(Pub­lished in The Huff­in­g­ton Post)

Research shows age a deci­sive fac­tor in care deci­sions

A new Cana­di­an study shows that age is a crit­i­cal fac­tor in the kind of treat­ment patients receive. Accord­ing to the research, which involved patients with trau­mat­ic spinal cord injuries, “patients over 70 years of age expe­ri­enced con­sid­er­able delays between admis­sion and surgery.” Old­er patients also “expe­ri­enced delays in trans­fer to a spe­cial­ized treat­ment cen­tre….”  As the authors of the report put it:

Our analy­sis showed that advanced age alone was asso­ci­at­ed with delays in both triage and sur­gi­cal treat­ment.

To at least one promi­nent med­ical com­men­ta­tor, these find­ings raise the prospect of ageism. As the CBC’s Dr. Bri­an Gold­man not­ed recent­ly in a piece called Ageism Still Ram­pant in Health­care, the study is just one more indi­ca­tion that “there are many exam­ples of ageism in health­care.”

There are stud­ies. And then there is first-hand expe­ri­ence.

When my elder­ly moth­er was hos­pi­tal­ized with a trau­mat­ic head injury a few years ago, it quick­ly became clear that the care and treat­ment of oth­er patients was the pri­or­i­ty. After being neglect­ed in the ICU while on life sup­port, she soon devel­oped ventilator-associated pneu­mo­nia. Hav­ing recov­ered from that, her con­di­tion began to dete­ri­o­rate again. But nurs­ing staff insist­ed that she was not even sick enough to be in the ICU at that point. Less than 24 hours lat­er, she suf­fered a car­diac arrest.

After these dis­as­ters, a senior hos­pi­tal doc­tor “guar­an­teed” my moth­er would nev­er leave the hos­pi­tal alive because of her age. The pri­ma­ry doc­tor in charge of her care remind­ed us that there were many oth­ers wait­ing who could make bet­ter use of the bed. It was clear from our one and only meet­ing with him that he had writ­ten off my moth­er.

Mirac­u­lous­ly, she sur­vived her night­mare at this major teach­ing hos­pi­tal and was lat­er trans­ferred to a small­er hos­pi­tal clos­er to her home.

But once again, there were con­stant reminders about her age and the high cost of her med­ical care. One nurse even chart­ed annoy­ance over the delay in my mother’s hos­pi­tal bed being freed up, not­ing that the fam­i­ly had refused to con­sent to a DNR order.

She was neglect­ed to the point where she devel­oped pres­sure ulcers nev­er prop­er­ly treat­ed and was left severe­ly mal­nour­ished. There were repeat­ed med­ica­tion errors that left her in dis­tress and even placed her life at risk. When she was final­ly dis­charged, it came with the writ­ten assur­ance by the hospital’s chief internist that her demise was “immi­nent.” We were urged to not even con­sid­er bring­ing her home and to have her placed in a long term care facil­i­ty instead.

Some might con­clude that my mother’s age jus­ti­fied this neg­a­tive prog­no­sis and the absence of treat­ment a younger patient would like­ly have received. They would be wrong.

Once at home, where she received 24/7 care from her fam­i­ly, includ­ing sup­port and ther­a­py nev­er giv­en in the hos­pi­tal, she began a remark­able recov­ery. How remark­able? You be the judge. We were told she would nev­er eat reg­u­lar meals again and would require all nutri­tion via a stom­ach feed­ing tube. They said she would nev­er talk or read again. Most sig­nif­i­cant­ly, we were told with absolute cer­tain­ty that she would be dead with­in months.

But just last week, near­ly five years since her injury, she was the guest of hon­our at my birth­day. At the din­ing room table, she enjoyed the same meal as the rest of the fam­i­ly. She helped to put the icing on the birth­day cake ear­li­er in the day and sang “Hap­py Birth­day” with a joy undi­min­ished by her age. It was a price­less birth­day gift, and it would not have hap­pened had we heed­ed the med­ical advice giv­en dur­ing her hos­pi­tal­iza­tion.

I hear many sto­ries from fam­i­lies who have expe­ri­enced what they believe is ageism in the hos­pi­tal set­ting. They talk about how mom or dad was just writ­ten off and aban­doned. They describe a cold­ness to the kind of care received and a com­plete lack of empa­thy. They lament their loved one’s dying in a way that deprived them of the dig­ni­ty and respect they deserved and a belief that the elder­ly are seen as an easy cost sav­ing unit in an already over­stretched health­care sys­tem. In nurs­ing homes, the over use of anti-psychotic med­ica­tion to sedate the vul­ner­a­ble elder­ly remains a seri­ous prob­lem.

Sure­ly we are capa­ble of doing bet­ter.

There is some­thing miss­ing in a health­care sys­tem that can too eas­i­ly become a thief of hope because of ageism. Indeed, this is the oth­er side of the coin involv­ing the much dis­cussed issue of assist­ed death inter­ven­tion. There are elder­ly patients who want to live. And for many, like my moth­er, there may well be a chance to recov­er if a rea­son­able lev­el of care, atten­tion and com­pas­sion are giv­en.

Most of them have paid the price over the years as con­trib­u­tors to our soci­ety and its free­doms to deserve that oppor­tu­ni­ty.