Ageism in health care: Improving the health and well-being of older adults

At MultiCare, we are committed to working toward health equity — ensuring all people have access to quality health care regardless of age, race, ethnicity, gender identity, religion, sexual orientation, ability, socioeconomic status or location.

But we also recognize the reality that longstanding biases and barriers embedded in the health care system, and our society, can prevent people from accessing the care they need.

In this series — inspired in part by society’s growing awareness that not everyone has the same chance to be healthy — we take a deeper look at the disparities that impact our patients and how we as health care providers and community members can reduce those disparities and improve the health and well-being of all.

What is ageism?

Early in his career, Michael Shannon, MD — who practiced as an endocrinologist and geriatrician before joining MultiCare Connected Care* as chief medical officer — took care of a 78-year-old man with end-stage emphysema.

When the patient ended up in the hospital, he had to decide whether to have a tube inserted into his airway to breathe, an invasive procedure that would slightly prolong his life but not save it.

“He had recently gotten remarried to his high school sweetheart,” Dr. Shannon says. “He told me, ‘Every day I can be with her is important to me, even if I’m on a breathing tube.’ I found myself having to firmly advocate for this man’s wishes with his hospital care team. I think sometimes ageism can lead us to assume what other people might want or need instead of asking, ‘What’s most important to you?’”

Robert Butler, MD, the founding director of the National Institute on Aging, created the term “ageism” to describe stereotyping, prejudice, bias or discrimination toward people based on their age.

In the first of this two-part article, learn about ageism as well as efforts across MultiCare Health System to support the health and well-being of older adults.

The toll of ageism

Like racism, sexism and other forms of discrimination, ageism can lead to health disparities, particularly for older adults. A study out of the Yale School of Health, with over 7 million participants, found evidence that ageism can shorten life spans, lead to worse outcomes for both mental and physical health conditions, create barriers to accessing care, and lead to inappropriate care.

Ageism has an economic cost, too — a study published in The Gerontologist found that ageism led to excess health care spending of $63 billion over the course of a single year in the United States.

Ageism permeates culture at every level — from our interpersonal interactions to the institutional practices we must navigate to the way we perceive our own self-worth. As activist and author Ashton Applewhite says, “Ageism is prejudice against our own future selves.”

Age-friendly, all-inclusive care for seniors

Jessica Van Fleet-Green, MD, and Ramya Kumar, DO, sometimes witness the effects of ageism on patients who enroll in Pacific Northwest Program of All-Inclusive Care (PACE) Partners.

PNW PACE Partners, part of MultiCare, extends multidisciplinary, all-inclusive, highly coordinated care to adults 55 and older. Participants meet Washington state’s requirement for long-term care services yet wish to remain at home (or in another community setting) and can do so safely (other criteria apply as well).

“There is often an assumption with this population that they’re going to be medically complex,” Dr. Kumar says. “Providers in traditional health care settings can assume they don’t have the time to properly care for them — and patients pick up on that,” Dr. Kumar says. “We often have to do a lot of rapport building with a patient at first to show them that we are invested in them as a person.”

PNW PACE Partners follows the Institute for Healthcare Improvement’s age-friendly health care model, which focuses on four key areas: mobility, mentation (cognitive and emotional functioning), medication, and a patient’s own goals and preferences for care.

“We frequently see well-intended but misguided care of elders,” Dr. Van Fleet-Green says. “There can be a tendency to overtreat and under-listen, which can lead to the involvement of multiple specialists, numerous labs and studies, and long lists of medications. It’s evident when you meet many of these patients that what they want is for the health care team to understand what matters to them and take time to hear their story.”

One of the team’s focus areas is the reduction of inappropriate polypharmacy — when a person is taking multiple medications. Common among older adults who may have chronic conditions, polypharmacy can increase the risk of adverse drug interactions, cause cognitive impairment and lead to falls, according to the National Institute on Aging.

“Many patients don’t even know why they are on particular medications — and sometimes the reason is not even clear to us,” Dr. Kumar says. “When we carefully manage the number and types of medications patients are taking, they tend to have a much better quality of life.”

Following an initial assessment of each patient’s personal and medical needs, the PACE team — which includes nurses, nurse practitioners, social workers, therapists and physicians — develops a customized care plan and coordinates service delivery out of the PNW PACE Partners Center in Tacoma (or in some cases a patient’s home). Services include nursing, primary and specialty care, transportation, appointment scheduling, social work, prescriptions and more.

Drs. Van Fleet-Green and Kumar also see education as an important part of their work —residents from MultiCare Tacoma Family Medicine and MultiCare East Pierce Family Medicine gain valuable experience in delivering age-friendly care at PNW PACE Partners.

“We are very intentional about having residents at PACE,” Dr. Van Fleet-Green says. “We want the next generation to learn what age-friendly care is and how to provide it in any type of medical setting.”

2023 CEO & President’s Award winners

PNW PACE Partners and the Veteran Advocacy Program at Yakima Memorial are both winners of 2023 CEO & President’s Awards. This annual award series honors excellence and achievement at MultiCare.

Equitable access to care for veterans

Delivering age-friendly care isn’t just about what happens during a medical encounter — it’s also about ensuring equitable access to services and benefits. Yakima County is home to about 11,000 veterans of the U.S. Armed Forces, and more than 50 percent of those veterans are 65 and older.

In 2019, Matthew McCay helped establish the Veteran Advocacy Program at MultiCare Yakima Memorial. A key part of the program is educating veterans about their medical and disability benefits through the Department of Veterans Affairs (VA) and helping them overcome barriers to using those benefits.

“Sometimes veterans don’t know that they’re eligible for benefits through the VA,” says McCay, manager of the program. “Some veterans, particularly those who are older, may not use the internet or email, or they may struggle with the sheer complexity and bureaucracy of the systems they must navigate to get what they need.”

Each day, McCay rounds on veterans admitted to Yakima Memorial, identifying specific needs they have and talking with them about their benefits. He may guide them through filling out and submitting medical paperwork or help them call the VA to clear up an issue.

“Sometimes older veterans will ask me to listen to phone calls or voicemail messages from people pretending to be the VA and asking for money,” McCay says. “Scammers target this population and it can be hard for patients to tell what’s legitimate and what’s not.”

Another important aim of the Veteran Advocacy Program is improving outcomes for veterans, specifically reducing average length of stay in the hospital and the rate of rehospitalizations, which both tend to be higher for veterans than nonveteran populations, according to McCay.

One way they do that is by maintaining the visibility of veterans — identifying them at patient registration and noting their veteran status in electronic medical records and displays at nurses stations.

“Knowing a person is a veteran informs the way care is delivered,” McCay says. “Dr. Stephen Hunt, a well-known VA clinician and researcher, has found that veterans as a people group have trends in health care. For example, they may be more likely to have certain diseases and injuries or experience exposure to certain chemicals.”

Many veterans also see both a VA provider and a civilian provider, making it important to reconcile medication lists to avoid potentially dangerous duplications.

McCay, a veteran himself, also arranges trainings for clinicians and support staff about caring for veterans and keeps team members up to date about veteran-related legislation or changes in VA protocols.

“I’m proud of the work I do,” McCay says. “Yet I think there is still more to be done when it comes to removing unnecessarily complex barriers to care for older patients — veterans and nonveterans.”

In the next of this two-part series, we’ll dig deeper into the effects of ageism and highlight additional efforts across MultiCare to support healthy aging and equitable access to services.

*MultiCare Connected Care is MultiCare’s accountable care organization (ACO). An ACO is a clinically integrated network of hospitals, doctors, advanced practice providers and specialists who assume responsibility for a designated population of patients and work together to keep them healthy.