Earlier this year, I attended the Senior Civic Academy hosted by the City of Boston’s Age Strong Commission. Listening to discussions of how things like the affordable housing shortage and public transportation in the city affect older adults, I thought about how, as people age, they are often “othered” from society. In other words, it’s easy when we talk about older adults to view or treat them as intrinsically different from the rest of us
Providing services and supports that meet the specific needs of older adults is necessary, of course. After all, in the United States and many other countries around the world, the number of adults age 65 and older is growing rapidly. The US Census Bureau reports that by 2050 the country's 65-and-older population is projected to reach 83.7 million. As the aging population grows, it’s essential for all clinicians to understand the basics of geriatric care and how it differs from care for younger people.
It’s also true, however, that we ignore the full humanity of older adults when we, for example, fail to recognize they have needs and preferences regarding more than death and dying. Kevin Little, PhD, IHI faculty, and my colleague on the Age-Friendly Health Systems team agrees. “I’m in this demographic,” he notes, and he wishes that clinicians would address more than end-of-life care with people like him. Discussions of advance care planning and health care proxies are vital, Kevin acknowledges, “But what matters is I’m alive right now! Yes, I may not want to be resuscitated. I may not want feeding tubes. But I’m not there yet.”
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When we neglect to learn what matters most to a patient — before
an advanced illness diagnosis — we miss opportunities to provide optimal, life-enhancing care. As Kevin says, “Say I’ve got a chronic condition and I’m on some medication. Let’s engage with what’s important to me now. Because if you tell me that I won’t be as dizzy and I’ll regain some of my mobility if I’m willing to give up some medication, I’m going to do it.” But clinicians won’t know that unless they ask.
Ageism is Harm
Robert K. Greenleaf, the influential writer about servant leadership, has written about the essential role of elders in communities. He once asked readers to imagine a man in his nineties living in a fishing community and no longer able to go out on fishing boats. Greenleaf described this man as “quietly knitting nets for lobster traps which the active fisherman in the family would use.” The elderly man was, he pointed out, “still serving with what he could do best at his age.”
This story made me consider an important question: In addition to improving care for older adults, couldn’t we all do a better job of respecting what they have contributed to society, and may still contribute, provided the right opportunities? After all, in many of our communities, older adults are some of our most valuable volunteers.
Sadly, instead of honoring our elders, there is evidence that our disrespect harms older adults and costs all of us in the end. According to an article in AAMC News, a study published last year found that ageism against people 60 and older resulted in more than 17 million cases of the eight costliest illnesses, including cardiovascular disease and chronic respiratory disease. This Yale School of Public Health study estimated that these failures cost approximately $63 billion a year. Based on this kind of evidence, it seems that reframing ageism as a patient safety risk fits with recent efforts that view disrespect as a form of harm.
Shifting the Narrative
Being 70 with congestive heart failure is different from being 70 and in a coma. As Kevin says, many older adults aren’t there yet. Can we shift our thinking to relate to older adults as whole human beings and see what we can learn from them?
As Kevin says, “Let’s [be quiet] for a little bit and listen. Let’s start with listening to the voices and experiences of the people we are attempting to serve. If we do, we might develop a better way to care for older adults that’s cost effective and has better outcomes. Then, society could shift resources to younger people to relieve suffering, to build better trajectories of life so that people as they age are more productive, happier, healthier, and better able to be in community with their friends and families.”
In other words, can we design not just a better health care system but entire communities that are truly age-friendly?
Allison Luke is an IHI Age-Friendly Health Systems Project Coordinator.
Care and Health for Older Adults sessions are part of IHI’s National Forum this December.
You may also be interested in:
Age-Friendly Health Systems tools
How Focusing on What Matters Simplifies Complex Care for Older Adults