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]

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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.”