Duke Medical Ethics Journal

This is not to say that the occurrence of ageism is always mal-spirited or intentional, as in many cases it appears unconsciously [3]. This implicit bias causes more alarm amongst healthcare policy workers because it makes the root of ageism in the medical setting harder to pinpoint and thus mitigate. Many recent surveys have illustrated common trends that healthcare professionals are grounded in a desire to do good towards older adults but their behaviors inevitably deprive patients of their autonomy [1]. One such theory of ageist tendencies toward older people from healthcare professionals is encapsulated by the “Terror Management Theory” [3]. This theory explains how the idea of ageism is closely associated with the human desire to dissociate from reminders of one’s own inevitable death [2]. Through this avoidance and ego-protective mechanism, negative attitudes and behaviors towards the elderly are reinforced [3]. This explanation of age anxiety is not targeted at solely healthcare professionals but the impacts of these ageist attitudes play the largest role in providing quality care and medical attention to the older population. As a result, the main areas in which ageism is most apparent and detrimental in our healthcare system are discriminatory communication and lack of emotional engagement, less respect for patient autonomy and patronizing environments, avoidance and neglect of preventative and extensive medical procedures, and lastly, severe elderly underrepresentation in clinical research [1]. 

 

The importance of open, honest, and unbiased communication between a patient and a healthcare professional is invaluable to diagnosis and treatment and thus, overall medical experience. Ageism can break down these communication ideals and cause the pathway to providing excellent and necessary healthcare to fail. A 2005 study video recorded doctor-patient interactions and an alarming amount of footage portrayed doctors not smiling and looking away from the elderly patient [3]. This survey also analyzed these older patients’ satisfaction with their medical interaction and a vast majority were negative as many blamed the interaction on “poor bedside manner” [3]. This sort of prejudiced speech was present not only in doctors but also in nurses. Whereas the general trend showed doctors utilizing passive communication, nurses conveyed a largely patronizing tone toward elderly patients when conducting workups [3]. Additionally, a 2004 study illustrated that the names of older patients are significantly less likely to be remembered than younger patients [3]. When older patients recognize that their healthcare team is not as invested in their care, they are discouraged by the outcomes they might get from their care. 

 

Another crucial responsibility of healthcare professionals is to uphold patient autonomy as this is the pillar that empowers patients to actively participate in their own care. Ageism has inhibited the ability of older patients to obtain maximum autonomy over their care. Autonomy has been shown to decrease among older patients due to the stereotype that older people cannot make sound, reasonable decisions about their own care. Circling back to Robert Butler’s echoing words about the term ageism, we are greatly inclined to see older patients are more incompetent than a standard, young patient. This attitude has encouraged a “dependency-support script” which describes a greater willingness to help someone who displays compliant reliance rather than free will, as observed in a study in the 1980s [3]. Findings from this study show how healthcare professionals are far more positively responsive to the dependent behaviors of elderly patients than to expressions of independence [3]. Although healthcare professionals’ hesitation to give older patients full independence can stem from good intentions, the presumption that this restricted autonomy applies to all patients at or above the 65-year-old mark is a very dangerous overgeneralization. 

 

The most detrimental application of ageism in the medical sphere is the limited proactiveness and extensiveness of diagnoses and treatments for older patients. Not only have studies directly observing negligent behavior in hospital settings supported this, but the structure of our healthcare policies for older patients has been equally revealing of diminished care for older patients. Large discrepancies have been shown in breast cancer care between younger women and older women. A study from the early 2000s shows how only 7% of physicians in the study conducted breast examinations on older female patients on a routine basis. Although an older study and we can hope that these numbers have increased on a wide-spread scale, the significantly low statistic is indicative of the preventative care differences solely based on the age of the patient [3]. This is recently seen with the way that the UK's National Health Service Breast Cancer Screening Program is structured. In this program, regular mammography is offered only to women under the age of 65 but was recently extended to the age of 70 [3]. Another study in 2006 approached breast cancer care bias through a different lens–physicans’ recommendation of invasive treatment for older patients compared to younger patients. Younger patients are significantly more likely to be recommended for breast-conservation therapy, whereas a higher percentage of older patients were recommended for modified radical mastectomy [3]. On the premise that prognosis and breast cancer stages between the two different age groups were relatively equal, the treatment recommendations were not as equal. Although such radical treatments might have been necessary for older women, many were recommended this invasive procedure before exploring other more accommodating and yet still effective treatments.