Wednesday, May 11, 2022

"Antidotes to Ageism" Video, and the Need for Better Patient Agency

The organization Changing the Narrative in Colorado in partnership with the Boulder County Area Agency on Aging, created a 16-minute video: "Antidotes for Ageism: A brief guide to creating inclusive care in an ageist society."

"Ageism is a real problem everywhere, including in healthcare. It isn’t just wrong; it has impacts on our health, lifespan and economy."

You can download their "Guidelines for Age-Inclusive Communication," as a .pdf file. This document includes a reference:  "Research by FrameWorks Institute shows that certain terms are often associated with – and reinforce – negative stereotypes about older people that result in stereotyping and discrimination."

UPDATE, Thursday, May 12, 2022: I'm watching the video now, which begins with a definition of "ageism," as "Stereotypes (how we think), prejudice (how we feel), and discrimination (how we act) towards others, or oneself, based on age."

Maybe policing thoughts and feelings is attempted by raising awareness, but this is not always the case. Minds and hearts are reluctant to change, especially when ageism has been pervasive implicit bias in Western culture for at least 200 years(?) Better to approach the problem with enhancing the agency of those affected.

One interviewee states, "My goal is to change the way we think about growing older." Another promotes volunteerism, which seems to be a step down from more ambitious and personal pursuit such as starting a company.

The best comment was by someone who said "each year brings more confidence, having more experience in life, ability to take more risks, and to venture into areas I probably wouldn't have done at a younger age. The fact is fighting ageism is about changing your own mind first, and the most compelling agent for change is serving as an example.

Interestingly enough, with advancing research into artificial intelligence and the race to mimicking human thought and decision making, the problem of bias must be approached. Bias is a given when you use a computational approach for decision making. Human decision making is even more complicated and harder to analyze and correct. Daniel Kahneman's "Thinking, Fast and Slow," and his work in the psychological study of human decision making was recognized with a Nobel Prize.

With healthcare, there isn't the same urgency in treating older adults or using more involved therapies, perhaps underestimating the possibility of a good result. It's the "I don't want to push things you don't want to do" attitude. Too often, when clinicians are approached with this problem, it comes down to using the excuse that "it's the system." This makes it easy to absolve responsibility.

The video suggests that older adults are subjected to more unnecessary clinical tests. But this can be debated that some developing chronic conditions are associated with age such as metabolic syndrome. Older adults have been excluded from clinical trials, again with the belief that this will lead to more robust results. And, for this reason, the data don't exist for treatments such as vaccines.

Then we have elderspeak. It's entirely appropriate to speak out when you're subjected to this.

Wrong assumptions: depression is not a normal part of aging. Sexuality is not to be discussed. Other factors such as ethnicity, gender identity, socio-economic status, lifestyle choices etc., are similarly ignored.

The worst realization is that poor delivery of health care is not causally limited to ageism or any other type of social prejudice. Doctors and nursing are forced to sit in front of a computer to capture codes and not observe the patient as a unique individual--they have be reduced to a series of check boxes for more efficient billing. Clinicians are increasingly experiencing burnout, and the patients become more burdensome as the monolithic healthcare system is untouchable. Predictions are being made that costs healthcare in the US will rise significantly due to the burden of the evolving Covid-19 pandemic.

My antidote for ageism, and all the other various implicit biases, as well as the many systemic failings of the US healthcare is agency. The much-discussed patient-centered model is elusive. It's up to each individual person who interacts with the healthcare system had better be prepared to do his or her homework. You can keep a daily journal of medications taken, blood pressure readings, moods, etc., to make it easier to get proper recognition of your particular health needs by presenting these in your clinic visit.

Ageism is not going away anytime soon. Work to improve your agency first.

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