Are you being ignored because of your age?
Is the health ‘age gap’ stopping people from getting the care they need in later life, asks Victoria Lambert
When Geraldine Smith booked an NHS home dental visit, she thanked her lucky stars. At 91, going out to a dentist’s surgery was an exhausting prospect.
But the experience left her frustrated. “Instead of being seen as a patient,” Smith – a former civil servant from Surrey – explains, “I was treated like an idiot. My dentist seemed more interested in whether I had signed powers of attorney and had an up-to-date note on resuscitation in the event of a heart attack than the state of my gums. It was none of her business.”
The frustration with her treatment is not surprising. Older people routinely report that they are treated as though they all have incipient dementia, and are spoken to loudly – and with no respect.
Could that attitude towards the elderly be part of a wider problem: one that sees them discriminated against in healthcare situations because of their age?
Research involving the University of Oxford, published last week in the journal Physiotherapy, found that older men who have had hip and knee operations are missing out on crucial post-op physiotherapy because of their age.
And last year, a report by the Royal Society for Public Health found that ageist attitudes exist across generations, affecting health and wellbeing – with Christopher Brooks, the senior policy manager at Age UK, saying older people frequently experience discriminatory treatment across public and private services.
Prof Karen Middleton, chief executive of the Chartered Society of Physiotherapy, has seen first-hand the effect of missing out on post-op physiotherapy. “Far too many older
‘Do we see our elderly as not quite worth the investment as younger people?’
people are left to fend for themselves after leaving the hospital,” she says, “whether it’s after a knee or hip replacement or other conditions such as stroke. We know, for instance, that after a hip fracture operation, only one in five services provide people with immediate rehabilitation on discharge, despite the solid evidence that shows this is vital in order for people to make a full recovery.”
Iona Price’s mother was a prime example. After falling in her care home in 2012, Alice, 88, was taken to hospital with a broken hip.
Price, 61, who lives in Haslemere, Surrey, says: “The operation was quick and successful but afterwards she went into post-op delirium, which is not uncommon. It usually manifests as becoming very agitated, but sometimes – like with my mother – the patient just disengages and wants to sleep all the time.”
Post-op delirium is common in older patients and may be caused by reactions to drugs, lack of movement or infection. But hospital staff missed the diagnosis as Alice had just been diagnosed with the earliest stages of dementia. “I told them this was not normal behaviour for my mother,” says Price. “But I was ignored.”
The condition meant Alice was not working with her physio either.
Eventually, staff admitted the delirium and Alice was discharged into a nursing home, where the fogginess lifted – but lack of joined-up services meant her physio needs had to be applied for again via her GP.
“We had to wait 12 weeks and my mother was becoming depressed, says Price. “Lack of mobility was having an impact on her life. Unfortunately, just after she started physio, in 2013, my mother developed a chest infection and died a few weeks later.”
Alice did have the benefit of good healthcare in hospital, but for some older patients with cancer, treatment options may not be as clear cut.
This is because many oncologists don’t have enough training in geriatrics. A US study found that nearly a third of patients (27 per cent) aged over 70 had different treatment plans depending on whether they were seen only by the cancer team or by the geriatric department, too. Dutch research published in the Journal of Geriatric Oncology discovered that patients who received a geriatric assessment were recommended to have less intensive treatment or palliative care.
This is because aggressive chemotherapy can have more impact on older patients – plus seniors rarely make it on to clinical trials.
Christian Hebenstreit, senior vicepresident and general manager EMEA (Europe, the Middle East and Africa) of Medidata, a life sciences company that supports clinical trials, says getting older people involved is not easy. “Only three per cent of the general population has access to clinical trials,” explains Hebenstreit. “The reasons for this vary, but most often geography is what excludes the older population (aged 60 and above) from clinical trials because, regardless of whether the patient is eager to take part and contribute, they often can’t, due to accessibility issues.”
He believes new technologies will change this, such as the use of wearable technologies to enable virtual trials, which is especially useful for older patients who may be less mobile than their younger counterparts.
And there are ethical concerns, too, says James O’loan, a consultant pharmacist with online healthcare service Doctor4u: “Clinical trials are also not offered to older people as much as the younger generation, as there are concerns over consent if the elderly person has impaired cognitive function. “Research into dementia is essential,” he says, “but this makes it difficult when the generation most likely to be affected by this disease is excluded from clinical trials.”
Exclusion is a common issue for the elderly when it comes to medical care. Research by the BBC’S Victoria Derbyshire programme found that over-65s with eating disorders are being prevented from accessing some specialist clinics despite NHS England saying they are open to all ages. For some, such support is seen as essential in keeping them alive.
A lack of talking therapies is important because depression and anxiety are increasingly prevalent in older age groups. According to Alistair Burns, national clinical director for dementia at NHS England, these mental health conditions affect nearly eight million people over 55, but often go unnoticed and untreated.
Part of this, says Dr Andrew Boyd, a south London GP, is that society doesn’t support the elderly as it once did, and many are isolated. “We don’t grow old and die surrounded by family.”
And as appointment systems are increasingly online, the elderly can find they can’t get an appointment to see their GP.
O’loan is worried about how digital technology will affect older patients: “Many of these online appointments are prioritised on Patient Access, which is a fantastic tool that offers convenient appointment booking. However, those who don’t have access to this find themselves at the back of the queue.”
Perhaps one of the most surprising inequalities comes at the end of life. A 2015 University of Edinburgh report for the charity Marie Curie found that older people had more unmet pain, less access to generalist and specialist palliative care and greater information needs than younger people with clearer illnesses. O’loan says: “We see fewer older patients receiving palliative care than those who are younger and terminally ill. This may be because more of the older generation prefer to be at home to die and make their own decisions regarding end-of-life care, or it may be that there is a lack of access to palliative care for the elderly. Their needs are different from younger people and this type of care tends to focus on those who are younger and suffering from cancer rather than a range of diseases that affect the elderly.”
Yet despite all this bleak research, there is still much to celebrate in medical care for older people. “Because of the success of Western healthcare,” Dr Boyd says, “people are surviving to 80 or 90. But they do have illnesses which are chronic and not fixable.
“What they need is that kind of holistic continuity of care which balances physical, psychological and spiritual needs. We’re just not achieving that yet.” Had Iona Price, not her mother, broken her hip, does she think she would have had better care? “That’s the question,” she says. “Do we see our elderly as not quite worth the investment as younger generations? I couldn’t say for sure.”
She adds: “I probably wouldn’t have needed so much care and I think that might be the crux of it. If you are older you need longer to recover and that’s what needs to be accommodated within the system.”