Tackling ageism in health care, part 2

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.

Ageism surrounds us

Ten thousand people turn 65 every day in the U.S., according to AARP International. By 2050, older adults will comprise more than 20 percent of the population.

Yet despite the growing proportion of older adults in society, ageism — the stereotyping, prejudice, bias or discrimination toward people based on their age — is rampant.

It shows up in advertising, in the media we consume and in the workplace. Ageism is also present in health care, leading to adverse outcomes, increased mortality, inability to access care and sometimes denial of care, according to an article in Nature Aging.

How do we take better care of older adults now — and lay the groundwork to take better care of our future selves?

In the second of this two-part series, we further explore the effects of ageism and MultiCare Health System’s efforts to combat it.

Improving outcomes and clinical interactions for older adults

Ageism in the health care setting affects older adults in a variety of ways, from how they are spoken to during a medical encounter to what diagnoses they receive.

“Throughout my career, I’ve noticed this tendency to address older adults as ‘sweetie’ and ‘honey,’” says Cathy Cooper, LICSW, a social worker specializing in palliative care at MultiCare Auburn Medical Center. “While it’s not meant to be disrespectful, it can be perceived that way. Instead, we should be asking people how they want to be addressed.”

Using terms of endearment in such a way can be part of a style of speech known as elderspeak, which — while common in health care settings — can be both patronizing and harmful to patients, undermining their confidence in their own abilities.

Sometimes ageism can lead to inaccurate or delayed diagnoses. Health care professionals may not always be aware of atypical disease presentations in older adults. One study found that at least one-third of seniors who present at the emergency department with a serious infection do not have one of the hallmark symptoms: a fever.

“Urinary tract infections are common among older adults, yet they tend to cause confusion rather than some of the more typical symptoms we might see in a younger person,” says Zeeba Mathews, MD, a physician at MultiCare Good Samaritan Hospital who specializes in palliative care. “Sometimes people mistakenly assume that a patient has long-standing dementia when really it’s just an acute change because of an infection.”

While not every patient who presents at the emergency department (ED) with symptoms of delirium or confusion has dementia, EDs see a high proportion of patients with this diagnosis. An article in JAMA Neurology reports that approximately 25 percent of ED visits by those 65 and older are made by those with dementia or a related condition.

“Hospitals are often not set up well to take care of these patients,” Cooper says. “Research shows that even a short hospital stay can lead to a significant loss of functioning, and they may never regain those abilities even after they’re discharged.”

To improve the care of patients with dementia and related conditions, Cooper has received a grant from MultiCare Foundations to launch a training initiative for hospital staff and volunteers at Auburn Medical Center.

“The goal is to teach people best practices for interacting with patients who have dementia or are experiencing delirium,” Cooper says. “We want to give people the hands-on skills they need for positive, safe, effective interactions.”

Ageism in research

Beyond medical encounters, ageism can impact research — historically, older adults have been underrepresented in clinical trials. Trial protocols may set age limits for participants, or older adults may be indirectly excluded due to pre-existing chronic conditions or medications they’re taking, according to an Oxford University Press article.

Even if older adults are not outright excluded, the recruitment and retention of this population can be a challenge.

“Sometimes potential participants are understandably hesitant to add yet another medical visit or medication to their schedule, which studies may require,” says Jessica Horton, a clinical research supervisor at the MultiCare Institute for Research & Innovation. “Many studies also make use of technology like electronic diaries, which can be a deterrent for some older adults.”

Regardless of the reasons, exclusion of seniors in clinical trials is problematic —potentially leading to gaps in knowledge about the safety, effectiveness and accurate dosing of new treatments for this age group.

In 2023, the Research Institute initiated two vaccine-related studies specifically targeting older populations. One study, which is still enrolling those 65 and older, is testing a vaccine to prevent blood infections in people with a history of urinary tract infections. Another tested a vaccine for respiratory syncytial virus (RSV) in those 65 and older. The Centers for Disease Control and Prevention estimates that between 6,000-10,000 deaths occur each year among this age group due to RSV.

“A lot of our participants who are older adults are really excited to be a part of research,” says Sarah Furth, another clinical research coordinator at the Research Institute. “Similar to other patient populations, they want to contribute to the greater good, improve care for themselves and for future generations in their family.”

Suicide risk doesn’t just affect the young

“Men 75 and older have the highest risk of suicide out of any age group in the U.S. However, they are often left out of the conversation about suicide risk, and ageism plays a role in that.”
— Julie Jensen, manager of Older Adult Services, MultiCare Behavioral Health Network

Supporting the mental health of seniors

Psychological well-being is an important part of overall health across the lifespan. Yet mental illnesses such as anxiety and depression affect one in four older adults, according to the National Council on Aging, and less than half of older adults with mental health disorders receive treatment.

“Ageism can contribute to this treatment gap,” says Julie Jensen, manager of Older Adult Services for the MultiCare Behavioral Health Network. “Sometimes people think that mental health conditions are a normal part of aging, but they aren’t. This can lead to a lack of services and also discourages people from seeking help.”

MultiCare founded Older Adult Services 30 years ago when Washington state identified seniors as one of the most underserved in terms of access to mental health care, according to Jensen.

Today, Older Adult Services — which serves more than 500 patients a month — remains one of the few community mental health programs available in the Pacific Northwest that focuses solely on seniors.

Based in Puyallup, Older Adult Services delivers short-term outpatient mental health care to adults 60 and over who are dealing with issues such as grief and loss, age-related cognitive conditions, substance use, depression, suicidality and more.

“Men 75 and older have the highest risk of suicide out of any age group,” Jensen says. “However, they are often left out of the conversation about suicide risk, and ageism plays a role in that.”

Older Adult Services also works closely with the Geriatric Inpatient Psychiatry Unit at Auburn Medical Center, which specializes in treating older adults with dementia and disorders such as schizophrenia, depression and anxiety.

“There’s a tendency for older adults to suffer in silence when it comes to mental health concerns, but nobody should have to do that,” Jensen says. “We focus on providing counseling and giving people the tools they need to get better.”