Ageing in America has continued to accelerate. This has been attributed to the 1946 and 1964 baby boom generation. The Americans born during this period are now turning 60 to 65 years of age. For the next eighteen years approximately one American will turn 60 years of age in 7.5 seconds. The consequence of this increased rate of the aged population is already being experienced in the entire society today, mainly on our health care system. This paper will examine influence of ageism on the delivery of health care services and the treatment of the aged. Then the paper will suggest various recommendations which the health practitioners and the general society can do to do in future to reduce these challenges.
Statistics carried out over time have shown the rate at which the aged adults are increasing in America. Studies carried out in 1900 showed that one in every twenty five American is older than the age of sixty five. This is four percent of the general population equivalent to 3.1 million people older than 65. By July 2003, the number of those older than 65 years was numbered at 35.9 million which represented 12.7% of the entire population. This clearly shows that the population of the older adults is on the rise at a very fast rate. By 2030, it is predicted that the over 65 in the population will by 70 million forming 22% of the entire population. Ageism is a systematic discrimination and stereotyping against people who are old. This is fostered from the notion that older adults are of no value and not useful. Many myths that fuel ageism regarding the older adults and the aging are through the language that have a negative connotation on the images of old persons.
Such images limit opportunities in health care, employment and work place discrimination. Health care discrimination is even worse because the elderly person lacks the energy which may lead to him/her being discriminated, mistreated or abused. Studies have shown that professionals dealing with health care professionals have negative attitudes towards the older patients than those patients of the younger generation. It is therefore important for health practitioners and professionals to develop ways developing good attitudes and feelings towards the aged persons. This is because eliminating the spread of ageism can only be done on an individual level. It is ones responsibility to stop discriminating the older adults in the provision of health care.
Importance of positive attitudes in the provision of health care
Believing or thinking in a negative manner about old people or the process of becoming old is known as ageism (Doty, 1987, p 213). The society has beliefs and attitudes concerning aging which can have profound effects how people will view the aged people. Aging stereotypes are still prevalent in today’s society health care providers are not immune to ageism stereotypes because they have risen in the society. Ageism can negatively affect services delivery, health care provider’s professional training and consequently their patient’s health outcome and behaviours.
Health has been defined as the complete state of the mental, social and physical well being and not simply the absence of disease. (Chopra, 2000, p 4). Such a definition is in opposition with the traditional model by which health was defined simply by the lack of disease in ones body. Perfect health according to Chopra is a program of the mind, body, medicine and the availability of basic needs. This is encompasses psychological well being as one of the most important component in ones health. Health can also be seen in terms of the quality of life which includes ones ability to make a choice and at the same time to gain satisfaction of life despite functional limitations. Therefore health is a dynamic process of intersection between individuals and communities.
Health also involve ones freedom to make a choice and thus members of the community including health care providers have the choice to make a deliberate action to make the necessary changes that will enhance the health of the old adults. Ageism has however come in between the freedom of making a choice through affecting the way people make decision which affect the health of the old adults. Based on the belief that it is possible to prevent some of the inevitable deterioration associated with the old people, then it would be possible and easier for a health care providers to be more active in one own self care. If the health care givers and practitioners values and see the old person as equal members as them in the society, then the positive belief should be evident in their day to day practice of training and service provision, as they encounter the old patients. Similarly, if a positive attitude is developed which confronts ageism, then this will be a vital component of promoting health through programming and training.
Ageism in health care
Considerable evidence has shown that health care providers show discrimination towards the elderly people. This is seen in areas of screening procedures, patient interaction, treatments decisions and information exchange. During the interaction between a patient and a physician, a physician or other health care provider may hold behaviours, attitude and beliefs associated with ageism towards the older patient. Research shows that physicians do not care or show concern when treating the medical condition of the older adults. When interacting with older adults, doctors sometimes view them with disgust and describe them with discriminatory words such as crazy, depressing or disturbing old person (Nelson, 2005p 207-221). Adult people are likely less to be screened in scanning procedures compared to younger people. And are therefore less likely to be diagnosed at early stages of the health problem (Robb, C., Hongbin, C., & Haley, W. E. (2002p 1-12)
After undergoing diagnosis and being potentially- cured, older adults continue to be discriminated. Older patients as compared to the young ones are less likely to be given high quality treatment which shows less chances of their cure from the ailments. This is because doctors fear that the older patients are not strong enough to tolerate curable treatment and may also develop complications in the process of treatment or surgery leading to death. Other researches indicate that older patients suffering from heart diseases are less likely to receive further tests and treatments despite the severity of their condition. The studies show that care givers take the approach of only managing the diseases that the older adults have, rather than curing or preventing it. This shows the stereotypic attitudes in the process of aging in terms of the quality of health which decreases with age. Therefore, health care givers do not see the point of attempting to prevent the inevitable conditions experienced during old age. (Nelson, 2005, p 207-221: Robb, C., Hongbin, C., & Haley, W. E. (2002, p 1-12). These attitudes usually have a significant effect in the health outcome in the process of medical treatment of the elderly.
Effects of ageism on the delivery of health to the elderly
Ageism affects both the training a practice of the care givers and most significantly to the older people in terms of health. Infantilization and stereotypes of the elderly through patronizing language affects their behaviours and their self esteem. The older people will feel useless, dependent and non contributing members of the society after repeatedly hearing stereotypes towards them. They may perceive themselves as being blank in terms of the looking –glass, which is, the same way that others in the society look at them. Studies indicate that older adults perform worse on measures of memory and competence when they hear stereotypes about their supposed uselessness and incompetence. Older people experience self stereotypes or take their cultures stereotype of age which they have grown up with them. Such behaviours reinforce the already existing stereotypes in the treatment of the elderly, (Levy, B, 2001, P 578-579: NELSON, 2005, p 207-221)
Consequences of ageism
Age Concern identified three related concepts concerning age discrimination which are direct discrimination, indirect discrimination and ageism. Generally, Age Concern defines the discrimination against older people as an action which adversely affects the older people based on their chronological age alone (Age Concern 2007, P 34-5). Direct discrimination is the unequal treatment of age that cannot be justified. They are not offered certain services when they are over the age of 65. Indirect discrimination is a practice that disadvantages older adults. For example when mental health services are only designed to provide the needs of the young people alone without taking into consideration the preferences and needs of older people, then that would be discrimination.
Ageism according to Age Concern is the negative prejudice and stereotype towards the older people. An assumption like the mental health problems of older people is inevitable, is a prejudice statement with no proven truth. Services to older people in addressing their problems such as mental illness, cancer, prostate enlargement, eye disease, skin care, osteoporosis, TB, heart problems, high BP, diabetics, and Alzheimer’s which are common diseases at old age are usually under provided. Age Concern highlights the various challenges that happen in both secondary and primary care. Research carried out within community services has shown that only a third of older people who suffer from depression discuss their mental health with their specialists care givers. And only a third of them are treated (Age Concern Inquiry, 20007, p 27).
This discrimination has been attributed by the fallacy that depression is an inevitable part of one becoming old and it bares its roots in some areas of public policy (Lishman, 2007). Such a picture in the health service sector is less encouraging because we see older adults not achieving their needs and thus their health condition deteriorates with time because if early diagnosis could be taken, then, their condition would be treated at early stages. Stigma and attitudes toward the old pepole also has an impact to professional providers. This attitudes leads to poor quality care and treatments which impacts on the access, provisions and the generally outcome of the treatment. Stigma has led to marginalization within the health system whereby a specific hospital will only offer services and the needs of young patients. It also leads to low status for service providing care and for professionals as well as warehousing outside the health system (Graham et.al, p 674).
This discrimination has also been seen in how policy makers make up policies that touch on the concerns of older adults. The working age adults are not given chances to care take time off from their work to care for their old parents and close relatives. Working and family policy, in the US only provide time off for parents with new born. This means that the working adults have been tuned to focus away from services that are required by the old people. This has brought conflicting massages from service providers and commissioner (Age Concern, 2007, p 37). There is a mixed misunderstanding of strategic health authorities, Trusts and Services concerning the NSFFOP standards of anti ageism. This policy discourages services that were exclusively for older people.As a consequent to unethical and discriminatory policies on ageism, centres that deal with caring for the old are overcrowded. Family members are not able to take time to care for their older adults. This leads to dysfunctional family units with loose ties. The canters are overcrowded leading to poor quality services and care.
GPs have reported that their failure to address and treat older patients suffering from depression is due to lack of sufficient training to manage and diagnose depression in older adults, only two thirds of them they could readily access specialist advice(Audit Commission, 2002, p 19). Specialist in mental health services are in short supply which means that older people suffering from mental health problems are not in contact with specialist of mental health service(Coooper& Fearn, 1998; Kavanagh and Knapp, 1999). What is needed to be done is to increase the proposition of cares to be equal to that of the patient. The available specialists should have multidisciplinary teams to work together in the provisions of all the needs and services requires by the older adults.
Specialist and health care givers should be provided with adequate training opportunities. They should be trained on their specific fields but more on how to apply these skills to older adults. Skills in psychiatric disorders, managing, heart problems, managing high blood pressure, skin care and others should be extended on how to care for older patients with such problems. The National Health Service (NHS) should provide enough financial support in the care of older adults. The NHS has contributed to a significant gap in service availability for older people in the recent past. In 2007 the old age psychiatrist got concerned about the future of their services when NHS acted in a discriminatory way by reducing the funds that was to be for older people suffering from dementia and other health problem
so as to cut down financial pressure it was experiencing in other sectors. (Tucker et al., 2007, p 216 RCP, 2007)NSFOP should work at implementing appropriate policies that will address older people access to services in meeting their multiple needs. Older people should not be excluded from any services on the basis of their age. Principle should be put forward that there should be special services because older people have specialized care needs and treatment. This means that they require clinical specialists and a different dedicated service (Reed, et al, 2006, p 850). The complexity of medical problems that older adults could have will require the availability of specialists and practitioners especially those working with social care and mainstream health.
There should be guidance which indicates that services should not exclude people on the basis of their age. Health services in America today have been traditionally structured, funded and organised in a way that it has unintentionally creating barriers on the basis of age. This has been used as a factor that determines eligibility in the receivership of medical services. This consequently creates an imbalance in the service that is available. Hospital organizations starting with the board and the managerial sector have to look at the kind of service that is provided in the hospital. They should ensure the services and needs are for the benefit of all Americans irrespective of their ages.
They also have to ensure that they have a department that will specialize in the provision of delicate services and needs required by the older adults as well as the children because they are the most vulnerable group in the society. These departments should adequately be staffed with qualified personal of various skills to address the medical needs of the older adults. Age discrimination occurs indirectly because of how services have been structured in health centres. The frame work that exists in health centres is as a result of the use of age to differentiate services with the intention of enabling and individual to access appropriate specialist treatment. This may however result to indirect form of discrimination. In acute ward hospital, health professionals have discriminated against older people by refusing to treat persons with functional mental health problem aged over 70.
The staff members have preferred to channel the patients to other residents care of Older Person’s Medical, Health Team. Other better alternative should be developed in such a health centre. The community service centre should for example consider structuring another building that will specifically deal with such cases instead of transferring a patient to far off places they are unfamiliar with to get treatment. Health care providers and practitioners should learn how to intervene the medical condition of an elderly person early enough for the benefit of early treatment. For the case of diabetes it is important to determine the early symptoms such as frequent urination and increased temperature or in the case of depression, anxiety should be checked.
This is an effective way of preventing full blown medical problem which is more effective that treating the medical condition. ealth centres should therefore consider implementing a range of structural services that will address diagnosis of disease as well as patient sourcing and increased demand on the services that it offers. Therefore the local authorities should look into the eligibility criteria. This means social care services are available to every user with critical and substantial needs.There should be joint working of health practitioners, care givers and social workers to knowledge and information sharing. Lack of this joint effort among them has been identified as a contributing factor to age discrimination. Health organizations and social services have different health services and philosophies.
This is as a result of problems with communication sharing. Therefore there should be an integrated intervention between social health and services with different management and policy structures. For example NHS trust and social services have different policies which cause disparities and difficulties in services provision. Discussions have to be held to come up with a strategic level among them so as to tackle the conflicting issues.
The aim of this paper was to examine the inequalities brought about by ageism in the provision of medical services to older adults. The sources that have contributed to these papers clearly present the evidence of how ageism can bring diverse implications to the health life of older people. Service providers are also not able to adequately provide their services well as a result of ageism. It is therefore important to stop discriminatory and stereotypic action and languages while caring for the older people. This can only be attained when and individual health practitioner makes a choice of not being stereotypic.Hospital organisations should also come up with structure that does not directly or indirectly cause discrimination on the basis of age. Government policies should address the plight which the old Americans are facing because they require special care and special medical treatment. They should not be overlooked by the society because they are our fathers and mothers and without them we could not be here today. Respect is what they need not discrimination or ageism.
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