Many patients and families report that they have encountered a mindset of ageism on the part of healthcare professionals. This occurs when “advanced” age is used as the reason to not perform certain tests, to not follow best practices and recommended protocols, or, in the worst situations, to not provide treatment at all. And it is not just those in the advanced stages of life who are vulnerable to ageism. Some healthcare providers and insurers refuse certain therapies and rehabilitation services, such as brain recovery programs, to anyone over the age of 65.
While such attitudes have no place in the hospital setting, we know from personal experience, and the parade of anecdotal evidence, that they are present far more often than most of us realize. When ageism raises its head, it can often lead to painful complications that might otherwise be avoided.
Lorraine Finlay, the (then) 89-year-old mother of The Center for Patient Protection’s founder, was left in a malnourished state with painful pressure ulcers because of neglect and inattention to mandatory standards of care. When she developed aspiration pneumonia, a specialist denied her access to the hospital’s ICU, telling her family, “What’s the point? Her demise is imminent anyway.” He would not authorize respiratory therapy to assist with her breathing, either, thereby giving effect to his own DNR decision when the family would not consent to his request.
Lorraine miraculously survived that ordeal, only to suffer a major convulsive seizure. She could have been spared the trauma of that event, and its aftermath, if her care team had heeded the warning signs Lorraine’s family had been trying to draw to their attention. Having failed Lorraine in that regard, it was not until 24 hours after the seizure that a doctor bothered to examine her, again despite repeated pleas by the family. No lab or neurological tests were ever performed.
There were constant references at the time of Lorraine’s hospitalization to her advanced age, to the high cost of her care, and to what was called the “unreasonable expectations of her family” for recovery. Just before she was discharged that Easter, a doctor told us not to even think about having our mother with us at Christmas.
Now, at the age of 93, she just celebrated her fifth Easter Sunday since returning home to her family, enjoying, as she always has, her traditional glass of champagne. It is the survival that countless senior clinicians at two hospitals repeatedly warned, in the form of iron clad “guarantees” accompanied by stern lectures about their long experience, would never occur because of her age. As Lorraine said when she learned some time ago of their dismal prognosis: “Well, they were wrong, weren’t they?”
Age alone should never be used as the reason for pressuring a patient and family to give up, or for denying care. But cost pressures in hospitals are causing many to consider — though none will admit this — the rationing or limiting of care to the elderly. We have seen the consequences of this attitude and we have also seen how wrong clinicians can be when they pronounce an elderly patient past the point of benefiting from more aggressive therapy.
Hospitals and clinicians who practice ageism are what The Center’s founder, Kathleen Finlay, has called the Thieves of Hope. They treat patients simply as statistics and often dismiss the healing powers of hope and the indomitable nature of the human spirit to recover.
The Center for Patient Protection is proud to wage a robust campaign to raise awareness about the dangers of this form of healthcare discrimination, and encourages patients and families who have experienced it to continue to report such incidents and to make use of The Center’s Hospital Incident Report.
After being diagnosed with a disease that may be potentially curable, older people are further discriminated against. Though there may be surgeries or operations with high survival rates that might cure their condition, older patients are less likely than younger patients to receive all the necessary treatments. For example, health professionals pursue less aggressive treatment options in older patients, and fewer adults are enrolled in tests of new prescription drugs. It has been posited that this is because doctors fear their older patients are not physically strong enough to tolerate the curative treatments and are more likely to have complications during surgery that may end in death.
Other research studies have been done with patients with heart disease, and, in these cases, the older patients were still less likely to receive further tests or treatments, independent of the severity of their health problems. Thus, the approach to the treatment of older people is concentrated on managing the disease rather than preventing or curing it. This is based on the stereotype that it is the natural process of aging for the quality of health to decrease, and, therefore, there is no point in attempting to prevent the inevitable decline of old age.
From an Article By Brian Goldman, M.D.
Ageism is rampant in the culture of medicine, just as it is in society in general. Studies show that seniors with heart attacks are less likely to get angioplasty or coronary bypass, and if they do receive these invasive interventions, they often wait significantly longer than patients half their age. “If I’ve got a 50-year-old and a 92-year-old in the resuscitation room and both need my attention, I help the 50-year-old first,” a colleague once told me. “Sometimes, you’ve got to make choices.”