Dear Doctors: Your column regarding an older man's doctor who denied him a PSA test struck a nerve. He was just told no without an explanation. As I get older, I find that my doctors don't listen to me. Can you please talk about ageism in medical care? Are there strategies for patients to overcome it?
Dear Reader: The term “ageism” refers to the various stereotypes, assumptions and preconceptions that are connected to someone's older age, which result in their being treated differently.
Unfortunately, as with many other areas of life, ageism is present in medical care. Age bias shows up in the way that health care providers talk to their patients, the degree to which they listen, the range of diagnostic tests they offer and the scope of treatments they are willing to make available.
A number of recent studies have focused on the growing prevalence of ageism in health care. Not surprisingly, they have found it leads not only to a lower quality of life for older patients, but can also result in missed or delayed diagnoses, more emergency room visits, more frequent hospitalizations and a shorter lifespan.
A common form of ageism is “elderspeak.” Nurses, doctors and support staff may address older patients as “honey,” “dear” or “young lady”; limit the vocabulary they use and dumb down explanations; or even use a sing-song voice, as when soothing an infant. This type of communication is not only embarrassing, but it is patronizing and can be isolating. Patients with poor hearing or eyesight say they are often treated as cognitively impaired. Some older adults find that treatable conditions -- such as chronic pain, arthritis and neuropathy -- are dismissed as a feature of older age.
While it is true that guidelines for screening tests and therapies change as we grow older, the intent is not to limit care. Rather, it reflects the shift in risks and benefits that can take place in older age. In our own practices, we do embrace a more conservative approach with older patients in diagnostics and management. For instance, our approach to a 40-year-old with knee arthritis differs from that of a 90-year-old. Our goal is not to over-diagnose or over-treat. That said, we strongly believe that shared decision-making is even more paramount with older adults. We will explain a diagnosis in detail, and in outlining treatment options, we always ask our patient, what matters to you? Is it symptom management, quality of life, fewer interventions, longevity? The answers become the starting point of our treatment.
Some older adults may benefit from a geriatrician as a primary care physician. Geriatricians have advanced training in health issues that affect older adults, and they often have more time for appointments. If you are otherwise happy with the care you are receiving, you may have to firmly but politely alert a health care provider to their ageist behavior. A matter-of-fact statement like, "I am older, but I am mentally sharp, I'm interested in all of my medical options and I need our appointments to reflect that," can be quite effective.
(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)
