Older patients face prejudice

When Austin Weatherall pushed the buzzer in his hospital room to signal for a nurse to help him get to the washroom, no one came.

As Jeannine Olson, one of the nurses on the ward explained, “Old people are always on the buzzer, calling us constantly for little reasons. We usually wait until they call a second time before we take them seriously.”

It wasn’t until Austin’s daughter arrived for a visit with her father and found him frustrated and weeping by the side of his bed that any concern was shown on the part of the medical staff.

Speaking out
This is just one small example of how our health care system mistreats its older patients. But, like the nurse who ignores the buzzer, society refuses to takes seniors’ concerns seriously. This may change, however, as more people, including medical professionals, are finally beginning to speak out on the issue.

Dr. Janice Lessard, a Toronto-area geriatrician, has long been an advocate for improving the treatment of older patients.

She says you don’t have to dig deep to uncover an unspoken bias the medical system has against the elderly. It’s clearly evident when treatment is ratiod-or even denied-to people because of their age.

It’s also deeply rooted in a system that fails to deliver accessible and age-appropriate health care.

This bias is known as ageism, or age discrimination, and is manifested by society’s belief that older people have outlived their usefulness and exist only as burdens on our cash- and resource-poor health system.

“You can see it the minute an older person enters the system,” Dr. Lessard says. “Because of their age, they’re often denied access to all the services offered to other patients.”

Medical ageism at work
Using the scenario of an older person coming to a busy emergency room, Dr. Lessard describes one example of medical ageism at work. Usually, the first person the patient sees is a physician who’s had only cursory training in geriatric medicine.

“These doctors can’t adequately treat the older patient because they don’t recognize the symptom. They don’t recognize it because they haven’t been taught it in medical school. They’re not taught it in medical school because it’s not felt to be an important area of medicine,” says Dr. Lessard, with growing exasperation.

So, despite the fact the patient may immediately need to see a specialist, they’re sent packing with a hurriedly written prescription and the barely hidden message: “You’re old. What else can you expect?”

Some doctors have even been known to write GOMER on their reports, a nasty acronym that spells out the distaste many in the medical profession hold for the elderly-GOMER: Get Out of My Emergency Room.

Next page: Overcoming bias

Overcoming bias
In cases where the patient is adamant or has strong family support, they’re able to overcome the initial bias and get deeper into the system. But Dr. Lessard says that this sometimes proves to be a hollow victory-the further you go, the more ageism you encounter.

Those patients who do get admitted are often done so without proper diagnosis-problem patients handed off to the next physician.

Then it’s on to hospital wards not designed to meet the needs of older people, staffed by nurses who don’t know what to do with them.

The final indignity comes when they’re tied down with restraints, officially for their own safety but more often to ensure they don’t budge and cause extra work for the staff.

Under these conditions, it’s no surprise that the older patient’s health deteriorates, forcing them into long-term care or, to free up a bed, into nursing homes.

In other cases, they’re put on a waiting list for surgery or simply told that they’re too old to be treated.

Gobbling up dollars
Of course, this scenario isn’t always played out but it’s much more common than anyone in authority cares to admit. And it’s wrong to blame health care providers for it — they’re operating within a system that mirrors society’s values.

For some time, there’s been a feeling that older people are simply gobbling up most of our precious health care dollars.

Actually, the numbers don’t bear this out. Studies show that only about 20 per cent of seniors are heavy users of formal health services. The rest use it at a rate parallel to the rest of the population.

Plus, 90 per cent of seniors continue to live on their own and not in long-term care or nursing homes, further belying the myth that seniors are an unsupportable drain on the system.

Next page: Where’s the outrage?

Where’s the outrage?
So where’s the great outrage that will spell the end of healthcare ageism? For the patients and their families who’ve experienced it, there’s plenty of anger. But the rest of society seems eerily quiet on the issue, perhaps hoping that older people will not speak up but graciously accept their fate.

Dr. Lessard thinks change will inevitably come on two fronts:

• Society will begin to acknowledge the countless hours of services older Canadians provide (babysitting and volunteering), which aren’t rewarded by pay or recognition but are tremendously important contributions toward upholding our social structures.
• As the percentage of elderly who make up the population continues to grow – including the vast baby boom generation-sheer numbers will force the system to adopt a new attitude.

Hospitals need strategies
Hospitals must prepare for this by putting new strategies in place. We’ve built pediatric wards for our children. Perhaps now we should build specially designed geriatric wards.

It might also mean encouraging more doctors into geriatric medicine. Latest figures show there are, appallingly, only 171 geriatricians in all of Canada, compared to 2,053 pediatricians.

It’s also time to trash the notion that older people aren’t fit to receive treatment comparable to other generations. Instead of using the template that says 40-year-olds must receive surgery ahead of 70-year-olds, Dr. Lessard feels we must look at each case on its own.

“After all, there are a lot of 70-year-olds who are much healthier than 40-year-olds,” she says.

Older Canadians aren’t making extravagant demands. They just want equal access to our health care system and its services. It’s time to provide that.