Stamp Out Ageism and the Thieves of Hope

All of us, from the very young to the very old, and every­one in between, should have the right to try.  We should nev­er be con­front­ed by a health­care cul­ture that makes us feel like we have an oblig­a­tion jto give up and die.

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. It became very clear that the health­care pro­fes­sion­als deliv­er­ing Lor­raine’s care strong­ly resent­ed the fam­i­ly’s hopes for recov­ery. It was reflect­ed in seri­ous break­downs in care and a suc­ces­sion of painful, life-threatening med­ical errors. Just before she was dis­charged that East­er, a doc­tor told us not to even think about hav­ing our moth­er with us at Christ­mas. Her demise was “immi­nent” he said.

But Lor­raine lived on in her fam­i­ly home into her 96th year. Her recov­ery allowed her to enjoy more hol­i­days and to expe­ri­ence the love or her fam­i­ly, joy of her pets, and the beau­ty of her beloved gar­den. It was recov­ery that count­less expe­ri­enced clin­i­cians at two hos­pi­tals repeat­ed­ly warned would nev­er occur because of her age. As Lor­raine said when she learned 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 do a ter­ri­ble injus­tice to the elder­ly, their fam­i­lies and soci­ety. Kath­leen Fin­lay has called them the Thieves of Hope.  All of us, from the very young to the very old, and every­one in between, should have the right to try. We should nev­er be con­front­ed by a health­care cul­ture that makes us feel like we have an oblig­a­tion to give up and die.  Too often health­care pro­fes­sion­als treat patients as sta­tis­tics while dis­miss­ing the heal­ing pow­ers of hope and faith and the indomitable nature of the human spir­it to live. 

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.

What is Ageism?


There is con­sid­er­able evi­dence of dis­crim­i­na­tion against the elder­ly in health care.[35][36][37] This is par­tic­u­lar­ly true for aspects of the physician-patient inter­ac­tion, such as screen­ing pro­ce­dures, infor­ma­tion exchanges, and treat­ment deci­sions. In the patient-physician inter­ac­tion, physi­cians and oth­er health care providers may hold atti­tudes, beliefs, and behav­iors that are asso­ci­at­ed with ageism against old­er patients. Stud­ies have found that some physi­cians do not seem to show any care or con­cern toward treat­ing the med­ical prob­lems of old­er peo­ple. Then, when actu­al­ly inter­act­ing with these old­er patients on the job, the doc­tors some­times view them with dis­gust and describe them in neg­a­tive ways, such as “depress­ing” or “crazy.”[38] For screen­ing pro­ce­dures, elder­ly peo­ple are less like­ly than younger peo­ple to be screened for can­cers and, due to the lack of this pre­ven­ta­tive mea­sure, less like­ly to be diag­nosed at ear­ly stages of their con­di­tions.[39]

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,[40] and few­er adults are enrolled in tests of new pre­scrip­tion drugs.[41] 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.[38][39]


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.”