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When older patients run into ageism while being medically treated. (Article claims it happens)

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81GyGuy
Veteran Member
Joined : Oct 2012
Posts : 3529
Posted 9/6/2022 11:06 AM (GMT -8)
A topic likely of interest to us here since most of us are older folks.

Highlights from last-linked article below:

This will continue to be a growing problem as the country continues to age at a faster rate than in the past.

"By 2035, adults 65 and older are expected to outnumber children in the U.S. for the first time."

" ... people over 65 are 15 percent of today’s population, (but) they account for 39 percent of hospitalizations."


Further:

" ... most adults over 65 have at least one chronic condition, and 77 percent have at least two."

Taking several meds for these multiple conditions complicates things, since older people metabolize drugs differently from younger people, due to changing physiology. Many physicians are not as aware of this fact as they should be.

Elders are often underrepresented in clinical trials.

"Standard " medication doses may have been derived from and intended to apply to younger patients. Applying such "standards" to older patients may be problematic.

Gerontologists are increasingly in short supply. It has never been a popular medical specialty in any case.

Also, and very concerning:

" ... medication-related problems are estimated to be one of the top five causes of death in those 65 and older, and a major cause of confusion, depression, falls, disability and loss of independence. One in three seniors who take five or more medications will have at least one bad drug reaction each year; two-thirds will require medical attention. And those over 65 are 2.5 times more likely to visit an emergency room for an adverse drug reaction than younger individuals."

And:

" ... 1 in 5 adults over 50 experiences age-related discrimination in heath care settings; 1 in 17 said they experience it frequently. This bias is associated with new or worsening disability, poorer mental and physical health, and use of fewer preventive health services."

"Even government health agencies like the CDC frequently lump everyone over 65 into one homogenous group. But these individuals’ remaining lifespans could easily exceed 20 or 30 years, and they’re no more alike than are infants and tweens or kindergarteners and high schoolers."


And especially concerning:

"Many physicians, as well as older adults themselves, believe pain, fatigue, depression and dependency are a “normal” part of aging ... (and) too often, treatable conditions like chronic pain or arthritis are dismissed as just a part of old age."

HOWEVER,

"Some hopeful signs of change are slowly emerging. More hospitals are establishing senior-specific emergency departments, which use nurse practitioners who are trained to assess older patients for cognitive function, medication interactions, depression and appropriate home support. Some health systems are also creating a culture of “age-friendly care,” emphasizing holistic approaches and what matters to the person, rather than subjecting them to every available invasive intervention."

For example, some changes taking place in some hospitals:

https://online.regiscollege.edu/blog/care-for-elderly-patients/

And there is perhaps a reassuring thought in all of this for us: the patient base that most urologists have is composed largely of older people, so the system of urology practice has necessarily evolved to accommodate the needs of older patients.

Of interest:

PERCENT DISTRIBUTION OF UROLOGY OFFICE VISITS, BY PATIENT’S AGE: 2015–2016:

Under 45...................14.9 %
45-64.........................32.4
65-74.........................27.2
75 and over...............25.4

Source:
https://www.cdc.gov/nchs/data/namcs/factsheets/namcs-2015-16-urology-508.pdf
(BTW, this is a rather good quick-facts sheet for some urology statistics. Worth a look)

So maybe our uros "know" us better than the doctors in some other specialties might.

(And I really take issue with the "viewpoint" expressed above that old age will always "naturally" involve pain and discomfort, and that one must simply learn or live with it).

And I'm also wondering if the tone in the article below is perhaps a bit more negative than it needs to be, but I suppose there are indeed instances of ageism in medicine that it claims exist.

Personally, I myself don't recall ever experiencing any overt instances of ageism in the medical workplace over the years, and certainly none since the PCa Dx back in 2011.

Have you? Post and tell us about it if you have.

https://www.nbcnews.com/think/opinion/doctors-are-ageist-it-s-harming-older-patients-ncna1022286
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Tim G
Veteran Member
Joined : Jul 2006
Posts : 3052
Posted 9/7/2022 1:00 AM (GMT -8)
I have not personally experienced ageism in my encounters with the medical system; however, I cared for my parents for 12 years (my father died at 92 and my mother at 96) and encountered it in their medical treatment. Their PCP was a Geriatrician and a wonderful provider, but visits to specialists and other providers sometimes involved dismissive comments, misdiagnosis, and other, subtle ageist treatments.

This got me interested in ageism as a bias in medicine and in society. Two books that I have read on this subject, and recommend are: Ageism Unmasked: Exploring Age Bias and How to End It by Tracey Gendron (Steerforth Press, 2022) and Elderhood: Redefining Aging, Transforming Medicine, Reimagining Life by Geriatrician Elaine Aronson (Bloomsbury, 2019) What an education!
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VinceInMT
Veteran Member
Joined : Mar 2018
Posts : 658
Posted 9/7/2022 6:44 AM (GMT -8)
Since going on Medicare my PCP has me go to a “Wellness Check” where they do basic tests like hearing, vision, BP, etc. This is followed by an interview about lifestyle and recommendations about things I should do. Because of my age, I am told that I should get rid of all the area rugs in my house as they are tripping hazards. I told them that my greatest tripping hazards are the ruts, roots, and rocks I encounter on my trail runs and are they saying I stop doing those. The answer was that I should think about doing so. They aren’t taking my entire lifestyle into consideration rather than just my age.
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alephnull
Veteran Member
Joined : Dec 2013
Posts : 2452
Posted 9/7/2022 7:53 AM (GMT -8)
They are reading from a 50 year old script for elderly patients. I am not elderly by any stretch. My only encounter with ageism was with my first PCP at age 40 or so. I would mention something and he would just say, oh you're just getting older. I know it doesn't sound like much, but it was the door opening for that cr ap.
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mattam
Veteran Member
Joined : Aug 2015
Posts : 3984
Posted 9/7/2022 8:23 AM (GMT -8)
It even happens on the Forum. Posters sometimes think it's ridiculous that an 80 or 90 year-old man has decided to go on ADT. Well, maybe that 90 year-old man has plans for living to 100.
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81GyGuy
Veteran Member
Joined : Oct 2012
Posts : 3529
Posted 9/7/2022 9:34 AM (GMT -8)
VinceInMT has touched on a significant aspect of the ageism discussion, namely that there are in fact two forms of it.

The first, and the one that probably immediately comes to mind, is the assumption on the part of some that, simply because we are older, our mental faculties have declined to the degree that we must now be treated as large children. If this happens to us we must resist it utterly, and make it clear to those who believe this that they are utterly mistaken.

But there is a second form of ageism, one that is arguably more common as well as more devious. It is more devious because it is well-intentioned, but also intrusive. It takes the form of someone saying to us "you really shouldn't be doing that because it's dangerous at your age."

What's dangerous? Marathon running (even for a charity)? Mountain climbing? Skydiving?

But that word "intrusive" is still there. To which can be added the phrase "whose life is it, anyway?" That is, if we choose to take on physical activities that may raise concerns about what they may do to our older bones or older muscles, etc., is that not our business?

Or how about, as an example of this issue, something as seemingly innocuous as amusement park rides? Or are they innocuous? Some of them turn people upside down, shake them around, and put them into totally unnatural physical situations.

Should something like that be automatically out of bounds for us, assuming we even want to do it, simply because we are older?

We have all heard of amusement parks requiring children to be of a certain height before being allowed to go on certain rides. Should they also require that riders be below a certain age before being allowed to go on rides?

Here is an article that discusses that very question, the bottom line of it being that individual health, not age, is the important thing:

"Are You Too Old To Ride Roller Coasters?
https://www.cnn.com/2016/07/22/health/roller-coaster-age-limit/index.htmlbtut
(Can't get it to link, but my quotes from it below pretty much summarize it)

From it:

“Riding a roller coaster is far safer than riding in a car to the park, but only if you don’t have any heart, neck or back conditions that might be exacerbated by the speed and stress of a coaster.”

"In recent years, rides have been designed to be faster, taller and ever more intense, such as the Kingda Ka ride at Six Flags Great Adventure in New Jersey. It’s heralded as the tallest and fastest roller coaster in North America, claiming to accelerate from 0 to 128 miles per hour in only 3½ seconds." (Wouldn't that be too dangerous for anybody???)

"The major concern as people get older is blood pressure changes and changes in heart conduction ... exposure to sudden accelerations from roller coasters can pose physiological challenges to people with these problems."

"Other health conditions can make going on high-speed rides unsafe, including pregnancy, recent surgery, heart problems, high blood pressure and aneurysms ... Parks now address this by putting up warning signs at ride entrances, asking people with these conditions to refrain from riding."


As for motion sickness resulting from such rides?

" ... people do not necessarily become more susceptible to motion sickness when they get older. In fact, according to the Centers for Disease Control and Prevention, the feeling is most common among children 2 to 12 ... (and) ... sensitivity to motion tends to decline with age."

From the above, and from other articles I read, the conclusion seems to be that it really depends on the individual's situation, that, as noted, individual health, not one's age, is the determining factor.

And the factor that should govern one's decision on how to spend one's physical activity time in general.

So maybe that time won't include bungee jumping, but things like race-running or hill-climbing should be in the picture, if one's health is up to it.
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Tim G
Veteran Member
Joined : Jul 2006
Posts : 3052
Posted 9/7/2022 2:00 PM (GMT -8)

VinceInMT said...
Since going on Medicare my PCP has me go to a “Wellness Check” where they do basic tests like hearing, vision, BP, etc. This is followed by an interview about lifestyle and recommendations about things I should do. Because of my age, I am told that I should get rid of all the area rugs in my house as they are tripping hazards. I told them that my greatest tripping hazards are the ruts, roots, and rocks I encounter on my trail runs and are they saying I stop doing those. The answer was that I should think about doing so. They aren’t taking my entire lifestyle into consideration rather than just my age.

You hit the nail on the head with surgical precision, Vince. One-size-fits-all medicine helps no one and can be hazardous to your health.
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Tim G
Veteran Member
Joined : Jul 2006
Posts : 3052
Posted 9/7/2022 2:06 PM (GMT -8)

alephnull said...
They are reading from a 50 year old script for elderly patients. I am not elderly by any stretch. My only encounter with ageism was with my first PCP at age 40 or so. I would mention something and he would just say, oh you're just getting older. I know it doesn't sound like much, but it was the door opening for that cr ap.

The story goes like this: A 85-year-old goes to his doctor and complains about the pain in his left knee. The doctor looks over his medical record, does a cursory examination and orders an x-ray of the knee, which is negative. The doc shakes her head and tells her patient that she can't find anything wrong, stating "You're not a spring chicken and you must expect these kinds of problems at your age. The patient replies: My other knee is 85 years old and it doesn't hurt at all.
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Jack64
Regular Member
Joined : Oct 2021
Posts : 393
Posted 9/7/2022 5:25 PM (GMT -8)
81GyGuy, funny you would post this thread that hits home for me. Today I met with my Uro for a check to see how everything was going. At one point I told him that everyday around 2pm, I hit a wall similar to when I was younger in sports. He looked at my chart and said it was normal for a person my age to get tired in the afternoon and take a nap. Funny, before ADT started 10 months ago, I never got tired in the afternoon. I guess from now on, even after ADT, I will be taking a nap in the afternoon. LOL. My Prolia injection was two months overdue. He said I should have been called to come in for the injection. Again, no coordination. He also said no need for a MO.
I have heard time and again here that second opinions were good for more clarity on biopsy results. He said that only 10% is ever changed up or down. He said that GL scores are more opinion than fact. That today’s technology, (Can’t remember the name of the technology used), is very accurate at determining the GL level. In any case all was good as far as my current results. He said to fight through any SEs and when the Orgovyx was finished, my T-level would come back quickly. So I will wait and see. My best to all,
Jack
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VinceInMT
Veteran Member
Joined : Mar 2018
Posts : 658
Posted 9/7/2022 8:28 PM (GMT -8)
Another example comes to mind. I have a new PCP, a young DO who seems to know what he’s doing. At our first visit, which I scheduled in order to get an annual PSA test and a renewal of my single prescription (Lisinopril 20mg), he gave me a presentation of new data and recommendations that says I should start taking a statin.

He said that they no longer look at cholesterol as the indicator but blood pressure, BMI, and age. When my numbers were put into the formula, it indicates that I have a 14% risk of a heart attack or a stroke. By taking a statin, I could reduce my risk to 8%.

OK, I said, but, as he showed me, that data comes from a study of millions of the general population. What I know is that statistics applies to groups and not individuals. I question the BMI since as an athlete (distance runner and swimmer) my BMI always registers a bit high because I have more muscle density, especially below the waste (I’m 5’-10, 185#) than the general population. There are BMI charts that take that into account but not in this study. My BP yesterday morning was 92/62. My cholesterols and triglycerides look great. I’ve been on a solid vegetarian diet for over 40 years, don’t smoke, drink only craft beer once in a while, so AGE seems to be the variable I can’t offset.

I declined the statins. With my lifestyle, I figure I am doing well enough and I don’t want to deal with possible side effects for a mere 6% decreased risk of heart disease when 14% is pretty low already.
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TJ123
Regular Member
Joined : Feb 2018
Posts : 257
Posted 9/7/2022 10:25 PM (GMT -8)
I am darn glad I've made it to the age I am. I consider all years thereafter to be bonus years. Doctors and hospitals saved my life twice. Once from heart disease and once from cancer. Had I been born in 1920 instead of 30 odd years later - I'd probably be dead. So no complaints from me. Ageism? I don't even know that that is. If I'm nice to the doctors and their staffs, they're nice to me. I'm on multiple meds. Both the prescribing doctors and the pharmacies where they're dispense ensure there's no drug interactions and it's safe to mix. Once I had an individual reaction (hypoglycemia) to a pill for type 2 diabetes and the doctor took me right off it and replaced it with another. Problem solved. Doctors are humans too and sometimes make mistakes. I take all that into account.
Seniors are treated remarkably well in America. In general, we're the ones with most of the money from saving for a lifetime - yet we get all the shopping and dining discounts. I think they oughta give the discounts to the kids who are struggling to get by and make ends meet. I don't need no stinking 2 for 1 discount. Give it to some college student who has a hard time making his or her monthly rent. Oh, I know. Some seniors struggle with the finances. But in my experience, most are doing pretty darn well, as we should be. Most worked their entire lives to build a little nest egg. Things happen. I know. But I'm speaking overall. God bless this country for the way it treats it's senior - who are retired and no longer adding production to the economy.
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