“COVID hit us in the head two by four”: urgently fight ageism

Earlier this year, the World Health Organization announced global campaign against ageism – discrimination against older people, which is widespread and harmful, but often goes unnoticed.

“We must change the perception of age and aging” and “adopt strategies to counter” age attitudes and behavior, concluded the WHO in its opinion. main report support of the campaign.

Several WHO-endorsed strategies – educating people about ageism, building intergenerational contacts, and changing policies and laws to ensure age equality – are being tested in the United States. However, experts suggest that in light of the shocking death toll from the coronavirus pandemic, including more than 500,000 older Americans, closer attention is needed.

“COVID hit us in the head two by four, [showing that] you can’t keep doing the same thing over and over and expecting different results, ”said Jess Maurer, executive director of the Maine Council on Aging. October Webinar on Ageism in Healthcare sponsored by KHN and the John A. Hartford Foundation. “You have to eliminate the root cause, and ageism is the root cause here.”

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

Distinguish old age from disease. In October, a group of experts from the USA, Canada, India, Portugal, Switzerland and the United Kingdom called for the elimination of old age as one of the causes and symptoms of the disease in 11th edition 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 illness is “potentially harmful,” experts write in Lancet… They warn that this could lead to inadequate clinical assessment and care, as well as increased “social marginalization and discrimination” against older people.

Revealing ageist beliefs and language. Groundbreaking research published in 2015 by the FrameWorks Institute, a social research organization, found that many people associate aging with deterioration, addiction and decline – a stereotype that almost certainly contributed to the policies that harmed older people during the pandemic. On the contrary, experts understand that older people differ greatly in their abilities and that a significant number of them are healthy, independent and able to contribute to society.

Using this and subsequent research, Aging Rethinking Initiative, efforts to promote cultural change, work to change the way people think and talk about aging, and train organizations across the country. Rather than expressing fatalism about aging (“a silver tsunami that will flood society”), he emphasizes ingenuity, because in the words “we can solve any problem if we decide to do it,” said Patricia D’Antonio, project director and vice -the head of the company. politics and professional issues in the Gerontological Society of America. In addition, this initiative promotes equity as a value, such as “we must treat older people as equals”.

From the outset, the American Medical Association, the American Psychological Association, and the Associated Press adopted impartial language about aging, and communities in Colorado, New Hampshire, Massachusetts, Connecticut, New York, and Texas became partners.

The fight against ageism at the grassroots level. In Colorado, the Strategic Narrative Change Campaign has hosted more than 300 workshops on age language, beliefs and customs over the past three years. He is now launching a campaign to draw attention to ageism in healthcare, including a 15-minute video that will debut in November.

“Our goal is to educate people about the link between ageism and poor health, and to mobilize both the elderly and [health] professionals to advocate for better healthcare, ”said Janine Vanderburg, director of Narrative Change.

Faced with the dire impact of the pandemic, the Maine Council on Aging earlier this year launched The power of aging A project that sponsors a series of community discussions on ageism and asks organizations to accept “vow against aging… “

The goal is to educate people about their own “age biases” – mostly unconscious assumptions about aging – and help them understand “how age biases affect everything,” Maurer said. For those who are interested in assessing their own age bias, a test from Implicit Project of Harvard University often recommended. (Log in and select “IAT age” on the next page.)

Changing education for healthcare professionals. Two years ago, Harvard Medical School began integrating geriatrics and palliative care education into its curriculum, realizing that it was not doing enough to prepare future doctors to care for the elderly. Despite the rapid growth of the elderly population, according to the latest data from the Association of American Medical Colleges, only 55% of US medical schools required a geriatric education in 2020.

Dr. Andrea Schwartz, Associate Professor of Medicine, leads Harvard’s efforts to educate students on everything from places where older people get help (nursing homes, supportive services, home programs, community facilities) to how to manage general problems. geriatric syndromes such as falls and delirium. In addition, students will learn how to talk to older patients about what is most important to them and what they want most from their care.

Schwartz also chaired the committee for academic programs in geriatrics, which recently published updated minimum competencies in geriatrics which any medical school graduate should have.

Changing professional requirements. Dr. Sharon Inoue, also a professor of medicine at Harvard, suggests complementary approaches that can help improve care for the elderly. When a doctor wants to receive a board-specific certificate, or if doctors, nurses or pharmacists renew their licenses, she says, they are required to demonstrate training or competence in “geriatrics fundamentals.” And many more clinical trials need to include a representative population of older people in order to create a better evidence base for their treatment.

Geriatrician Inoue was particularly frightened by the pandemic when doctors and nurses failed to recognize that elderly people with COVID-19 were admitted to hospital emergency departments with “atypical” symptoms such as loss of appetite and delirium. Such “atypical” manifestations are common in older people, but instead of being tested for COVID or treated, these older people were sent back to nursing homes or public places where they contributed to the spread of infections, she said.

Involvement of geriatric expertise. If there is a better side to the pandemic, it is that healthcare professionals and health system leaders saw the problems with their own eyes and realized that older people needed special attention.

“Everything we geriatricians are trying to tell our colleagues has suddenly come under scrutiny,” said Dr. Rosanna Leipzig, professor of geriatrics at Icahn School of Medicine on Mount Sinai in New York.

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

Building health systems for older people. “I believe we are at a turning point,” said Terry Fulmer, president of the John A. Hartford Foundation, which along with the American Hospital Association, the US Catholic Health Association and the Institute for Health Improvement. (The John A. Hartford Foundation is a sponsor of the KHN.)

More than 2,500 health care systems, hospitals, health clinics and other health care providers have joined this movement, which sets four priorities (“4M”) in the care of older people: caring for their mobility, medications, thinking (cognitive abilities and mental health) and what matters most to them is the foundation of human-centered care.

Establishing a standardized framework for improved care for the elderly has helped health care providers and systems know how to act, even in the face of tremendous uncertainty over the past two years. “We thought [the pandemic] would slow us down, but what we found in most cases was the opposite – people could cling to 4M to have a sense of mastery and achievement during such chaos, ”Fulmer said.

Kaiser Health News is the national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation and is not affiliated with Kaiser Permanente.

This story first appeared in Kaiser Health News

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