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Successful Aging: When health care can lead down a discriminating path

Q I went for a scheduled stress test today. The technician was ready to inject a substance that would artificially raise my heart when I told her I preferred to use of the treadmill and have the nuclear test with the injection as a backup. The technician replied, “The nuclear test is better, only athletes do intense work outs that get their heart rate where it needs to be.” I pushed back, got my way and used the treadmill with no problem. I am 75, in great shape and never experienced this kind of attitude. This strikes me as age discrimination. Yes?

— G.C.

A Dear G.C.:

Indeed this sounds like age discrimination meaning that the technician made a decision solely based on you age, not your capacity or ability. What you describe is part of a larger issue: Ageism in health care.

In a recent article published by the American Society on Aging in their journal Generations, co-authors Dr. Karin M. Ouchida and Dr. Mark S. Lachs, specialists in geriatric medicine at Weill Cornell Medical College, indicate the health care community is not immune to ageism.

They write: “It (ageism) permeates the attitudes of medical providers, the mind-set of older patients and the structure of the healthcare system, having a potentially profound influence on the type and amount of care offered, requested and received.”

In your case it’s likely that the technician meant no harm. She may have assumed you could not perform on a treadmill because of recently testing a 70-year-old woman who was not able to use the tread mill and assumed that limitation applied to you.

More likely the technician just absorbed assumptions our society makes about age: That all older people decline at the same rate, that age is a good indicator of performance and that older adults in general have uniform limits.

These are wrong on all counts.

Experts in aging emphasize the profound diversity among older adults and have been quoted as saying, “If you’ve seen one 85-year-old, you’ve seen one 85-year-old.”

Among health care professionals, attitudes that older people are demented, frail and not-save able can occur during their early training days. Medical staff often is exposed only to hospitalized geriatric patients with complex medical problems versus exposure to healthy older adults living in the community. Their point of reference can easily be limited.

Such attitudes and beliefs may be one reason we have so few geriatricians.

According to the American Geriatric Society, we have about 7,500 certified geriatricians in the U.S. We need about 17,000 to care for about 12 million older Americans. And by 2030 we will need an estimated 36,000 geriatricians.

Although the lowest paid, surveys indicate that geriatricians have the highest level of job satisfaction among all physicians.

Expressions of ageism can be explicit or implicit. Here is an example of explicit ageism as noted in the article:

“A respected internal medicine resident flippantly tells her team she is worried because her patient on morning rounds ‘looked like this.’ The resident closes her eyes and opens her mouth with her tongue protruding to one side. ‘But then I remembered ... I’m on the geriatric service.’ ”

Implicit ageism involves one’s unconscious thoughts, feelings and behaviors towards older people. This likely was the case with your cardiac technician.

The late noted geriatrician Dr. Robert N. Butler wrote in his Pulitzer Prize-winning book, “Why Survive? Growing Old in America, “... a deep and profound prejudice against the elderly (is) found to some degree in all of us.”

So it’s not just the health care industry.

We know that older adults themselves often have negative views of aging which can affect their health. Ouchida and Lachs write that when older adults believe depression, pain, fatigue and dependency on others are part of normal aging, they are less likely to seek health care services.

And with low expectations about aging they are less likely to engage in physical activity, regular physical exams, eating a balance diet, using seat belts and limiting their use of alcohol and tobacco.

In contrast, those with positive perceptions of aging are more likely to engage in activities that can prevent disease and slow down normal aging.

G.C., thank you for sharing your experience. By pushing back to the technician, you were giving her a lesson about aging. Let’s hope she realized it.

Since age discrimination occurs in many sectors of society, we will dig a bit more deeply on the subject in the next column, particularly since this year is the 50th anniversary of the Age Discrimination in Employment Act.

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