Joan Whitney, 84, a retired assistant professor of clinical pharmacy at the University of California, San Francisco, often feels discounted when dealing with healthcare providers.
Several years ago, she told the emergency room doctor that the antibiotic he wanted to prescribe would not work against the urinary tract infection she had.
He did not listen even when she mentioned her professional qualities. She asked to see someone else, but to no avail. “I was ignored and I eventually gave up,” said Whitney, who is a lung and urethral cancer survivor and needs a special catheter to drain urine from her bladder. (The outpatient renal service later changed the prescription.)
Then, earlier this year, Whitney was admitted to the same emergency room, screaming in pain, with another urinary tract infection and a severe anal fissure. When she asked for Dilaudid, a powerful drug that had worked for her before, the young doctor told her, “We do not distribute opioids to people looking for them. Let’s just see what Tylenol does. “
Whitney said her pain did not subside for eight hours.
“I think the fact that I was a woman for 84 years was important,” she told me. “When older people come in this way, they don’t get the same level of commitment to do something to fix the situation. It’s like “Oh, here’s an old man with pain. Well, that often happens to older people. “
Whitney’s experience speaks to ageism in healthcare settings, a long-standing issue that is gaining new attention during the coronavirus pandemic that has killed more than half a million Americans aged 65 and over.
Ageism occurs when people face stereotypes, prejudices, or discrimination because of their age. The assumption that all older people are fragile and helpless is a common misconception. Prejudice can consist of feelings such as “older people are unpleasant and difficult to deal with.” Discrimination is evident when the needs of older people are not recognized or respected, or when they are treated less favorably than younger people.
In healthcare settings, ageism can be overt. Example: health care rationing plans (“crisis standards of care”) that define treatment for young people earlier than older people. These standards, which hospitals in Idaho, as well as parts of Alaska and Montana, are currently adopting, have a value judgment that young people’s lives are worth more because they seem to have a few more years to live.
Justice in Aging, the legal advocacy group, filed a civil rights complaint with the US Department of Health and Human Services in September, alleging that the Idaho crisis response standards were outdated and demanded an investigation.
In other cases, ageism is implied. Dr. Julie Silverstein, president of Oak Street Health Atlantic, gives an example of this: physicians who assume that elderly patients who speak slowly have cognitive impairments and cannot talk about their medical problems. If this happens, the doctor may not involve the patient in making medical decisions, which could jeopardize treatment, Silverstein said. Oak Street Health operates more than 100 primary health care centers for low-income seniors in 18 states.
Emojen Stamper, 91, from the Bronx in New York City, was sent to a resource-limited nursing home after contracting the coronavirus in March. “It was like a dungeon,” she recalled, “and they didn’t even lift a finger to do anything for me.” The assumption that older people are not resilient and unable to recover from illness is implicitly associated with age.
Stamper’s son fought to get his mother admitted to a rehab hospital where she could receive intensive care. “When I got there, the doctor said to my son, ‘Oh, your mother is 90,’ as if he was a little surprised, and my son said, ‘You don’t know my mother. You don’t know this 90-year-old, ”Stamper told me. “It lets them know how disposable they think you become when you reach a certain age.”
At the end of the summer, when Stamper was hospitalized for an abdominal disorder, a nurse and paramedic came to her room with papers that she was supposed to sign. “Oh, you can write!” Stamper said the nurse exclaimed loudly as she wrote her signature. “They were so shocked that I became wary, it was offensive. They don’t respect you. “
According to a 2015 report, nearly 20% of Americans age 50 and older say they have been discriminated against in health care settings, which could lead to inappropriate or inadequate care. One study estimates that the annual health cost of ageism in America, including over-treatment and under-treatment of common diseases, is $ 63 billion.
Nubia Escobar, 75, who emigrated from Colombia nearly 50 years ago, would like doctors to spend more time listening to the concerns of older patients. This became an issue two years ago when her longtime New York City cardiologist retired to Florida and the new doctor was having trouble managing her hypertension.
Concerned that she might faint due to very low blood pressure, Escobar sought a different opinion. This cardiologist “rushed at me — he didn’t ask many questions or listen. He sat there talking to my daughter and looking at her, ”she said.
On this date, the mother was accompanied by Veronica Escobar, a senior lawyer. She remembers how the doctor was harsh and constantly interrupted her mother. “I didn’t like the way he treated her and I saw the anger on my mother’s face,” she told me. Since then, Nubia Escobar has been examined by a geriatrician, who has concluded that she has too much medication.
The geriatrician “was patient,” Nubia Escobar told me. “How can I put it? She gave me the feeling that all the time she thinks what could be best for me. “
Pat Bailey, 63, does not receive that much attention in the Los Angeles County, California nursing home, where she lived for five years after a severe stroke and several subsequent heart attacks. “When I ask questions, they treat me like old and stupid and don’t answer,” she told me in a telephone conversation.
Studies have shown that one in five nursing home residents have persistent pain and a significant number of patients are not receiving adequate treatment. Bailey, who has a paralyzed left side, said she was among them. “When I tell them it hurts, they just ignore it or tell me that now is not the time to take the pain reliever,” she complained.
Most of the time, Bailey feels like “I am invisible” and as if she is being treated like “a slug in bed and not a real person.” Only one nurse speaks to her regularly and makes her feel like she cares about Bailey’s well-being.
“The fact that I do not walk and do nothing for myself does not mean that I am not alive. I’m dying inside, but I’m still alive, ”she told me.
Ed Palent, 88, and his wife, 89-year-old Sandy from Denver, were also disappointed when they saw a new doctor after their longtime doctor retired. “They went to the annual checkup, and all this doctor wanted from them was to ask how they wanted to die and get them to sign all kinds of forms,” said their daughter Shelley Bischoff, who, with their permission, said that survived by her parents.
“They were very upset and told him, ‘We don’t want to talk about it,” but he didn’t give up. They needed a doctor who would help them live, not find out how they would die. “
The patients did not return, but instead joined another medical practice where, according to them, the young doctor did not even look at them after a cursory examination. This doctor was unable to identify a dangerous bacterial infection of Staphylococcus aureus on Ed’s arm, which was later diagnosed by a dermatologist. Again, the couple felt unnoticed and they left.
They now work with a concierge doctor who is making constant efforts to get to know them better. “It’s the opposite of ageism:“ We care about you and it’s our job to help you stay as healthy as possible for as long as possible, ”Bischoff said. “It’s a shame it’s so hard to find.”