Is ageism prevalent in our healthcare system?

According to a study in the Notre Dame Journal of Law, Ethics & Public Policy called Invisible, Unequal, and Forgotten: Health Disparities in the Elderly, yes, it is. The research focuses on the US but I think the same issue is here in Canada.

The article states that more than thirty years of research revealed that negative and indifferent attitudes towards the elderly exist among educators, medical students, and residents. First-year medical students at the beginning of the academic year were surveyed regarding the care of the elderly. Students were less likely to admit an eighty-five year- old woman to the intensive care unit, intubate her, and provide aggressive care for her than they were to treat an acutely ill ten-year-old girl with chronic leukemia. Male and younger students were more likely to have negative attitudes towards a hypothetical seventy-year-old patient.

In several recent studies, medical students and internal medicine and surgery residents received instruction on the comparable efficacy of breast conservation and modified radical mastectomy in the treatment of breast cancer. The patients in the scenario differed by age and occupation. There were no differences in treatment recommendations based on high- and low-income occupations. A pattern of ageism was observed in responses. Modified radical mastectomy was recommended for 34-38% of older patients and 11-15% of younger patients. Breast reconstruction surgery was recommended to 89-96% of younger patients, compared with only 66-72% of older patients.

Attitudes towards older adults do influence the provision of care to the elderly. For example, the examination of the rates and types of procedures used in the elderly reveals ageism exists in cardiology. Higher rates of life-saving interventions, such as cardiac revascularization, occur in younger patients rather than older patients.

Despite a higher prevalence of coronary artery disease in the elderly, older adults, especially older women, are less likely to receive appropriate cardiac care, including echocardiography and cholesterol testing. Elderly with severe heart disease are more likely to receive medical management rather than surgical intervention and less likely to receive optimal therapy after a heart attack. It is asserted that ageism in the medical profession is a manifestation of ageist attitudes in society at large, a society that gives preference to youth over age; in addition, a proportion of ageism may be due to a lack of awareness of evidence-based medicine concerning the treatment of older adults. Similar patterns of age discrimination exists for numerous health condition, such as stroke, Dementia, Heart Conditions, Cancer to name a few.

End of life, care is also an area where care is lacking, despite heightened awareness of end-of-life care issues, studies indicate that patients receive the care that is not congruent with their wishes and that alleviation of symptoms is inadequate.

 A significant proportion of dying patients have inadequate pain control or are referred for hospice or palliative care services very late in their terminal illness. Some physicians experience ethical issues in providing end-of-life care that conflicts with their consciences.

Death and dying in the United States predominately involve the elderly. Persons aged sixty-five and older account for three-fourths of dying patients in the nation. Older patients are disproportionately impacted by unsatisfactory end-of-life care. Similar to other health care concerns, end-of-life care for all Americans are deficient, but minority groups suffer inordinately from insufficient care. As more and more boomers age, these issues will need to be addressed.