Need is great for geriatric physicians
Ageism. There is that ugly word again. No matter how you spell it, ageism or agism, it translates into a pitiful and pernicious form of discrimination that is destructive in just about every environment.
Ask the 55-year-old who has just been “downsized” out of a job and ask how the job hunt is going. Ask the single older woman at the wedding reception how many men have asked her to dance. Chances are almost 100 percent that no one has asked, and what’s more, she is probably sitting alone, disregarded because everyone knows old people are dull, or can’t hear, or are not much fun. Don’t even think to ask about her sex life because everyone knows old people are asexual.
When I was a child, my father could produce gales of laughter from his children when he told us his version of “Snow White and the Seven Little Warts.” Dad made up bizarre adventures that mostly involved the hapless warts, one of whom I remember was named “Harry.” Harry was, well, hairy. “Full of hiss, hair and halitosis,” as Dad described him, much to our delight.
I was reminded of Dad’s stories a while back when a colleague pointed out that ageism creates the “Seven Dwarfs’ Club.” She said that at some point people think we all join this club, and she names the dwarfs Weaky, Leaky, Wimpy, Wrinkled, Forgetful, Sexless and Ugly. The myths of aging march on. They would have us believe that in addition to the seven dwarfs mentioned, we could add Toothless, Spiritless, Goofy, Grumpy and Grim, and that is just for starters. Who wants to grow old in their company?
Preconceived ideas like these lead to a kind of stereotyping that can easily destroy self-esteem and lead to depression. In most areas, older adults joke about their situations and are able to laugh them off. My favorite: “You know you are getting older when you tell your best friend you are having an affair and she asks if you are having it catered.”
But there is nothing funny when ageism enters your health care provider’s office and you are seen by this person as old first and as you second. Evidence abounds that at least 60 percent of older adults receive substandard health care. A study published in the Journal of the American Geriatrics Society (March 2003) noted that “health care professionals tend to believe that most older individuals are frail and dependent, and that those who are not are atypical.”
There is no great mystery involved here. Health care providers come with the same biases as everyone else. The problem is that with education, most people lose biases. In medicine, that is just not happening. Many medical schools offer no, or minimal, geriatric training. Numerous fellowships in geriatrics are going unfilled. It is estimated that by 2030, we will need 36,000 geriatricians, and currently there are probably fewer than 6,000 actually practicing medicine. The problem that is looming is that unless major steps are taken to recruit and train geriatric physicians, the average number of patients per physician in the field will soon be more than 7,000.
Again, there is no mystery in the fact that so few physicians and other health care providers are choosing geriatrics as their specialty. There simply is no financial incentive for them to do so. The health care systems that are currently in place are actually punitive to those who would practice geriatrics, especially outside of the academic setting.
If ageism is to be banished from medical care of older adults, the number of knowledgeable professionals must be increased. Given the political and economic climate, the shortcomings of Medicare and Medical Assistance, along with the growing privatization of Medicare, the challenge is formidable. However, as stated by the American Geriatric Society, “The consequences of inaction will be profound. The combination of a burgeoning number of older persons and an inadequately prepared, poorly organized physician work force is a recipe for expensive, fragmented health care that does not meet the needs of our older population.”
“Geriatricians take care of people, not just their diseases.” This is the philosophy of the American Geriatric Society, and it leaves no room for discrimination.
Barbara Quirk is a geriatric nurse practitioner.