Evidence-based care models that address the specialized needs of elderly patients exist, but nearly one third of survey respondents say they "frequently" experience age-related discrimination from doctors or hospitals.
Ageism is common in healthcare, and when older adults experience it frequently, they're more likely to develop new or worsened disability, according to a study in the Journal of General Internal Medicine.
Researchers analyzed data from 6,017 Americans older than 50 who took part in the 2008, 2010, and 2012 nationally representative Health and Retirement Study. They found that one out of five of these adults experience discrimination in healthcare settings, and one in 17 experiences it frequently.
Almost one-third of respondents (29%) who reported frequent healthcare discrimination developed new or worsened disability over four years, compared to just 16.8% of those who infrequently experienced it and 14.7 % who never experienced it.
"Ageism in healthcare is very common and experienced by many older adults," says lead author Stephanie Rogers, MD, MPAS, MPH, a clinical geriatric fellow at University of California San Francisco. "People who felt like they were discriminated against had worsened functional status."
She says these people were actually less able to do simple things such as bathing, walking, feeding, and dressing.
Although the study findings are stark, Rogers says she wasn't surprised by them. The surprise actually came during her residency training when she saw how older adults were treated in the healthcare system.
"We seemed to treat them like everyone else," she says. She saw the elderly being treated with the same interventions as people in their 30s and 40s, even though their bodies were much different. For instance, they are much frailer, and they metabolize medicines differently.
Rogers also notes that most research studies exclude older adults, meaning that a huge subsection of the population isn't being included in clinical trials.
"We were treating them the same as younger patients, and it didn't seem quite the right way to do things," she says. "It's just now starting to be recognized that we should be treating older adults differently than we treat younger adults."
Little Interest in Geriatrics
Yet for all of these differences—and for the growing number of seniors in this country—Rogers says there doesn't seem to be much interest in or respect for geriatrics. There are only about 7,000 geriatricians in the United States. "Why would you want to specialize in older adults?" other physicians would ask her.
Compare that with pediatrics, which has its own subspecialists, wards, and dedicated hospitals, and good access to pediatricians, Rogers says. In fact, the American Academy of Pediatrics counts 91,915 pediatric-focused physicians in the United States, and says there's a still shortage of pediatric medical subspecialists in many fields, as well as a shortage of pediatric surgical specialists.
Although her study didn't look at how older adults were discriminated against, Rogers says patients who experience it may have worse communication from doctors or don't believe they're getting enough information from their doctors. In addition, the physical space of a building might not be accommodating for them in some way, or local providers might not offer care for their specific needs.
"They may be feeling they're not respected by the healthcare professional or the healthcare system," Rogers says.
Anecdotal reports reveal that people who are discriminated against often feel voiceless or invisible, but Rogers says that this study "shows that this is actually happening, and we need to figure out ways to fight this discrimination and level the playing field."
There are already proven ways to more effectively care for older adults; hospitals and health systems just aren't using them, Rogers contends.
She points to well-established, evidence-based care models such as Acute Care for the Elderly (ACE) units and the Hospital Elder Life Program (HELP), which aims to prevent delirium. She says implementing programs like these may not only improve patient outcomes, but also save hospitals money and improve satisfaction scores.
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"These models exist, but very few hospitals actually use these models," Rogers says. "The hospital systems have not recognized the importance of them or implemented them."
Whatever the reason geriatrics is neglected and older adults are discriminated against, Rogers says it's something that the healthcare system needs to address, and urgently.
"Our nation is aging and we're going to have many, many older patients in our healthcare system. We need to find the models and use the models that exist to care for them better," she says. "This is neglected, and this needs to be a priority."
Alexandra Wilson Pecci is an editor for HealthLeaders.