Confronting Ageism in Healthcare
Oct 16, 2023 Victoria Pelham
You struggle to remember major appointments or where you left your wallet every day. This worries you, but others shrug it off as “senior moments.”
At your doctor’s office, you wonder why your vision is blurred or if your heart medication causes fatigue, which was never explained to you. The doctor blames all your symptoms on getting older. They speak slowly, as if they were talking to a child.
It might seem like it’s all in your head, but ageism is a very real, overlooked barrier to good health. About 20% of people over 50 face age-based discrimination in healthcare, according to U.S. National Health and Retirement data. It can contribute to cognitive decline, more hospital stays, disability, worse health and quality of life, and depression. Over the long term, these attitudes shorten lives.
Signs of Ageism
Ageism can manifest as ignoring or dismissing treatable concerns—falls, joint pain, hearing or vision loss—that would be checked out right away in younger patients.
“Even though these challenges are common with aging, it doesn’t mean they’re a normal process of aging,” Rosen said.
Alzheimer’s disease or dementia can show up as difficulty finding familiar places or forgetting a close loved one’s name. But studies show dementia tends to go unnoticed, with around half of people with symptoms lacking diagnosis. The Alzheimer’s Association notes doctors and patients aren’t having enough conversations about memory loss. Almost all primary care doctors wait until a patient or family member mentions it.
Age-based prejudice leads to serious inequalities, including missed or delayed diagnoses and less information about medical decisions and treatment side effects.
Many people are also denied critical healthcare or given improper treatment. And older adults are largely left out of clinical trials, which could be lifesaving, showing how drugs affect people differently with age.
“Ageism gets less attention, but treating everyone fairly throughout their lives is part of providing equitable care,” stressed Christina Harris, MD, chief health equity officer at Cedars-Sinai.
Further, it overlaps with racism and other forms of discrimination, making accessing healthcare even harder for certain individuals as they get older.
“It’s not just one camp or another—these things layer,” Harris said.
Stereotypes in Preventive Care
Bias can start with the questions a doctor asks—or doesn’t, Harris pointed out.
A provider might assume a 75-year-old patient doesn’t need to, can’t or won’t exercise, when in fact physical activity protects bones and muscles well into the golden years. Each patient’s abilities and goals should be factored into a care plan, said Harris. If an older person loves tennis, they should be encouraged to keep playing.
That’s also true for medical screenings, Rosen added: It can be ageist to decide for a patient that screening and care isn’t worthwhile based on age alone.
While the U.S. Preventive Services Task Force decided there isn’t enough evidence to recommend mammograms for women after 75, the American Cancer Society suggests screening mammograms if someone is healthy and functioning well, and their life expectancy is at least 10 years. Because of these recommendations, many providers and patients think that breast cancer risk drops with age, when age is really the single most important risk factor for the disease.
Rosen approaches screenings as a conversation, weighing benefits and risks and letting every patient make their own informed decision.
“Why wouldn’t a healthy, high-functioning 80-year-old want a mammogram and detection and treatment for early cancer?” Rosen said.
"Ageism is probably the most under-recognized unconscious bias."
Age-Friendly Health System
- What Matters (patients’ care wishes)
- Medication (avoiding risky treatments for older adults)
- Mentation (preventing, diagnosing and caring for dementia, depression and delirium)
- Mobility (safe, daily movement)
The John A. Hartford Foundation and Institute for Healthcare Improvement initiative wants to help hospitals adapt to dramatically growing rates of patients over 65—expected to reach 84 million people by 2050. The model also emphasizes doing no harm, which Rosen said tackles ageism head-on.
“It’s a fail-safe to ensure you’re providing tailored care and not missing anything,” she said.
At Cedars-Sinai, which sees more patients over 80 than any other major academic medical center, age-friendly work revolves around robust dementia care and the Geriatric Fracture Program that closely evaluates and aims to strengthen bone health and fracture recovery.
The team also built out a geriatric-certified Emergency Department, including a geriatric education nurse specialist, adjacent senior care unit and a “TLC” volunteer program supporting aging patients and helping them avoid delirium (mental confusion). In 2022, the Community Benefit office introduced new geriatric screening for social factors that affect health and linking patients to resources.
Age discrimination hurts job opportunities, too, Rosen said, and, in turn, older people’s ability to pay for transportation, housing, groceries and medications. They’re also more likely to be isolated.
Experts urge more medical training in residency programs and continuing education.
“The more we talk about ageism, the better,” she stressed. “That’s how you combat unconscious bias.”
Confronting Age Bias
If you feel your doctor isn’t listening to you or answering questions, speak up, Rosen said. Your concerns are valid.
Some people are worried they’ll be punished for pushing back. She encourages those who are uncomfortable to bring an advocate or have them call your hospital or doctor to raise concerns.
And you can always seek a second opinion, including with a geriatrician, who will be more familiar with treating patients over 65.
Also, check your internal biases, Rosen stresses. Patients and family members often dismiss their own health issues as normal or decide they’re “old,” so they don’t matter anyway before a doctor has even seen them.
“Ageism comes from all over, even within,” she said.