Ageism in Health Care - Coursework Example

Ageism in Health Care Introduction The population of the elderly people is increasing worldwide due to advances in general living standards, nutrition, education and healthcare (Pittman, 2007). However, the older people do not have the same respect and dignity as much as younger people have. As the 75 year old Doris Roberts (cited in Dittman, 2003), the Emmy-award winning actress rightly put it, ""My peers and I are portrayed as dependent, helpless, unproductive and demanding rather than deserving; in reality, the majority of seniors are self-sufficient, middle-class consumers with more assets than most young people, and the time and talent to offer society." The older people are discriminated in every walk-of life including health care. They are neglected or treated in an inferior manner or not given the best options for heath care due to their age factor. This prejudice is known as agesim. The term ageism was coined by Dr. Robert N. Butler in the 1960s and he defined it as “a deep and profound prejudice against the elderly which is found to some degree in all of us...ageism allows the younger generations to see older people as different from themselves; thus they subtly cease to identify with their elders as human beings” (Alliance for Aging Research, 2003). Ageism has become a part of many cultures and doctors, other health professionals and parts of the heathcare system have contributed to ageism, making it an endemic in the population. Ageism not only affects the health of the elderly person, it also affects the decision-making of good healthcare. According to AAR (2003), agesim has become a part of the psychology of not only the elderly but also the family of the elderly and runs at a subconsious level, adversely affecting the medical outcomes. Ageism needs to be addressed as it has intrigued into deeper aspects of health care and health administration and is sooner or later going to take a turn as a national challenge of any country. Addressing issues of ageing not only helps the present generation but also sheilds the next generation from the haunts of this attitude (AAR, 2003). In this essay, ageism, in the context of health care of the elderly will be discussed with intentions to identify barriers of care to the elderly and also produce solutions to overcome those barriers. Problems of the old people Aging is a natural physiological process and there are many changes which occur in the various organs of the body. Aging causes many normal reactions to fade. Various functions like hearing, vision, ability to respond, locomotor abilities, concentration, reflex actions and coping abilities begin to decline. At the same time, the fragility of the cells and organ systems increases the vulnerability of the organs to injury and damage (NIMHANS, 2003). The recovery process is slow as age advances and the time taken to recover from an injury increases. Also, the patterns of social life of the elderly are different from those who are young and middle-aged. Many elderly live an isolated life and some others in rest homes (NIMHANS, 2003). The change in the pattern of living, associated with increased difficulties in recognition of risk and ability to cope increases the risk of injuries in the elderly (NIMHANS, 2003). Delayed recovery and inability to take proper care of themselves results in poor quality of life which futher incapacitates the day-to-day activities (NIMHANS, 2003). Ageing causes many health problems in the elderly like altered response to medication, altered nutritional status, urinary incontinence, urine retention, fecal incontinence, pressure ulcers, mood disorders, dizziness, dementia and functional impairment, immobility and impaired gait (Nettina, 2006). Elderly people are more prone to falls and fractures, cognitive dysfunction, postural hypotension, electrolyte disorders, cardiac failure and polypharmacy (Nettina, 2006). Polypharmacy is more of a concern in the elderly because, illness is more common in the elderly and hence the number of prescribed drugs also is more. the pharmacokinetics of the aged is so different that the effects of the drugs are more. The factors which contribute to altered pharmacokinetics are decrease in lean body mass and total body weight, increased percentage of body fat, decreased protein binding of drugs, increase in volume of distribution for lipophilic drugs that penetrate the central nervous system, decline in the metabolic capacity of the liver, decreased liver mass and hepatic blood flow, decreased renal blood flow and glomerular filtration rate. There may also be changes in the receptor numbers, affinity, and post receptor cellular effects (Laird, n.d.). Along with these, there are also changes in the homeostatic mechanisms. An understanding of various aspects of aging is essential for any health care professional to handle older people in the most appropriate manner. Where such an understanding is lacking, the health professional fails to relate to the needs of the elderly person and develops an underestimating attitude which eventually leads to disparities in age-related healthcare which is ageism. Impact of ageism Ageism causes underestimation of the physical and mental capacities of the elderly population. Any health care system that is shaped by assumptions based on ageism hurts the intentions of one and all and contributes to premature loss of independence, increased disabilty, morbidity and mortality, and increased depression and dissatisfaction in the minds of the elderly people who otherwise may continue to lead a life of satisfaction, content and good health (AAR, 2003). In a suvey on people above 60 years of age, it has been found that ageism was experienced by 80 percent of elderly people (AAR, 2003). Similar reports were established by the the 2001 survey by Duke Universitys Erdman Palmore, PhD, in which 58 percent of the elderly people reported that they were subjected to ageism (AAR, 2003). Negative steroetypes of ageism are hurtful to the older population and can result in shortening of their lives. In a study by Levy et al (Dittman, 2003), perception of ageism decreased the lifespan by 7.5 years. In the same study it was reported that ageism contributed to feelings of worthlessness and worse memory. Many physicians are often unaware of the needs of old people. They perceive old people to be frail, depressed, confused, needy, overtalkative or quarrelsome. Because of these ideas of perception, the physicians perform medical examination in an old patient with a defensive attitude. Some physicians speak only to the care-giver of the old person and not the old person making the old person develop a sense of invisibility and making him less responsive and less involved in his or her own personal care (AAR, 2003). Barriers to the health care of the elderly The impact of ageism was described by a study published in the Journal of the American Medical Association in the year 2003 (AAR, 2003). According to that study, "25 to 40% of Americans over 65 have some hearing impairment, enough to impact the ability of some to work, drive, enjoy music and other entertainment or hear a grandchild squeal and giggle. But despite that number, most older Americans are not assessed or treated by physicians for hearing loss, according to the study, even though hearing aids and other treatments such as antibiotics to treat ear infections could improve hearing for many." The Alliance for Aging Research or AAR (2003) identified 5 dimensions of ageist bias in the United States health care. The AAR claimed that the health professionals in the society are not well trained to handle and respond to the needs of the geriatric population. Also, it was noticed that the older population were subjected to lesser preventive care, and important screening tests which identify diseases in early stages are not performed in most elderly people. According to Dr. Tom Perls of the New England Centenarian Study (Cited in AAR, 2003), “healthcare professionals often make assumptions about their older patients based on age, rather than on functional status, but assumptions people have often interfered with an older person’s care” The report of the AAR (2003) also condemned the fact that health professionals were not instituting medical interventions which have been proven to be useful in the older population. The preventive services for old people include screening for bone mass, colorectal cancer, prostate cancer and glaucoma, pap smear, mammography and pelvic examination. The vaccinations include pneumococcal vaccine, flu vaccine, hepatitis B vaccine. There are reports which suggest that one in 3 older people do not get flu vaccines and very few get vaccinated against pneumococcus. Lack of education on the part of patients and physicians contributes to this discrepancy. Some physicians, though they advice screening and vaccinations appropriately, are not aggressive and do not stress the importance of screening and other preventive measures (AAR, 2003). According to a CDC report in 2003, only one in ten of the people above 65 years of age go through proper screening and preventive measures (AAR, 2003). This is an enormous deficit in the wake of 80 percent of all heart attacks and 60 percent of all cancers occuring in people above 65 years of age (AAR, 2003). Also, despite the fact that colorectal cancer incidence soars in the above-50 age group, and it is a leading cause of death due to cancer, only one in four elderly persons receive colorectal cancer screening (AAR, 2003). The normal laboratory reports are different in the elderly and many laboratories seldom stress this difference. Vaccines and screening tests which aim to prevent potentially dangerous disease are seldon performed in the elderly. In some situations, life-saving surgeries may be denied either by the health professionals or by the family memebrs due to undue importance to the age (AAR, 2003). Thus it can be said that there exists a poor geriatrically-informed standards of care which can decrease the life-span of the elderly person due to under-medication, over-medication and misuse of approved drugs. Health providers rarely assess the risk of lifestyle related diseases like the AIDS and smoking because of the myths that prevail like old people are not sexually active, etc. However, may old people are sexually active and also resort to activities like smoking, alccoholism and substance abuse. These people must be given advice about condom use and programs to prevent drug use, smoking and alcoholism must be targetted against them (AAR, 2003). Chronic depression is noticed in 15 percent of population aged above 65 years of age. Untreated depression can contribute to worsening of health status and disability. Depression can also lead to suicide which is ten times more common in the elderly people than in younger population. Thus physicans must address issues pertaing to mental health with high degree of suspicion and patience (AAR, 2003). These and such other problems are consequences of ageism which needs to be addressed. Another most important aspect which the AAR attacked was on research. The report argued that depite the fact that elderly population is the largest consumer of drugs, they are frequently excluded from trials. Evidence from reports in the recent years has shown the high prevelance of ageism at all levels of delivery of health care. The health care systems of many countries have failed to recognise and address issues pertaining to the elderly. In the United States, the goverment introduced Medicaid in the year 1965 which addresses the medical needs of population beyond 65 years of age and young population with physical and mental diabilities. But the scheme is inadequate and elderly patients have to shell some expenses from their pockets too. The medicaid also directs the medical reimbursement for the physicians treating geriatric population to be minimal and this only worsens the relationship between the old people and their physicians. According to a report published by the Journal of Medical Association in 2003, it is likely that more and more physicians will avoid caring for the elderly if their reimbursements continue to be nominal. The report stated that 61% of primary care physicians and 44% of specialists plan to impose new or additional limits on the Medicare patients they treat, while 71% of the physicians intend to make changes in their practices that could adversely affect patient access, such as discontinuing certain services and referring complex cases." The most important barrier for care of the elderly is lack of proper education and training of health professionals and health care providers. Research has shown that the training of health professionals is inadequate to handle and relate to geriatric patients. According to CBS News (Cosgrove-Mather, 2003), "only about 10 percent of American medical schools require course work or rotations in geriatric medicine, and fewer than 3 percent of medical school graduates take elective courses in geriatrics" and "only five out of 145 medical colleges have full geriatric medicine departments." The statistics of geriatricians proves the lack of interest of the health care faculty about the elderly. According to CBS news (Cosgrove-Mather, 2003), "there are some 42,000 pediatricians in the country compared to 9,000 specialists in geriatric medicine, a number that is far too small as the nation girds for 77 million aging baby boomers." According to a study by JAMA in 1991 (cited in AAR, 2003), "the Institute of Medicine recommended that medical school geriatrics programs be comprised of at least nine full-time faculty members. Nearly 12 years later, 71% of geriatrics programs surveyed had fewer than nine faculty, while 51% of reporting schools had less than six. More than 60% of the program directors cited a lack of sufficient research, faculty and trainees, poor reimbursement for clinical care, and a lack of institutional financial support as significant obstacles to geriatrics program development." AAR (2003) has also identified deficiency in education and training with respect to geriatrics amongst various other health professionals like nurses, pharmacists, physician assisstants and other care-givers involved in the care of the elderly. There are reports which indicate that in the US, of the 200,000 pharmacists all over the country, only 720 of them have certifications in geriatric pharmacy. This is a severe discrepancy in the wake of most prescription and over-the-counter drug consumption coming from over-65 year population. Strategies to overcome ageism The health needs and care contexts of elderly people are many and varied. The economic, social and health status of the fast-growing elderly population poses a great challenge to all sectors. The WHO has projected that the elderly population of the world will cross the one billion mark by the year 2020 and by that time, over 700 million old people will be living in developing countries. It is unfortunate to say that little attention is paid to the enormous needs of the elderly population because the National Health Services are still preoccupied with tackling of the communicable diseases, maternal and child care (WHO, 2006). The World Health organisation has taken action to improve the health care of the elderly with the principle focus on community participation and family care, thereby promoting traditional family ties. The corner stone for supporting this is making optimal use of primary health care services (WHO, 2006). Ageism can be prevented by increased education and training of the health care providers, more research into various aspects of health of the elderly and education of both the physician and patient population about various screening procedures, etc (Cosgrove-Mather, 2003). Through proper education, health professionals can address many factors that impact health outcomes in the older adults like simultaneous illness, multiple drug regimens, values of the patients, preferences, impact of isolation, lack of independence in oldage, lack of adaptation to oldage and financial and economic issues (AAR, 2003). In the Europe and Japan, there are established geriatric departments in the hospital which is the otherwise around in the US and other parts of the world. Also, in France, gerontology is a compulsory subject in the medischools. In Italy, Spain and Germany, geriatrics is integrated with other medical courses. In the UK and Switzerland, there are courses in postgraduation for geriatrics and the undergraduates have problem-based geriatric problem solving in their curriculum. Since finances also are a problem in ageing, the government in collaboration with non-profit organisations must provide insurance and economically sound health services. According to AAR (2003), including elderly people in clinical trials is one of the steps which needs to be taken to combat ageism. Conclusion Though the elderly population is rising, attitude towards their needs has not improved in the society. Health Care is one of sectors in which age-related disparities are seen, ensuing in ageism. The most important contributing factors for this are lack of education and training of health professionals about the needs and health of the elderly, inappropriate finanical support and lack of information on the part of patient. Addressing these barriers can help tackle ageism. 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Injuries among elderly. Retrieved on October 28th 2009 from http://www.nimhans.kar.nic.in/epidemiology/bisp/fs3.pdf Pittman, J. (2007). Effect of Aging on Wound Healing Current Concepts. Journal of Wound, Ostomy and Continence Nursing, 34 (4), 412-417. World Health Organisation. (2006). Health of the Elderly. Retrieved on October 28th 2009 from http://www.searo.who.int/EN/Section980/Section1162/Section1167/Section1171_4806.htm Read More