By Judith Graham, Kaiser Health News
Joanne Whitney, 84, a retired associate clinical professor of pharmacy at the University of California-San Francisco, often feels devalued when dealing with healthcare providers.
There was the time a few years ago when she told an emergency doctor that the antibiotic he was going to prescribe would not counteract her type of urinary tract infection.
He didn’t want to listen even when she mentioned her professional references. She asked for someone else, in vain. “I was ignored and eventually given up,” said Whitney, who survived lung cancer and urethral cancer and relies on a special catheter to drain urine from her bladder. (An outpatient kidney service later changed the prescription.)
Then, earlier this year, Whitney ended up in the same emergency room, screaming in pain, with another urinary tract infection and a severe anal fissure. When she asked about Dilaudid, a strong anesthetic that had helped her before, a young doctor said, “We don’t give opioids to people who are looking for them. Let’s see what Tylenol does. “
Whitney said her pain continued unabated for eight hours.
“I think the fact that I’m 84 years old alone was important,” she said to me, like, ‘Oh, this is an old person in pain. Well, that often happens to older people. ‘”
Whitney’s experience speaks in favor of age discrimination in healthcare, a long-standing problem that has drawn new attention during the Covid pandemic that killed more than half a million Americans aged 65 and older.
Age discrimination occurs when people are confronted with stereotypes, prejudice or discrimination based on their age. The assumption that all older people are frail and helpless is a common, false stereotype. Prejudice can consist of feelings such as “older people are uncomfortable and difficult to manage”.
Age discrimination can be explicit in health care. For example, Crisis Standards of Care plans to treat younger adults before older adults. Embedded in these standards now being implemented by hospitals in Idaho and parts of Alaska and Montana is a value judgment: Young people’s lives are worth more because they probably have more years to live.
Justice in Aging, a legal advocacy group, filed a civil rights complaint with the U.S. Department of Health in September alleging that Idaho’s standards of care were out of date during the crisis and called for an investigation.
In other cases age discrimination is implicit. Dr. Julie Silverstein, president of the Atlantic Division at Oak Street Health, gives an example: Doctors believe that elderly patients who speak slowly are cognitively impaired and unable to address their medical concerns. When this happens, a doctor may not involve a patient in medical decision-making, potentially impacting care, Silverstein said. Oak Street Health operates more than 100 primary care centers for low-income seniors in 18 states.
Emogene stamper from the Bronx, New York, contracted Covid-19 in March. Her son fought to get her accepted into an institution that could offer intensive therapy. “When I got there, the doctor said to my son, ‘Oh, your mother is 90’ like he was kind of surprised, and my son said, ‘You don’t know my mother. You don’t know this 90-year-old, “said Stamper. (EMOGENE STAMPER)
Emogene Stamper, 91, from the Bronx, New York City, was sent to an underserved nursing home after contracting Covid in March. “It was like being in a dungeon,” she recalled, “and they didn’t lift a finger to do anything for me.” The assumption that older people are not resilient and cannot recover from illness is implicitly old-fashioned .
Stamper’s son fought to have his mother admitted to an inpatient rehab hospital where she could receive intensive therapy. “When I got there, the doctor said to my son, ‘Oh, your mother is 90’ like he was a little surprised, and my son said, ‘You don’t know my mother. You don’t know this 90 year old, ”Stamper told me.
When Stamper was hospitalized with an abdominal problem at the end of the summer, a nurse and nurse came into her room with papers that she was asked to sign. “Oh, you can write!” Said Stamper, the nurse shouting out loud as she wrote her signature. “They were so shocked that I was vigilant, it was offensive.
Nearly 20% of Americans ages 50 and older report having faced discrimination in healthcare that can lead to inadequate or inadequate care, according to a 2015 report. One study estimates the annual health cost of age discrimination in America, including over- and under-treatment of common diseases, at $ 63 billion.
Nubia Escobar would like doctors to spend more time listening to older patients’ concerns. When she recently got a second opinion from a cardiologist, she said, “He was sitting there talking to my daughter and looking at her.” (VERONICA ESCOBAR)
Nubia Escobar, 75, who emigrated from Colombia nearly 50 years ago, wishes doctors would spend more time listening to older patients’ concerns. This became a pressing problem two years ago when her long-time New York City cardiologist retired to Florida and a new doctor struggled to control her high blood pressure.
Worried that she might faint or fall because her blood pressure was so low, Escobar sought a second opinion. This cardiologist “hurried me – he didn’t ask many questions and didn’t listen. He sat and talked to my daughter and looked at her, “she said.
It was Veronica Escobar, an elderly lawyer, who accompanied her mother to this appointment. She remembers that the doctor was abrupt and kept interrupting her mother. “I didn’t like the way he treated her and I could see the anger on my mother’s face,” she told me. Nubia Escobar has since seen a geriatrician who concluded she was overdosed.
The geriatrician “was patient,” Nubia Escobar told me. “How should I put it?
Pat Bailey, 63, has received little of this kind of attention at the Los Angeles County, California, nursing home where she has lived for five years since her severe stroke and several subsequent heart attacks. “When I ask questions, they treat me like I’m old and stupid and don’t answer,” she told me over the phone.
Studies have shown that one in five nursing home residents has persistent pain and a significant number are inadequately treated. Bailey, whose left side is paralyzed, said she was among them. “If I tell them what hurts, they just ignore it or tell me it’s not time for a pain pill,” she complained.
Most of the time, Bailey feels like “I am invisible” and “a slug in bed, not a real person”. Only one nurse speaks to her regularly and makes her feel like she cares about Bailey’s welfare.
“Just because I don’t run and don’t do anything for myself doesn’t mean I’m not alive. I’m dying inside, but I’m still alive, “she told me.
When their longtime doctor retired, Ed Palent and his wife Sandy had to find a new doctor. “They went for an annual check-up and all this doctor wanted was to ask them how they were going to die and get them to sign all kinds of forms,” said Shelli Bischoff, her daughter. (SHELLI BISCHOFF)
Ed Palent, 88, and his wife, Sandy, 89, of Denver, also felt discouraged when they saw a new doctor after their longtime doctor retired. “They went for an annual check-up and all this doctor wanted was to ask them how they wanted to die and get them to sign all kinds of forms,” said their daughter Shelli Bischoff, who came over with her permission spoke of her parents’ experiences.
“They were very upset and said to him, ‘We don’t want to talk about it,’ but he persisted. They wanted a doctor who would help them live and not figure out how they are going to die. “
The Palents did not return and instead went to another doctor’s office where a young doctor barely looked at them after cursory examinations, they said. This doctor failed to identify a dangerous bacterial staph infection on Ed’s arm that was later diagnosed by a dermatologist. Again the couple felt overlooked and left.
Now you are at a family doctor’s practice that has endeavored to get to know you. “It’s the opposite of age discrimination: it’s ‘We take care of you and our job is to help you stay as healthy as possible for as long as possible,'” said Bischoff. “It’s a shame it’s so hard to find.”
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The KFF Kaiser Health News and the John A. Hartford Foundation host a 90-minute interactive web event on age discrimination in healthcare Join us on Thursday, October 21st at 12:00 PM Eastern Time for an open, practical, and encouraging conversation about this ubiquitous, systemic problem of age bias, discrimination, or stereotyping.
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