The Republican efforts to repeal and replace Obamacare, if successful, will have disastrous effects on the quality of life for older Americans and their extended families, according to the non-partisan Congressional Budget Office.
However, no matter what health-care system evolves (Obamacare, Trumpcare, single-payer or something else), the danger of older hospitalized patients being misdiagnosed due to age bias will still exist and grow.
In an online article at GetBetterHealth.com, Val Jones, M.D., recently documented how ageism in health care can be dangerous.
“Over the years, I’ve become more and more aware of ageism in health care — a bias against full treatment options for older patients,” Dr. Jones writes. “Assumptions about lower capabilities, cognitive status and sedentary lifestyle are all too common. There is a kind of ‘senior profiling’ that occurs among hospital staff, and this regularly leads to inappropriate medical care. As a physician myself, I’ve seen it.”
Jones describes how an older and active retired woman, who had been the board chair at a prestigious company and who was an avid Pilates participant and the caregiver for her disabled son, was misdiagnosed because of her age.
A physician new to the practice recommended a higher dose of diuretic (which she dutifully accepted), and several days later she became delirious from dehydration. Upon admission to the local hospital, staff presumed, due to her age, that the woman had advanced dementia. All she needed was IV fluids, but hospice care was recommended at discharge!
Jones refers to another patient, an attorney in her 70s, who had a slow-growing brain tumor, causing speech difficulties. “She, too, was written off as having dementia until an MRI was performed to explore the reason for new left-eye blindness.” However, the patient was denied brain rehabilitation services because of her “history of dementia,” a “history” that was nothing more than ageist bias.
Because we become more vulnerable to medication side effects, infections and delirium as we age, hospitalized older patients can present differently than their usual selves. Today, many hospital-based physicians, surgeons, nurses and therapists have no clue of the patient’s “normal baseline,” and ageist assumptions rear their ugly heads.
Jones writes, “My plea is for health-care staff to be very mindful of the tendency to profile older patients. Just because Mr. Johnson has behavioral disturbances in his hospital room doesn’t mean that he is like that at home. Be especially suspicious of reversible causes of mental status changes in the elderly, and presume that patients are normally functional and bright until proven otherwise.”
Indeed, shouldn’t we all presume that olders are normally functional and bright until proven otherwise?
So as the health-care debate rages and political positions are staked out, let’s remember that ageism runs deep in our country, and ageist misconceptions spring forth easily, not just in medical diagnosis but across the board. We all need some good old-fashioned consciousness-raising as we struggle to implement a health-care system that serves the needs of all of our people, all the way through our lives.
Marc Blesoff is a former Oak Park village trustee, co-founder of the Windmills softball organization, co-creator of Sunday Night Dinner, a retired criminal defense attorney, and a novice beekeeper. He currently facilitates Conscious Aging Workshops and Wise Aging Workshops in the Chicago area.