Here at AgingOptions, we run across articles from time to time that make us want to shout “Amen!” in heartfelt agreement. That was our reaction when we read this Judith Graham article on the Kaiser Health News website. Her premise: the American medical system, Graham asserts, provides poor service to seniors, because it is rife with ageism and doesn’t understand the unique health care needs of men and women in older adulthood. We concur completely.
Ageism in Medicine Overlooks a “Vital” Stage of Life: Elderhood
We’ve been preaching this message for years, arguing that seniors are better served when they entrust their care to a geriatrician who is board-certified. Now one of these geriatric physicians, Dr. Louise Aronson of the University of California-San Francisco, has written a new book called Elderhood. Aronson provides what one reviewer calls “an essential, empathetic look at a vital but often disparaged stage of life.” The review adds, “Most people alive today will spend more years in elderhood than in childhood, and many will be elders for 40 years or more. Yet at the very moment that humans are living longer than ever before, we’ve made old age into a disease, a condition to be dreaded, denigrated, neglected, and denied.”
Writing on the Kaiser website, Judith Graham agrees. “Society gives short shrift to older age,” she argues. “This distinct phase of life doesn’t get the same attention that’s devoted to childhood. And the special characteristics of people in their 60s, 70s, 80s and beyond are poorly understood.” What’s more, “Medicine reflects this narrow-mindedness.” Medical school students spend “scant time” studying aging, and as a result “doctors too often fail to appreciate older adults’ unique needs or to tailor treatments appropriately.” With the elder population growing rapidly, she adds, it’s time for a new approach to elder care.
Ageism in Medicine Perpetuates “Bias” and “Dysfunction”
In the Kaiser article, called “A Doctor Speaks Out About Ageism in Medicine,” Judith Graham reports on an interview in which Dr. Aronson expands on her indictment of our medical establishment’s chronic disservice to seniors and blasts our health policies and practices as “biased” and “dysfunctional.” The basic problem, Aronson argues, is that “medicine pretends that [elderhood] isn’t really different from young adulthood or middle age. But it is. And that needs a lot more recognition than it currently gets.” Elderhood, which generally begins in one’s 60s and can last from 20 to 40 years, has various stages, but they’re not predictable like the stages of child development. “People age differently,” says Aronson, “in different ways and at different rates. Sometimes people skip stages. Or they move from an earlier stage to a later stage but then move back again” as they face various types of health challenges.
Aronson describes the approximate stages of elderhood this way. “In their 60s and 70s, people’s joints may start to give them trouble,” she says. “Their skin changes. Their hearing and eyesight deteriorate. They begin to lose muscle mass. Your brain still works, but your processing speed is slower. In your 80s and above, you start to develop more stiffness. You’re more likely to fall or have trouble with continence or sleeping or cognition — the so-called geriatric syndromes. You begin to change how you do what you do to compensate.” What many doctors ignore, however, is how a person’s response to medical treatment changes as their bodies alter with aging. “Take a common disease like diabetes. The risks of tight blood sugar control become higher and the benefits become lower as people move into this ‘old old’ stage. But many doctors aren’t aware of the evidence or don’t follow it.”
Dr. Aronson shares a joke to illustrate her point. “Do you know the famous anecdote about the 97-year-old man with the painful left knee? He goes to a doctor who takes a history and does an exam. There’s no sign of trauma, and the doctor says, ‘Hey, the knee is 97 years old. What do you expect?’ And the patient says, ‘But my right knee is 97 and it doesn’t hurt a bit.’ That’s ageism: dismissing an older person’s concerns simply because the person is old. It happens all the time.”
Ageism in Medicine Ignores Research and Training
The medical establishment’s dismissive attitude toward senior health care is nothing new, Aronson suggests. “Traditionally, older adults have been excluded from clinical trials,” which means elder care is not being properly researched. The way we train U.S. doctors isn’t much better. “In medical education, only a tiny part of the curriculum is devoted to older adults,” she tells Kaiser Health News, even though “in hospitals and outpatient clinics [seniors] account for a very significant share of patients.” As a result, “most physicians have little or no specific training in the anatomy, physiology, pharmacology and special conditions and circumstances of old age — though we know that old people are the ones most likely to be harmed by hospital care and medications.”
Dr. Aronson believes there are hopeful signs of change, but medical consumers who encounter ageism from their doctors still have to confront it. “You have to say in the gentlest, friendliest way possible, ‘I picked you for my physician because I know you’re a wonderful doctor. But I have to admit, I’m pretty disappointed by what you just said, because it felt to me that you were discounting me. I’d really like a different approach.’” She adds, “Doctors are human beings, and we live in a super ageist society. They may have unconscious biases, but they may not be malicious. So, give them some time to think about what you said. If after some time they don’t respond, you should definitely change doctors.”
Fight Ageism in Medicine with the Right Plan in Retirement
Do Dr. Aronson’s points persuade you? Are you ready to seek out the services of a geriatrician? If so, we have a few suggestions for you. Start by reading the Kaiser interview with Dr. Louise Aronson, then by visiting the website of the American Geriatrics Society where you can search for a geriatric specialist in your area. You can also ask your own doctor if he or she has special training in geriatric medicine, but you may have to probe a bit for the answer. Above all, don’t hesitate to ask pointed questions. But the best option, we suggest, is to call our AgingOptions office and let us refer you to a geriatrician near you. You’ll be glad you did.
If you’re getting serious about retirement planning, you’ll also be very glad you accepted Rajiv’s invitation to attend one of our AgingOptions LifePlanning Seminars. There you’ll discover a uniquely powerful approach to retirement planning that integrates all the elements of your retirement into one seamless strategy: your finances, your housing choices, your legal protection, your health care requirements, and communication with your family. You can explore this breakthrough in retirement planning without cost or obligation. To find out seminar dates, times and locations, and to register online for the seminar of your choice, simply click on this link to our Live Events page, or call our office during the week. We’ll look forward to meeting you as together we explore the power of LifePlanning – your number one tool to ensure a secure and fruitful retirement. Age on!
(originally reported at www.khn.org)