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Crabby Old Lady's Silly Complaints

Ageism in Healthcare

Impactofageism

This story had been on my “to do soon” list just before my cancer diagnosis and now that my recovery is going so well, it's time to start catching up. Let me start with a couple of ageist profiling stories from Dr. Val Jones at the BetterHealth website:

”Take for example, the elderly woman who was leading an active life in retirement. She was the chairman of the board at a prestigious company, was an avid Pilates participant, and the caregiver for her disabled son.

“A new physician at her practice recommended a higher dose of diuretic (which she dutifully accepted), and several days later she became delirious from dehydration. She was admitted to the local hospital where it was presumed, due to her age, that she had advanced dementia. Hospice care was recommended at discharge. All she needed was IV fluids.

“I recently cared for an attorney in her 70’s who had a slow growing brain tumor that was causing speech difficulties. She too, was written off as having dementia until an MRI was performed to explore the reason for new left-eye blindness.

“The tumor was successfully removed, but she was denied brain rehabilitation services because of her 'history of dementia.'

“Of course, I recently wrote about my 80-year-old patient, Jack, who was presumed to be an alcoholic when he showed up to his local hospital with a stroke.”

These are not uncommon stories. One of the most serious side effects of ageism is inadequate health care. Another example from an important overview of ageism in healthcare was published in Generations, the journal of the American Society on Aging, in October 2015:

”The geriatrician and writer Dr. Louise Aronson (2015) describes a disturbing example of explicit ageism in which a surgeon asks the medical student observing his case what specialty she is thinking of pursuing.

“When she answers, 'Geriatrics,' the surgeon immediately begins mimicking an older adult complaining about constipation in a high-pitched whine. The attending surgeon had a reputation for being an outstanding teacher, yet repeats this parody throughout the surgical procedure.”

Let me pause here to say that the reason I was eager to get back to this topic is the excellent care I received at the Oregon Health & Science University (OHSU) hospital over nine days, which I wrote about here, that is in stark contrast to stories like those above which occur way too frequently.

Typesofageism

When health care providers harbor implicit or explicit prejudice against older patients, the possibility of under- or over-treatment increases – and that often starts with poor communication.

As the authors report in the Generations article, in one study doctors were rated as “less patient, less engaged and less egalitarian with their older patients.”

”One way healthcare providers unknowingly patronize older adults,” they continue, “is to use 'elderspeak' - speaking slowly, with exaggerated intonation, elevated pitch and volume, greater repetitions, and simpler vocabulary and grammatical structure.

“Older adults perceive elderspeak as demeaning and studies show it can result in lower self-esteem, withdrawal from social interactions, and depression, which only reinforce dependency and increase social isolation (Williams, Kemper, and Hummert, 2005).”

The authors also note that it is not just the providers who “may harbor or exhibit ageist attitudes. Older adults themselves often possess very negative views of aging, not realizing the potential impact on their health.”

This may be changing, however, among baby boomers who are more likely to be comfortable questioning authority than many of their older counterparts.

Older-adults-wordle

Ageism in healthcare is, of course, only one area of prejudice against elders but as the stories above demonstrate, it can be deadly. If you encounter any healthcare professional who is behaving in a demeaning manner or dismissing your complaints, politely explain that you expect and deserve his/her full attention and care.

Or, you could just fire the doctor and find a new one as I did last October when my then-primary care physician dismissed my symptoms that eventually led to the pancreatic cancer diagnosis as nothing but a mild virus an antibiotic would take care of.

Whenever I have written about ageism lo these many years, inevitably there is a pushback in the comments. Invariably one or more will quote the “stick and stones...” adage, insisting that derogatory names can't hurt them. Others deny that ageism is on a par with sexism, racism, etc.

Really? It's not okay to denigrate, stereotype and discriminate against women and people of color but okay for old people? Really?

No, not really. Let me tell you why ageism – in all its manifestations – matters to me. It is about justice, justice for everyone including old people. And because if I don't keep insisting, it will change me in ways I won't like.

International-day-of-older-adults-2016


Comments

>a mild virus an antibiotic would take care of

EEEK.... really? That doctor should have his license pulled. An antibiotic for a virus? Even I, who have not had one hour of formal medical training, know better!

You have given some very concerning examples. And what Trudi said above!

I try to avoid doctors as much as possible because I have always felt most have a very narrow focus on a particular symptom or body part. I can see how that would lend itself to mistakes that can compound when ageism comes into play.

Now I am at an age where friends and family are starting to have more and more medical problems. Too many social gatherings seem to devolve into a discussion of aches, pains, symptoms and diagnoses. This may be ageism on my part, but I do notice a competitive edge to such discussions that I find most annoying.

A few snapshots:

Some seniors in residences are afraid of getting booted out if they complain too much.

I kid you not.

Complaining too much, you know, like telling the boss their shower is broken, toilet won't flush, lights do not work, etc.

Managers have been known to threaten residents:

"If you aren't happy here, I have a waiting list for your apartment.

Seniors don't seem to have a say or an official role in how a residence is run.

This is just plain wrong!

Seniors are often treated like kindergarten students, in spite of our collective education, experience and in building our communities.

Seniors worry about their next move.

Managers of senior residences can be bullying, play favourites, treat residents inappropriately, overcharge, ignore requests for less fat, sugar and salt in food they are paying for, but not eating.

Managers of IRLS are similar to principals of schools.

How are they chosen?

What are their credentials?

Some are proficient at business, but effective as door knobs at key skills like emotional intelligence.

We all recall that university professor who knew his or her subject, but could not relate to his or her students or teach outside the lines.

And then we remember that teacher who made learning relevant to our world, showed us a million different ways to achieve a goal.

That's the teacher we run to and hug years later.

Many senior residents are extremely vulnerable, lonely and frightened about their health issues, about how to fit in with a group of strangers, about handling money.

Some seniors have no safety net, no one to stick up for them.

Damn this makes me burn just writing about it.

To everyone who sees something and does something for a senior.

You know who you are.

You are the real heroes.

She's back!

Thanks for this post. It's scary, and probably one reason why so many people, getting it bass-ackwards, deny that they're ageing for as long as humanly possible before giving up completely.

I forget. Who was it that said we have the best healthcare in the world?

Great bottom line: It is about justice for everybody.

I believe that agism is deeply baked into our culture. Take, for example, the dearth of geriatric doctors. It's too much trouble dealing with old folks. The financial systems aren't patient-friendly.

Professionals are afraid of old people for any number of reasons, not least of which is the threat they implicitly pose to the doctors' psyches.

I am experiencing ageism more now that I am so visibly old. Sometimes it's in small ways like when my primary care doctor was going to prescribe a diuretic for me and called it a water pill. I told him I would take the diuretic (with an emphasis on the word).

Other times it's more insidious. I have a new dentist and when he needs to give me instructions he wants my daughter's telephone number so he can tell her. It's as if he doesn't expect me to understand because I am old. I resent being treated like a child.

Thanks so much for this article. As a 50+ female, I never really considered ageism as a 'thing' along with racism or sexism until I recently went back to university to study psychology only to find ageism rife in most of our course work and literature - it hit me like a brick! Such was my angst in 'Developmental psych' that I complained to the lecturers and have now been informed that they plan on including some more positive aspects to aging. How can one expect better from our society if we're taught from within out own institutions what to 'expect' as we age! It's time to change the narrative!

The irony here is that ads like this generally always feature vibrant looking older people, not the frail elderly who are most at risk. I too fired a 50 something male primary care doctor and went in search of a younger female doctor. I found him laughably paternalistic, and he was one of those who spent the entire appointment staring at the computer screen. Some people must like that however because he came highly recommended.

It's a double edged sword in some cases though because people with mild cognitive impairment or hearing problems really should have written instructions, which might feel demeaning to some.

Actually, Lauren, I take a notebook with me to every meeting with doctors and make notes of what they tell me. I would welcome written instructions especially, nowadays in my case, when they can get complicated.

I'd think more of that poster about older adults day if at least some of them looked like older adults, not younger actors with buff bods, dyed hair, perfect teeth, and no wrinkles. I've the same complaint about a lot of tv commercials.

Don't wait until you're seriously ill to find a competent, respectful doctor that you like and trust for both treatment and any necessary referrals. Because when you do become ill, and it's inevitable, you won't feel like doctor shopping.

It IS about justice, especially when it comes to making the right medical call for an elder. A minor form of ageism that annoys me is being called "young lady." A young plumber called me "shug" so many times, I felt demeaned, and asked him to call me by my name.........now, he's working on my pump, costing me big bucks, so am I asking him in a pleasant, kind, diplomatic manner? You bet. He desists, but at the end, in his truck, after I've said goodbye, he says, "Bye, SHUG," and is gone. Yeah, double whammy of being a woman, and being an old woman. Makes me mad, hurts my feelings. Makes me want to think of some good sorta political action to take. Til then, let's all speak up for ourselves whenever possible. We'll be doing them a favor, because sooner or later, they're gonna be OLD.

Just read an article about ageism in the tech business, in which you are old at 35. Boy are they going to have a long "old age!"
But to the point, I agree with most of the comments here, and I also think we need to stand up for ourselves. I will tell an offending medical practitioner not to talk with me that way, and I do not see anything wrong with asking to be addressed with eye contact. If we do not request the kind of treatment we are entitled to, how will we ever train the docs to work with us correctly? And I am only half kidding here; I do think they deserve feedback, positive and negative. And we might remember they are not gods, they are not super people, they are just people and so are we.

Your are back! And in your usual rare form. Thanks for this excellent article. I was starting to let my gray hair grow out, but maybe after my next procedure....

This reminded me of something I've read several times--it's called "stereotype threat."

When people are reminded that they belong to an "out" group about whom negative stereotypes abound--people of color, women, disabled, elders--they are likely to be unconsciously bullied into living DOWN to those negative expectations.

One common example: "Women are always bad at math," or some similar statement can actually make the women present do worse on a math test. Perception can sometimes actually create reality.

That's plenty of reason to seek out professionals with whom you can have adult-to-adult conversations. The young will themselves be old one day, but we know they don't believe it--did we? In the meantime, look 'em in the eye and make 'em talk to you like a person.

And Ronni--have you considered suing that doctor?

I ran into this with Dad at the VA and at the hospital where he was admitted several Xs during the last 2 years of his life. I couldn't believe it. I don't understand how anyone working in the medical field can be so ignorant about treating the elderly.

Paula...
No lawsuits. I knew enough to get out of there permanently and life is too short.

This post has such terrific examples of ageism in health care, e.g. the example of the person who was presumed to be an alcoholic when he was showed up with a stroke.

I like the comment about "firing" one's own doctor for an ageist response, although then one is faced with finding a doctor who doesn't make such assumptions.

Welcome back Ronni! Excellent article! A lot to ponder! Being blessed with a long life, means getting old, so we must definitely fight this type of prejudice!

Doctafill pointed out a situation that hit me like a ton of bricks. I've been reading a book titled, "Evicted: Poverty and Profit in the American City," by Matthew Desmond. Doctafill's words resonated because they sound so much like the stories in this book about low income tenants who are treated badly by many landlords who don't want to be bothered to fix things, and would rather evict someone than make repairs. I suppose it's the age-old story of those who prey on the powerless, but it's shameful.

I can recall many times when I had to point things out that needed to be taken care of when my in-laws were in assisted living. Regardless of the thousands of dollars they were paying each month, the laundry wasn't done properly, medications were given out after they had already gone to bed and they had to be woken up or miss their PM meds . . . there were numerous instances of inconvenient and sometimes dangerous incidents. I've tried to forget about it over the years, but it's still disturbing to think how many people are probably living with such negligence and worse.


I'm so glad you're doing so well. Actually, I only started reading your blog when your ex mentioned it on his radio show or FB page a couple of months ago. While I've always been a fan of his, I've always been aware of what I'll call his limitations. I can't believe that someone who writes these literate, beautifully crafted, knowledgeable essays that could easily be published in "The Atlantic' or "The New Yorker" could ever have been married to your ex.
I realize the marriage was a long time ago, but it still seems incomprehensible to me.

Excellent article! As a Speech-Language-Pathologist working primarily with an adult population, mostly older, for several decades in hospitals including ERs, ICUs, in and outpatient, Rehab settings, Retirement Communities at all levels of care (Independent, Asst. Living, Skilled Nursing, Green House), Dementia/Alzheimer Facility -- I can confirm having encountered ageism in some situations including from some health care service providers such as physicians, nurses, aides. They are a minority in number, but present. I won't attempt to provide story examples as your article is sufficient in doing so.

The important point is that we're aware ageism exists, that we recognize the impact ageism can have on lives, and that there is a need to address those instances when ageism occurs -- to educate, and make a positive change for ourselves, others. Make no mistake, the quality of your and my health care can be affected.

I meant to add that individuals, often older ones, experiencing sensory loss -- especially hearing and vision -- can misperceive the world around them -- results in inappropriate responses. Often caregivers and even friends and family make a false assumption the person's mind is "a little bit bonkers" which couldn't be further from the truth. Ideally, all elders need an advocate. For those of us who are alone, and if we become less able to speak up for ourselves, that can be a challenge -- all the more reason why we need to address the ageist instances we encounter as they occur now.

Isn't it wonderful that your ex still thinks highly enough of you to give you a plug on his show. My ex's only try to put me down with those who still care for me... and then expect me to still want them, either as "friends" or sexually. I haven't seen either of them for years, but still receive updates from their relatives or an occasional note or phone call now and then. I have no desire to communicate with either of them, and am annoyed at those who bring up their names...

Am in complete agreement regarding ageism, but most of the time I tolerate it rather than make waves. Most in healthcare are not aware that they are doing it... I will mention it if they are particularly annoying. My doctor is old, too, and sometimes does not seem to know that he slips into it now and then, but he is conscientious and pleasant so I haven't said anything to him about it yet.

Ronni,

So glad you're back and in fine fettle, too! O.K,. it's totally none of my business and feel absolutely free to tell me so, but I cannot help but wonder: who's the long-time-ago ex with the radio show??

So far I've been pretty satisfied with the care I've gotten from our HMO. I was dismayed to lose my long-time doc (who probably left because he wasn't a fan of the merger/takeover that happened last year) and am still getting used to my new one. She's from Ethiopia, I believe.

Whenever I start to get my feathers ruffled due to language or communication issues, I try to remember how hard she must have worked and the barriers she must have overcome to become a physician in this country. She's female, Black and an immigrant and she now lives in Trumpistan. Unless the ageism is blatant, I'll cut her some slack--which doesn't necessarily mean that I'll let it pass.

I truly hate being called "honey," "sweetie" or "dearie" by medical assistants, nurses or in one case a female doctor, and amazingly to me, by a lesbian female doctor. Good grief! (Maybe I was just too old for her : ) I tell them right then to stop it, and I'm sure I am labelled "difficult" in their notes as a result. A male orthopedic surgeon called on an aged "young lady" after a talk on knee replacements -- I left a note with his young female assistant, who rolled her eyes when I told her what was in the note.

I agree that doctors may just ignore problems in the elderly. My 90 year old mother-in-law was complaining of abdominal pain and gut problems, but somehow her doctors didn't think it worth pursuing. Then she fell & was admitted to the hospital where routine x-rays to look for broken bones showed massive abdominal tumors. She has always been patient, uncomplaining, deferential and seemed to accept that doctors weren't interested in her problems. I live 1500 miles away & was not in a position to intervene, but I wonder if she had adequate advocacy from her daughters. She is now in hospice, blind, confused and in pain, but doesn't want to "ask for pills." The mind boggles, and wonders.

Having said all this, I think the fear (and consequent dislike and avoidance) of old age is universal -- no one thinks it will happen to them, and no one wants it to happen, despite its inevitability and the "positive talk" required in some circles. After a certain point, there is only one result, no matter how long it is put off (hence the term: borrowed time). But it is almost impossible to internalize this fact until you are faced with it yourself. My mother was 96, my father and father-in-law 92, my mother-in-law about to die at 91, and each of those long, prolonged endings has been been exhausting emotionally and financially to their children, some of whom were in their early 70's (and one already diagnosed with AZ) when the deaths finally occurred. My parents outlived their money, which is among my great fears, and our one son will never be able to pick up the tab as one of my siblings was able to do, with some contributions from others. Having lived through these four long, difficult old ages, with the three or more times per year long air trips required to fulfill filial duties in each case, I will do everything in my power not to inflict that on our son.

PS Elizabeth Rogers: that MD situation is not going to work, I promise you. You are already gritting your teeth, so do yourself a favor and start doctor shopping.

Thanks for taking on the subject. From the comments you hit a nerve! You sum it up perfectly -- justice is the subject left out of all prejudice - and justice must come from respect for all people.

A spot-on article. So many times I've seen patients diagnosed as demented when they had a urinary tract infection, which antibiotics cleared up. It's also been closer to home recently: my OH recently had two mini-strokes and was confused and unfocused. Primary care physician automatically diagnosed dementia. Boy, was I angry.

There are so many good reasons why we should question authority, and fight for our rights when we are old. The assumptions that everything wrong with us 'must be' attributed to our age is infuriating! This is an important post, and a powerful wake up call to all of us. So glad, you are back full force, and standing up for us again, Ronnie!

When I went to a specialist a while back and met the dentist for the first time he greeted me with "Well, good morning, Alice, and how are you today?" With great glee I said, "I'm fine, Bob, and how are you?" For the entire series of appointments I called him "Bob" and raved to his office staff about his 'informality'.

I'm not sure he appreciated the informality, but then, neither did I.

In any event, when someone calls me "honey" or "sweetie" I return the favor. With a smile, of course. The practice generally stops immediately.

Just one small step for us elders.

Wonderful post, Ronni, and so many great comments, too. I think fear and ignorance fuel all forms of prejudice and bigotry; the inability to put oneself in another's shoes exacerbates the problem.

I have always found the US particularly ageist ("35 " is the new "50") ... and yet it is run by old white men, most of whom are enough to make anyone ageist. My prejudices.

Thank you for speaking out and for speaking out so clearly, so strongly.

I just saw an excellent TED talk on ageism. Ashton Applewhite also has a book on ageism called "This Chair Rocks". Good read.

I'm only 69 but look younger (I guess as people are usually surprised I'm retired) and not had too much apparent ageism yet. Getting ready for it though.

I think one good response will be "Wow, are you going to like it when somebody does this or says this to you when you get this age?" Said with a smile of course.

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