dangerous. Older adults are often denied aggressive treatment, dismissed as “not good candidates” for certain procedures, or simply seen as less valuable. Studies continue to show a direct correlation: documented rates of iatrogenic (medically-caused) complications are significantly higher in older adults, even after controlling for existing illness and severity. Assumptions can kill.
When bias disappears
Two hours later, Dr. K returned to the phone with a remarkably different tone—one of genuine admiration. “Your mother is incredibly youthful and delightful; I can’t believe she’s 90. She’s really sharp too. Her fall was really devastating; we need to do everything we can to help her get walking and back home.”
Once he paused long enough to genuinely see the individual, the ageist bias evaporated. My mother became a person with vitality, resilience, and goals, not just a list of fractures and an age.
Four ways healthcare professionals can mitigate ageism
We must challenge the narrative that views aging as a monolithic state of decline. Here’s how we can foster a culture of respect, dignity, and individualized care:
1. Examine your internal bias.
Changes start within. Be honest about any negative stereotypes or assumptions you may harbor about older patients, particularly when reading a chart before meeting the person.
2. Learn their story.
All older adults have something vital to teach us. Take a moment to learn about their priorities, their past, and their present concerns. Once you understand the individual, the generic bias associated with their age will rapidly diminish.
3. Prioritize dignity and respect.
Always address patients formally (Mr./Ms./Dr. Last Name) unless explicitly invited to use their first name. Avoid belittling terms of endearment like “honey” or “dear.”
4. Lead by example.
Your respectful and comprehensive treatment of older patients sets a powerful standard for students, residents, and colleagues. Modeling non-ageist care is the most effective way to train the next generation.
A sustained groundswell is necessary to truly transform the messaging about aging. Let’s commit to creating that change—starting right here, right now, with the next patient we meet.