Friday April 4, 2008
Aging, Ageism, and the 'Silver Tsunami'
Picture this: two patients are wheeled into the Emergency Room at the same time. Both are having heart attacks and both need an angioplasty -- a procedure to unblock a coronary artery. When it comes to heart attacks, the faster you unblock the artery, the better for the patient. The hospital can only treat one patient at a time. So, how do you decide who goes first? Flip of the coin? Skill testing question? Tough choice, huh?
Now, suppose I tell you one patient is 42 years old and the other is 92. Does that make your choice any easier?
If you said yes, I know at least one geriatrician who calls that age discrimination.
In less than 3 years, the oldest of an estimated 10 million baby boomers will turn 65, and scenarios like the one I posed will become commonplace. Some are calling the coming avalanche of boomers a 'silver tsunami.' The people we talked to think calling it a 'tsunami' or an avalanche is quite an overstatement. Still, if the system is under stress now, it's likely to get worse in the coming years.
This week on White Coat, Black Art, we examine how the system deals with aging patients. And, we explore the line between age appropriate treatment and ageism. Cardiologist and researcher Dr. David Alter talks about a study which demonstrated that age discrimination exists in the health care system...though in practice he finds it's a lot more complicated than that. And, we have a provocative, interview with Dr. Janice Lessard, a Geriatrician who points out many of the casual, almost unconscious ways that people on the front lines practice age discrimination.
The show airs Monday April 7 at 1130 am and Friday April 11 at 8 pm (half an hour later in Newfoundland), on CBC Radio One.
In the meantime, we have a little treat for you. Usually, White Coat, Black Art shies away from medical news you can use. But I want you to listen to a conversation I had with Carol Kushner, a health policy consultant and co-author of two national bestsellers on what ails the health care system, Strong Medicine and Second Opinion. Kushner gives some very practical advice on how to keep seniors healthier, longer. And it mostly involves keeping them out of the health care system.
Previous Comments (12)
Please don't post my name, but I need to respond to your statement on today's 'ageism' program:
Dr. Lessard's example is the same as my grandfather's. When he was 86 he should have had an operation which would have made his life a whole lot more comfortable [oestomy?]. When he died at 92, his doctor said that had he known my grandfather would live that long, he would
'have done the operation years ago'!
That's ageism, Dr.
I feel in your comments you are blaming the victim, i.e., seniors and their families needs to speak up to get better care. Okay, these baby boomer generation seniors will do precisely that. But society should not expect those who are weaker, who cannot speak, who are vulnerable to speak up. We don't expect that of children. Maybe it's ageism to expect protection for seniors. I think not. It's the capacity to speak--culturally as well as physical weakness--that may make seniors vulnerable, just like kids.Anonymous, April 7, 2008 11:55 AM
Did I come home to Canada to die...very early? My experience in America is that not only isageism rampent and persave...once the profits of Medicare have been exhausted...sexism iis as well.
A woman of a "Certain Age" inless she presents a profitable problem, like needing a hysterectorm, is simply Medical Cannon Fodder!
According to the NY Times Science section, a Canadian woman is far less likely than a male canadian to receive a joint replacement.
A woman over a certain Age in Ontario is no longer covered for a Pap Test, and have you noticed that the more expensive the medication the less likely it is to be covered by OHIP!
Of coures, the older we get, the more bodily systems that need to be maintained, the greater the time involved, and of coures...the geater the expense!
But we still get to pay taxes...Hello?Kay Stephenson-Wrack, April 7, 2008 12:29 PM
Neither parent *needed* the angioplasty as earlier and a more recent study have shown. No benefit over doing nothing, and in many cases proven harm with stents clogging up and necessitating further intervention. Ka Ching.
It's wrong to think that more intevention, more drugs, newer drugs, mean better care: Vioxx, Baycol, Prepulsid, SSRIs. Not only not better than nothing, but once again, causing harm which requires further risk of harm, and in some cases death.
Better care does not equal more care.Riverein, April 7, 2008 12:33 PM
I have been a nurse for over 38 years and found your program excellent though heart-wrenching.I firmly believe in patient advocates and have assumed this role repeatedly -professionally and in my personal life. It requires a great deal of energy to maintain one's health -let alone deal with the biases of the medical/nursing /society perspectives when one has health challenges. Thank you for drawing attention to this prominent issue..judith, April 7, 2008 1:46 PM
For those interested in following Carol Kushner's comments, go here:
Evidence for Caution: women and statin use from Women and Health Protection and the Canadian Women's Health Network:
(Remove the dot)
James Wright, Therapeutics Initiative University of British Columbia, and John Abramson, Harvard; in The Lancet:
(Remove the dot)
Are lipid-lowering guidelines evidenced based?
I have taught exercise programs to seniors living in assisted care. It was under the auspices of the Faculty of Nursing who were doing a study to find out if seniors would benefit from a progressive, rounded weight lifting, stretching and cardio program.
They came, but were quiet, not smiling, not enjoying life, somewhat hostile to the idea of an exercise program, lethargic, having varying degrees of what I felt was unnecessary device and other-person dependency, and with health problems which they felt contraindicated exercise but which exercise has been proven to alleviate. (Sweden).
They were women (and one man) with crippling arthritis, on oxygen, dementia, pacemakers, hip replacements, back problems, legally blind, old knee, shoulder, foot injuries.
After the sessions, which were over one year and served about 500 seniors, they were joyous, enthusiastic, had recovered independence of basic personal needs (doing squats to strengthen quads=being able to use the toilet), learned techniques for carrying groceries and lifting and also, lifted weights in program to make this easier, did balance exercises, marched around the building to increase heart rate (those who were on oxygen marched in their chairs along with us.) We sang all the old songs they loved as we exercised. By the end of the program, there was no leader. I was completely superfluous.
They laughed, hugged, talked incessantly of their plans,
corrected each others technique, brought grandchildren to watch them exercise and after the classes, headed out for coffee, or to a community kitchen to help make pyroghy for Easter. Their grooming changed, they began a dance class, the staffs at these places were astounded, delighted and gained new respect and fondness (translates into better care) for these seniors.
Recently I learned about a book given to all Swedish doctors to guide them in how to PRESCRIBE exercise, for prevention of the above listed diseases, and treatment of the diseases. Not drugs. Exercise prescription.
Imagine. Where our physicians have the Physicians Desk Reference which comes from pharma, is written by pharma and is all about drugs, Swedish physicians have
a "PDR" that is for exercise.
How's your Swedish Dr. Goldman?riverein, April 7, 2008 2:13 PM
Well it's not like the government or anyone in general didn't know that there'd be a big boomer population aging at the same time.
Unfortunately, they will be unprepared for the boomers and then rant and rave about the boomers costing the system (oh, right, they already say that in some areas)....yet it's the boomers who paid for the system all along.
They don't have enough senior residences or nursing homes now - so wait til the boomers start needing them....mark it down, there won't be enough to deal with the problem down the road either.TM, April 7, 2008 2:26 PM
Based on what you've posted, my Swedish ought to get a lot better. We will definitely do a follow up story on this, so thanks a lot for sending it in!
bgBrian Goldman, April 11, 2008 9:17 AM
Ageism in our healthcare system starts long before the ER.
My mother, a dynamic 78 year old, has been a victim of the old game 'blame the patient for being sick' alternating with 'patronize the old person' in her attempt to get a long-standing health problem properly treated. She ended up in one of our big hospital ERs and, as Dr. Lessard pointed out, was asked about a 'living will'. Fortunately, she didn't have one so she moved along to ICU. Now that she is home, she is back at work trying to find a specialist who recognizes that just maybe, the patient has some knowledge to contribute to the partnership, and a 78 year old is worthy of proactive treatment. It is a sad thing to watch the patronizing attitude be passed on down to residents and medical students.
We healthcare providers should always ask oursleves 'Am I treating this person the way I would want my loved one to be treated?' It is that simple and that difficult.Elinor Richardson, RN, April 12, 2008 1:09 AM
Thanks for a great posting and for your heartfelt anecdote, Elinor. One the best parts of doing White Coat, Black Art is getting confirmation of what we're trying to present from people who work inside the system, like you.
I wanted to react to your final comment: "We healthcare providers should always ask ourselves 'Am I treating this person the way I would want my loved one to be treated?' It is that simple and that difficult."
I think "that simple and that difficult" sums up the issue quite nicely.
If it's a new hip we're talking about, then I probably want to know the doctor or nurse would choose for their family member(s).
On the other hand, if I'm trying to decide whether I or a loved one is getting age-appropriate treatment or ageism, instead of knowledge, you might be getting attitudes and opinions.
Without knowing, you could be mislead quite seriously.
BrianBrian Goldman, April 14, 2008 10:37 AM
Please post this anonymously since I discuss medical issues.
This was a painful item for me to listen to, because while my husband and I have, between us, three sets of parents who are not getting younger, they are all very much alive and if not entirely well, well enough.. and getting excellent medical treatment.
By contrast, this past December one of my closest friends, aged 53, dropped dead of a heart attack. A few weeks later one of my cousins -- a firefighter in his 40s, who had specialized in oil well blazes -- did as well. As did the father of one my son's closest friends less than three years ago -- a 42-year-old father of three, the eldest of whom was nine years old at the time.
I won't dispute that when my mother-in-law was finally diagnosed with heart disease as a woman in her 70s, she had been under-diagnosed until the day she was told she went for an angiogramme and wound up getting quintuple bypass surgery. But she did indeed get the surgery she needed, and a pacemaker, and (knock wood) is doing just great. But I do have to wonder if the three relatively-young men in my immediate circle of acquaintences who all died of heart attacks may also have been underdiagnosed and under treated. Two of them (the 53 year old and 42 year old) had pre-existing, known heart conditions, but neither received the kind of radical medical intervention that my parents and their peers seem to get as an entitlement.
Is it possible that older patients are able to articulate their dissatisfaction with what they perceive as ageism when it comes to medical treatment? That they may in fact enjoy the luxury of the *time* to kvetch about their care?
Unlike, for example, the 42 father of three, who had a career, and aging parents he loved and perhaps for whom he felt he occassionally needed to make time to advocate on behalf of, not to mention the kids -- none of whom was old enough to even cross the street without hands-on adult supervision -- to which he had to attend? Maybe he was just too darn busy with getting on with his life to dwell upon his substandard heart, and demand to know *why* he wasn't being fitted out with the pacemeaker that most certainly would have saved his life?
But maybe it isn't so simple.
When my husband looks his 87-year-old father's oncologist in the eye and says, "...and what protocol would you follow if my father was in his 50s?" he may indeed be reminding the doctor that ageism exists and perhaps should be avoided.
It may well be worth doing, even when my husband (a father of two elementary-school aged children, a man with a career, and decades of gainful tax-paying ahead of him, should he be blessed with the luxury of time) has made *weekly* trips to various appointments to serve as an advocate (one of a team of them -- including a professional medical advocate, a resource I did not know existed until my husband found one for his father) for his Dad. But when was the last time my husband made his *own* medical work-up a priority? The dutiful son. I can only hope he lives to the kind of ripe old age as his father, a man who charts his week around a plethora of medical appointments.Anonymous, April 14, 2008 6:09 PM
My parents generally received good hospital care but one can't help but wonder what it might have been like without the strong prescence of family. However, we were shocked when we heard blatant ageistic comments made by some hospital staff. On one occasion, an ER physician was determined to refuse proper treatment because of age.
I've heard from other families who said their parents experienced ageism in healthcare.
Your program brought forward a very important message. Be wary of ageistic attitudes within the healthcare system.
That includes long-term institutions.ellen watson, April 22, 2008 10:39 AM
What if I told you the 92 year old suffered the heart attack while playing mixed doubles in the US Open Tennis Tournament. Change your mind? (In 2003 this was won by a 91 year old.)
What if I told you the 42 year old damaged his heart through cigarette smoking and cocaine use. Change your mind?
What if I told you that the 42 year old used cocaine to self- medicate undiagnosed bipolar disorder? But that the heart has been so damaged he is unlikely to survive the procedure?
Shortly, the UK will pass legislation outlawing doctors from withholding medical treatment based on age.
Are we Canadians so age-bigotted that the average person cannot recognize what a stupid and unfair question this is?Dr. J. E. Lessard, June 23, 2008 6:18 PM