We live in a society that values youth and seems to dismiss elders as less than important. We hear of age discrimination in employment, but not so much about age discrimination in our healthcare system. It does exist, as we see from personal experience at AgingParents.com and through the reports of our clients seeking advice.
An example is an aging loved one who sees a doctor with complaints of pain. Perhaps the doctor doesn’t know the elder well. The physician, usually in a bit of rush, does a basic check of things like heart, blood pressure and breathing. They glance at any medications and lab reports and if nothing is new or alarming, they tend to dismiss complaints of pain unless they are very severe or unusual. Our clients tell us the response is often “it’s just age” or “you’re just getting old”. But pain can be a signal of something more sinister than arthritis or muscle aches. It can stem from any number of causes. Your aging loved one deserves to have a thorough check of the source of pain complaints. They don’t deserve to have them dismissed as related merely to aging. Maybe pain means more than that. Elders tend to accept what the doctor says, even if family thinks it’s not right. A younger person might speak up more or insist. The older generation may sometimes be less assertive with doctors. But age discrimination could be what results in the doctor ignoring and dismissing an older person’s complaints. In the doctor’s mind, it may be that the issue pain is “merely” about aging.
Another example is an elder who seems listless, sad and says little in response to basic questions. Maybe they’ve lost a little weight and if asked, say they’re not hungry much. Your aging parent could be this person, who may be seeing the doctor for some other identified medical condition. But the things here, lack of energy, sadness, losing weight and not verbally responding much are classic signs of depression. This condition is quite common with older adults who are experiencing numerous losses. They may be fearful of losing various physical abilities, they may have lost friends or their spouse or partner. These losses pile up and grief can lead to long term depression, taking a long while to resolve, if it does at all.
What’s Missing
There are many kind and compassionate healthcare professionals who do take patient complaints seriously. Unfortunately not all do. What we aren’t seeing is consistent attention to what are dismissed as “minor” complaints from older adults about such things as pain and depression. Doctors are missing the signs due perhaps to their own biases about what is important because in their minds, the person is “just getting old”. We do not see that as a valid excuse for failing to do a thorough examination and to offer well considered treatment when it is available.
What Family Can Do To Advocate For Aging Loved Ones
Privacy Considerations
If your aging parent complains to you or mentions persistent pain, and they’ve not gotten any satisfaction from the MDs they see, there are things family can do to step in and help. But first, you either have to attend the doctor’s appointment with your aging parent or retain a professional to accompany them. The parent has to agree to this. Doctors are bound by Federal privacy law, H.I.P.A.A. (Health Insurance Portability and Accountability Act) and typically cannot discuss your loved one’s medical information with you unless you have permission, or you/your aging parent gives permission to another with your aging parent’s signature on the document.
Speaking Up
Assuming you have or can get permission to speak with the MD, you can call and ask for a discussion about your aging parent’s persistent complaints. You become the advocate. You ask for answers or more investigation, testing or other means to get to the bottom of the problem. Note that not all pain actually has an identifiable cause even with thorough investigation from the healthcare provider. However, your loved one at least deserves the respect of having the complaint heard and explored. If a diagnosis is reached, appropriate treatment should be offered. Family can ask for that.
Depression
Untreated depression in older adults is a widespread problem. It can often be relieved with appropriate, well tested medication to help at least lessen the worst symptoms. Talk therapy in combination with medication is a tried and true formula for good outcomes. However, if the Primary Care Physician has age bias, they may not even notice the classic signs. “She’s just getting old” is not a compassionate way to look at this. Depression can be miserable for anyone! If you are concerned that your aging parent is depressed and you want to help, you need your loved one to agree to allow you to advocate for them. If they do agree, ask for a mental health evaluation (a geriatric psychiatrist is the best choice if you have access to one). Ask if medication can be tried. Ask for referrals to a kind therapist and encourage your loved one to engage. Telemedicine makes this much easier than ever before.
Care Managers
If you live at a distance from your aging parent, you can hire a professional care manager to accompany them to the doctor’s appointments. Care managers often have a social worker background and will take on the role of advocate with healthcare providers. You pay by the hour and Medicare does not cover this service. They call themselves “lifecare managers”, “geriatric care managers” or other monikers. They can be your eyes and ears and, if needed, your aging parent’s voice in the healthcare system. If you choose this option, screen carefully. Regulations vary from state to state, and most states do not require a formal license to call oneself a care manager.
The Takeaway
My nursing background is part of my belief that no one should suffer unnecessarily, regardless of age. Some elders do not advocate well for themselves. The urging here is that family may need to get involved as advocates to ensure insofar as possible that your aging parent’s pain, depression or other problems are not overlooked. Our healthcare system has the same built in age biases as the larger society. Assumptions about aging may not be at all valid.