“COVID hit us on the head with a two by four”: tackling ageism urgently

A greater sense of urgency is needed in light of the shocking death toll from the coronavirus pandemic, including more than 500,000 older Americans.

This article was published on Friday, November 5, 2021 in Kaiser Health News.

By Judith Graham

Earlier this year, the World Health Organization announced a global campaign to fight ageism – discrimination against older people that is pervasive and harmful but often unrecognized.

“We must change the discourse on age and aging” and “adopt strategies to counter” ageist attitudes and behavior, the WHO concluded in a major report accompanying the campaign.

Several WHO-approved strategies – educating people about ageism, fostering intergenerational contact, and changing policies and laws to promote age equity – are being tested in the United States. But a greater sense of urgency is needed in light of the shocking death toll from the coronavirus pandemic, including more than 500,000 older Americans, experts suggest.

“COVID hit us in the head with a two-by-four, [showing that] you can’t just keep doing the same thing over and over and expect different results “for seniors,” Jess Maurer, executive director of the Maine Council on Aging, said in an October webinar on ageism in healthcare sponsored by KHN and the John A. Hartford Foundation: “You have to tackle the root cause – and the root cause here is ageism.”

Some experts believe that there is a unique opportunity to address this concern because of what the country has been through. Here are some examples of what is being done, especially in healthcare settings.

Distinguish old age from illness. In October, a group of experts from the United States, Canada, India, Portugal, Switzerland and the United Kingdom called for old age to be removed as one of the causes and symptoms of disease in the 11^e revision of the International Classification of Diseases, a global resource used to standardize health data around the world.

Aging is a normal process, and equating old age with disease “is potentially damaging,” the experts wrote in The Lancet. This could lead to inadequate clinical assessment and care and increased “societal marginalization and discrimination” against older people, they warn.

Identify ageist beliefs and language. Groundbreaking research published in 2015 by the FrameWorks Institute, an organization that studies social issues, showed that many people associate aging with deterioration, addiction and decline – a stereotype that has almost surely contributed to policies that have harmed the elderly during the pandemic. On the other hand, experts understand that the abilities of older people vary widely and that a significant number of them are healthy, independent and able to contribute to society.

Using this and subsequent research, the Reframing Aging Initiative, an effort to advance cultural change, has strived to change the way people think and talk about aging, forming organizations across the board. country. Instead of expressing fatalism in the face of aging (“a silver tsunami that will overwhelm society”), it emphasizes ingenuity, as in “we can solve any problem if we resolve ourselves to do it, “said Patricia D’Antonio, project director and vice president of political and professional affairs at the Gerontological Society of America. In addition, the initiative promotes justice as a value, as in “we should treat older people as equals”.

Since its inception, the American Medical Association, the American Psychological Association, and the Associated Press have adopted unbiased language about aging, and communities in Colorado, New Hampshire, Massachusetts, Connecticut, New York and from Texas have signed up as partners.

Tackle ageism at the local level. In Colorado, Changing the Narrative, a strategic awareness campaign, has held more than 300 workshops to raise awareness of ageist language, beliefs and practices over the past three years. Now he’s launching a campaign to draw attention to ageism in healthcare, including a 15-minute video that will debut in November.

“Our goal is to teach people about the links between ageism and health issues and to engage both older and older people. [health] professionals to advocate for better medical care, ”said Janine Vanderburg, director of Changing the Narrative.

In response to the horrific impact of the pandemic, the Maine Council on Aging earlier this year launched the Power in Aging Project, which sponsors a series of community conversations on ageism and calls on organizations to make an “anti-ageism pledge. “.

The goal is to educate people about their own “age bias” – largely unconscious assumptions about aging – and to help them understand “how age bias impacts everything around them” , Maurer said. For those who wish to assess their own age bias, a Harvard University Project Implicit test is often recommended. (Log in and choose “IAT Age” on the next page.)

Change the training of health professionals. Two years ago, Harvard Medical School began incorporating training in geriatrics and palliative care into its curriculum, acknowledging that it had not done enough to prepare future physicians to care for the elderly. Despite the rapidly growing senior population, only 55% of U.S. medical schools required geriatric education in 2020, according to the latest data from the Association of American Medical Colleges.

Dr. Andrea Schwartz, Assistant Professor of Medicine, is leading the Harvard effort, which teaches students everything about the sites where seniors receive care (nursing homes, assisted living, home programs, community settings) to the how to manage geriatric syndromes such as falls and delirium. Additionally, students learn to talk with older patients about what is most important to them and what they expect most from their care.

Schwartz also chaired a geriatric college programs committee that recently released an update on the minimum geriatric skills that every medical school graduate should have.

Change in professional requirements. Dr. Sharon Inouye, also a professor of medicine at Harvard, suggests additional approaches that could advance better care for the elderly. When a physician seeks certification in a specialty or physicians, nurses or pharmacists renew their license, they should be required to demonstrate training or skills in “the basics of geriatrics,” he said. she declared. And many more clinical trials should include a representative range of older adults to build a better evidence base for their care.

Inouye, a geriatrician, was especially horrified during the pandemic when doctors and nurses failed to recognize older people with COVID-19 presenting in hospital emergency rooms with ‘atypical’ symptoms such as loss of appetite and delirium. Such ‘atypical’ presentations are common among older people, but instead of receiving COVID testing or treatment, these older people have been referred to nursing homes or community settings where they have helped spread infections, she declared.

Provide expertise in geriatrics. If there is a silver lining to the pandemic, it is that medical professionals and health system leaders observed firsthand the problems that followed and realized that the elderly needed a particular attention.

“Everything we geriatricians tried to tell our colleagues suddenly became obvious,” said Dr Rosanne Leipzig, professor of geriatrics at Icahn School of Medicine at Mount Sinai in New York City.

Today, more surgeons on Mount Sinai are asking geriatricians to help them manage older surgical patients, and orthopedic specialists are discussing setting up a similar program. “I think the value of geriatrics has increased as institutions see how we care for complicated elderly people and how that care improves outcomes,” Leipzig said.

Build health systems adapted to the elderly. “I think we’re at an inflection point,” said Terry Fulmer, president of the John A. Hartford Foundation, which supports the development of age-friendly health systems with the American Hospital Association, Catholic Health Association of the United States and the Institute for Healthcare Improvement. (The John A. Hartford Foundation is a funder of KHN.)

More than 2,500 health systems, hospitals, medical clinics and other health care providers have joined this movement which sets four priorities (“the 4M”) in the care of the elderly: ensuring their mobility, their medicines, their condition (cognition and mental health) and what matters most to them: the basis of person-centered care.

Creating a standardized framework for improving care for the elderly has helped healthcare providers and systems know how to proceed, even amid the enormous uncertainty of the past two years. “We thought [the pandemic] would slow us down, but what we found in most cases was the opposite: people could hold on to 4Ms to have a sense of mastery and accomplishment during a time of such chaos, ”Fulmer said. .

We look forward to hearing from readers about the questions you would like to answer, the issues you are having with your care, and the advice you need to deal with the healthcare system. Visit khn.org/columnists to submit your inquiries or advice.

Judith Graham: khn.navigatingaging@gmail.com, @judith_graham