It was the beginning of the coronavirus pandemic, the early part of 2020 when European countries such as Italy and Belgium bore the maximum brunt of the deadly disease.
Amidst the shrill ambulance sirens and human cries, we also heard stories about how elderly patients — both those with Covid-19 and those without — were left without any healthcare facilities. In a way, they were left to die. In fact, many died without any treatment.
In medical terms it is called “ration care” — where access to care is restricted for certain groups. During the Covid-19 emergency situation, younger patients were reportedly given preference over older ones.
In Sweden, doctors admitted that overwhelmed by coronavirus cases, elderly patients were denied treatment. In the United Kingdom and several states of the US, older patients were asked to vacate hospital beds. During that time, former Australian Prime Minister Tony Abbott said some elderly patients could be left to die naturally.
Such incidents of medical negligence and prejudice towards elderly patients are clear cases of ageism.
Ageism in healthcare is a complex issue — health professionals, researchers and policymakers themselves say it is not easy to identify and fight the problem in the real world because of the way it is defined and operationalised.
Dr Deepak Balani, chief of medical services at Sakra World Hospital in Bengaluru, says ageism exists but there is a reason for that.
“Ageism prevails in the system, but in a small way,” he says. “It is due to the pressure on the clinicians, especially during emergency situations.
“Doctors have to make complex decisions based on the need of the hour. We don’t discriminate against our patients. Priority is given to patients who demand the utmost medical attention and those who benefit the most from the available resources. There are multiple mechanisms to ensure that everyone irrespective of their age receives the required medical assistance.”
Rooted in prejudice
It was Robert Neil Butler, the American Pulitzer Prize-winning author, physician, gerontologist and psychiatrist, who first coined the term ageism in 1969. He described ageism as prejudice by one age group towards other age groups. In fact, it was Butler’s work that led to an increased societal and research interest in ageism and strategies to combat it.
According to ‘Ageism in Health Care: A Systematic Review of Operational Definitions and Inductive Conceptualizations’, an article published in the Gerontologist in 2017, “Ageist behaviours and attitudes in the context of healthcare are far from innocuous, given that the amount and quality of care requested, delivered, and received is affected by the existence of ageism.
“A recent study conducted in the United States found that “one in 17 [adults over the age of 50 years] experience frequent health care discrimination, and this is associated with new or worsened disability by 4 years”. In the worst scenarios, ageism in health care may imply a higher probability of death for older patients than for younger patients.”
Emergency demands prioritising treatment?
The coronavirus pandemic exposed the chinks in healthcare systems across the world — from doctors to nurses to hospital beds, everything was in short supply. Experts say prioritisation of one group over another does happen in such a scenario.
Recalling the peak Covid-19 days, Dr Balani said, “The issues faced by the medical fraternity included a severe resource crunch. There was prioritisation among patients based on severity of the disease and likelihood of survival. Clinicians were optimising the available resources.
“It is incidental that age might have been a factor. Clinicians have to take critical decisions in a short span of time during emergencies. They always have the best interest for their patients. Sometimes, age could have been a factor influencing the allocation of resources and providing the best the patient requires.”
Older patients mean lesser care and attention?
A study published on PubMed Central in 2017, ‘Ageism among physicians, nurses, and social workers: findings from a qualitative study’, showed ageist attitudes towards elderly can contribute to healthcare staff like doctors and nurses and social workers spending less time with them. It said doctors are less patient, less respectful and less involved with the care of older people. “This results in unfair differences in treatment not based on medical needs,” the study said.
It added that ageism was associated with shorter, less effective and more superficial communication from nurses.
When it comes to social workers in healthcare settings, the study found that they spent less time with older people who have cancer compared with younger people.
Ageism affects diagnosis, prognosis
Several research papers from across the world have shown that ageism affects both diagnosis and prognosis.
“Yes, ageism has an impact on both diagnosis and prognosis,” says Dr Balani. “For elderly people, as time passes, the disease’s incidence, frequency, range, and severity rises. However, the body’s ability to cope or recover from the condition gradually declines. When compared to younger patients, older ones have a higher incidence of ailments, including several non-communicable diseases.
“Elderly patients are more likely to suffer from psychological and neurological disorders such as sadness, loneliness and amnesia. As a result, geriatricians, who are primary-care doctors with additional training in treating older persons, are assigned since they require different handling and a multi-factorial approach.”
Fight ageism with educational interventions
Another study published in PubMed in 2020, ‘Ageist attitudes among healthcare professionals and older patients in a geriatric rehabilitation facility and their association with patients’ satisfaction with care, found both healthcare professionals and older patients held ageist attitudes to some extent.
“Certain older patients’ sociodemographic characteristics, as well as lower knowledge about old age, have been found associated with more ageist attitudes towards their peers,” it said. “In contrast, satisfaction with care does not seem to affect older patients’ attitudes towards their peers. Healthcare professionals working in a geriatric facility should be aware of the prevalence of ageism among older patients.”
The study stressed on “the importance of educational interventions among healthcare professionals to increase awareness of the prevalence of ageism among older patients in a geriatric setting.”