Missed Signals and Missed Care: Ageism Inside the Health System

In Canada, it has become almost routine to begin any conversation about healthcare with the same phrase: the system is in crisis. Emergency rooms are crowded. Family doctors are hard to find. Nurses and physicians are stretched thin. Everyone knows someone who has waited too long or felt rushed through an appointment.

That reality is undeniable. But it has also created a dangerous permission slip, one that allows poor treatment of seniors, minorities, and other vulnerable people to be excused rather than questioned. Being overwhelmed should never mean being dismissive. Yet for many older adults, that is exactly how care feels.

I experienced this firsthand after having my knee replaced.

The surgery itself went well, but shortly afterward, I fell and was given medication for pain. I had a bad reaction to the drug. Concerned, I was moved to another hospital where staff could keep a closer eye on me. Warnings were passed along. My wife was clear about what had happened and for what to watch.

Still, while I was in a drug-induced delirium, I fell again.

The warning signs were there. The information had been shared. But it wasn’t fully heard. Whether it was time pressure, assumptions about aging, or a belief that confusion was simply “normal at my age,” the result was the same. Dismissal led to harm.

This is how ageism operates inside systems, not through cruelty, but through assumptions. Older patients are often seen as fragile, confused, or inevitably declining. Symptoms are brushed off as part of aging rather than signals requiring attention. Pain is normalized. Confusion is expected. Complexity is simplified away.

Sometimes this leads to under-treatment. Symptoms are minimized. Diagnostic testing is delayed or never ordered. Opportunities for early intervention are missed.

Other times it leads to over-treatment. Psychotropic medications are prescribed too quickly. Sedation becomes a shortcut. Behaviour is managed chemically rather than understood contextually. Especially in long-term care, this can strip people of clarity, mobility, and independence.

A friend of mine has lived with chronic pain for more than seven years. She has seen multiple doctors, told her story countless times, and left more than one appointment feeling unheard. Eventually, she found a physician who did something remarkably simple: listened.

This doctor took her pain seriously. Ordered tests. Asked follow-up questions. Acknowledged uncertainty rather than dismissing it. For the first time in years, my friend feels there may be a path forward.

She told me something that has stayed with me. “Some of them didn’t hear my story,” she said. “They only saw a woman of a certain age.”

That sentence captures the quiet harm of medical ageism perfectly.

When clinicians see age before a person, they stop listening fully. When they assume decline, they stop investigating. And when people sense they aren’t being heard, they begin to doubt themselves. They downplay symptoms. They stop advocating. They accept discomfort as inevitable.

This doesn’t only affect health outcomes. It affects trust.

And yet, this is not a story about villains and victims. Many healthcare professionals are deeply committed, compassionate, and frustrated by the same system their patients struggle with. I’ve seen nurses who insist on slowing down, doctors who ask one more question, therapists who treat older patients as partners rather than problems to manage.

These are the bright spots, and they matter.

What distinguishes them isn’t extra time or special resources. It’s a mindset. A refusal to let age become a diagnostic shortcut. A willingness to stay curious. A belief that older adults are reliable narrators of their own experience.

Systems can reinforce ageism, but they can also interrupt it. When hospitals build processes that encourage shared decision-making, when staff are trained to recognize unconscious bias, and when older patients and caregivers are treated as credible sources of information, care improves. Not just emotionally, but clinically.

The healthcare system may be under strain, but that strain does not absolve us of responsibility. Especially when the cost of assumption is injury, prolonged pain, or loss of dignity.

If there is hope in this moment, it lies in noticing where listening breaks down, and where it holds.

Every time an older adult is heard fully, a different story unfolds. One where age does not obscure symptoms, and experience is not mistaken for confusion. One where care is shaped by evidence, empathy, and respect.

The healthcare crisis is real. But so is the opportunity to decide who gets seen clearly within it.