The Greatest Risk to Older Patients: Ageist Doctors

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At first, Britain’s famed National Health Service (NHS) worked perfectly.

Maneuvering between his bed and his wheelchair, Richard had fallen and fractured his hip. He lay helpless for 36 hours before a visitor found him and called for an ambulance. He was admitted without delay into a busy surgical unit in one of London’s internationally renowned teaching hospitals and was told he could expect to be taken to theater that night. (More on Here’s the Secret About Long Life: It Doesn’t Come in a Pill)

But three days later, he was still waiting, in clenching pain, on soiled sheets and more dehydrated and malnourished than when he had arrived. When I tackled hospital officials about his deterioration, they casually admitted that my friend was not a priority for surgery because he was in the final stages of a degenerative disease (in fact, he would go on to survive for several more years).

Overworked nurses took their cue from their bosses and left Richard to fend for himself at mealtimes instead of giving him the assistance he needed to eat and drink. Richard had been judged unviable, incurable and therefore less deserving than other patients. At the time, Richard was only in his 40s, but a newly published report on the NHS reveals that such toxic attitudes are endemic in the treatment of older patients. (More on Brain Changes May Explain Driving Problems in the Elderly)

In her report, Care and Compassion?, Ann Abraham, the ombudsman tasked with investigating complaints against the NHS, presents 10 cases in which ageism intensified the suffering of patients over the age of 65. A female patient was transported from the hospital to a care home strapped to a stretcher, drenched in urine, bruised and wearing another patient’s clothes; other patients were given too many drugs or too few. Their wishes and the wishes of their relatives were routinely ignored.

Such example, said Abraham, are far from exceptional. There were 9,000 complaints against the NHS last year, nearly 1 in 5 related to the treatment of the elderly. “They’re very distressing stories. … They’re powerful stories and they need to be listened to and acted on,” Abraham told the BBC.

The report might seem to bear out the warnings of opponents of Obama’s health care reforms, who vilified Britain’s “socialist” NHS and often focused their attacks on its perceived rationing of end-of-life care. “I’ve heard several senators say that Ted Kennedy with a brain tumor, being 77 years old as opposed to being 37 years old, if he were in England would not be treated for his disease,” said Sen. Chuck Grassley in 2009. “When you get to be 77, your life is considered less valuable under those systems.” (More on Want to Improve Your Memory? Try Taking a Walk)

While it’s obvious that money can often buy better care — in desperation, I arranged to move Richard, a passionate supporter of the NHS, from the NHS ward to a private wing so he could get the attention he needed — problems of age prejudice are not unique to the NHS nor are they an inevitable byproduct of universal systems. For the record, the NHS seems to me rather like the British weather: it’s something everyone here complains about but most of us vastly prefer to the alternatives (and there’s deep unease about the coalition government‘s plans for a radical NHS overhaul).

As Robert Butler pointed out in coining the term “ageism” and continued to illustrate during years of campaigning work around dementia and healthy aging, older people are routinely undervalued in all areas of life and under all health care systems. Further, ageism is a scourge that is not reserved purely for the over 65s. U.S. doctor Mark Lachs warns in his 2010 book, Treat Me, Not My Age, that “ageism in American medicine and society” impacts on middle-aged patients seeking treatment for sports injuries, for example, and in more serious cases “is a matter of life and death, as dangerous as any incorrectly prescribed medicine or slipped scalpel.”

The bias isn’t confined to Britain’s NHS. Unless attitudes change, we risk dying of ageism rather than old age.

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