My trusted colleague, Michael Katz from Blue Penguin, who helps me write this monthly newsletter, featured one of my newsletters in his most recent issue — the title of which was Insight Beats Information. Reading it could not have been timelier.
I welcome the wisdom and experience that age brings; it provides tremendous understanding and perspective, allowing me to see things that my younger self could not have. Unfortunately, in western culture in particular, age is not always well respected.
As I work with and advocate on behalf of older adults (including my parents who are 88 and 89), I am consistently confronted with bias — bias that can get in the way of their healthcare and often leads to an individual feeling as if they are not being treated with the dignity and respect they deserve.
Here are some common ageist situations encountered by older adults, with suggestions on how to manage them should they occur for you or a loved one…
Language
Evidence suggests that biased language has the power to impact the health of individuals. So I am happy to see that the Reframing Aging Initiative, the American Medical Association, and other organizations have been working to change the way we speak and think about aging in our society.
Examples of biased language include “elder,” “elderly,” “senior,” and “the aged.” Using words like these can lead to othering, which is why in our work with clients we use “older adult” to refer to anyone over the age of 80.
Physicians Appointments — Seating
To promote successful communication between a physician and an older adult that I might accompany to an appointment, I always pay close attention to the space we are in and do the following:
- Guide my client to sit in a chair where they are in direct eyesight of the physician (I purposely place myself out of direct view)
- If asked to sit on an exam table that is behind the provider, suggest that the individual would like to have a discussion before being examined and therefore suggest they sit in a chair
- Ask for additional chairs if there are not enough for those present, but be sure the client is positioned for direct interaction
Physicians Appointments — Communication
If the provider begins to address me, I:
- Ask the provider to direct their conversation to the client
- Ask the client: “Would you like to answer Dr. Riley’s question?”
- Avoid making eye contact with the provider and fix my gaze on the client
If the client has difficulty hearing or understanding, I suggest they tell the provider their preferences up front. They may say something like:
- “I’m a bit hard of hearing, so please speak loudly and be sure I can see your face as reading your lips and seeing your facial expressions helps me.”
- “I may have difficulty understanding all you are saying to me, so please go slowly and try to use language a non-medical person would understand.”
- “I may ask Dianne to help me if I need it.”
I pay close attention to my client’s face and watch their expressions. Here are things I find myself saying:
- “Grace, do you hear Dr. Riley? Did you understand what she just said?”
- “Dr. Riley, could you please further explain what an MRI is, what it is for, and why you are recommending it?”
- “Grace, may I add additional information to what you just told Dr. Riley?”
- “Grace, do you need Dr. Riley to repeat what she just said?”
Of course, there are occasions when a client is not able to communicate for themselves. In those circumstances, we may need to take a more active role in sharing and gathering information. That does not preclude us from preparing and reviewing an agenda with our client ahead of time, discussing the fact that we plan to speak on their behalf, and letting them know that we will comprehensively summarize and debrief after an appointment.
When Clients are Addressed Inappropriately
When meeting a new client, we first address them by “Mr.” or “Mrs.,” ask how they prefer to be addressed and abide by their wishes. They often encourage us to use their first names, so we educate those they encounter to do the same.
Unfortunately, it is not unusual for an older adult to be addressed by professionals in healthcare settings using words like “hon,” “dearie,” or “sweetie.” I cannot overemphasize how disrespectfully such encounters are perceived by older adults (I know, because they discuss it with me when we leave).
Although I know there is no ill intent, healthcare professionals should know better. When I encounter this phenomenon, I speak up and politely say something like,“Mrs. Smith prefers you call her Grace.”
Often, it just acts as a reminder and sets the tone for a respectful encounter.
Another way to intervene is by introducing yourself upon meeting a healthcare professional: “Hi, my name is Grace. What is your name and what is your role in this encounter?”
Assumptions Regarding Cognition
People often assume that just because someone is older, they must have cognitive deficits.
Although we know that an older person may be more at risk than a younger person for certain kinds of chronic illness or negative health incidents, health problems in later life are not a given. Even dementia, the risk of which increases with age, is not a normal part of aging; most people in their 80’s don’t have cognitive impairment that affects their daily functioning.
Over the years, I have attended numerous neuropsych testing sessions with clients and have read the detailed reports that neuropsychologists write. It is yet another reason I frequently encourage others to question the paradigm by which they view older adults (including themselves) and aging.
Final Thoughts
Ageism in healthcare is a huge topic that could include a discussion of preventive care, receipt of inappropriate or incomplete treatment, screening for diseases and participation in clinical trials, and much more.
If you experience ageism yourself or with a loved one, I encourage you to examine the paradigm by which you view aging and to speak up so that others may learn as well. It is a natural part of life and how we choose to view it and do it is very much within our control!