Ageism, like sexism, knows no boundaries. The health system is a prime example of ageism in action.
This week an article in the Medical Journal of Australia’s Insight online caught my eye. (‘Polypharmacy a shared duty’, by Charlotte Mitchell.)
The article quotes a recent study in Queensland and Victoria. Subjects were 1220 people over 70. They had been admitted to eleven acute hospitals in a five year period. On admission three quarters of these older patients took five or more drugs a day. More than a fifth were on ten or more.
Most people in the study went home taking the same medications as when they were admitted.
The article discusses who might be best suited to review the medications of older people. ‘Unprescribing’ is often in the best interests of older patients. It is a complicated procedure.
It seems there could be a bidding war between general practitioners and pharmacists for the right to review medications. Whoever does the reviews should know the patient well. An extensive medical history is also essential.
My interest in polypharmacy stems partly from my work as an aged care advocate. We confronted ageism on a daily basis
In some aged care facilities drugs are used to restrain difficult patients. Families, also have been known to use medication to keep unruly relatives quiet at home. Restraint by any means is a violation of human rights. It limits people’s freedom. Chemical restraint, with or without the ‘permission’ of families, is abusive. It is also ageism.
I also have personal experience of ageism in medicine.
In response to the article, one comment was that ‘the patient’s GP is the hub…at the centre of patient care.’
Writing to medical journals is not my usual style. But I was incensed. This is my comment to the article:
I am a 77 year old woman with the quaint idea that the patient should be at the centre of patient care, not the GP. In my early seventies, following a series of stressful life events, I was diagnosed with hypertension. Within a week of beginning beta-blocking medication, I became very unwell. Repeated visits to several general practitioners (one after the other) resulted the prescription of increasing dosages and more and more medication in spite of my questioning the need.
My mental and physical health deteriorated. My protests that I’d worked until I was 65, completed a PhD when I was 68 and my first book had been published the following year fell on deaf ears. It was an effort to string five words together. Nor did they hear that until I turned seventy I swam 1000 metres three times a week. By the time I was 72 I could barely walk to the letterbox. I was embarrassed and ashamed that I was ill and could get no one to listen.
All of this changed when I confided in one of my daughters. She made an appointment with a physician who listened! I was hospitalised and my medications reviewed and changed to minimal amounts of essential medication. My health improved dramatically. I am now a well, competent person. Thank God for doctors who listen to their elderly patients.
I wish I’d told the rest of the story.
‘I shouldn’t be like this,’ I complained to a GP. ‘It isn’t right for me to be so ill.’
‘What do you expect, at your age?’ he said as his eyes glazed over with boredom.
As my daughter said later, ‘You should have told him you expected a better GP’.
What can we do about ageism in the health care system?
- We can talk about ageism wherever we encounter it.
- We can insist on adequate health care and doctors to listen to us.
- Older people need to be vigilant about what medications are prescribed for us and for those we love.
- We must question doctors who add new medications to the mix.
- We need to talk to each other and to support each over health care issues.
- We can enlist the help of families and friends to advocate on our behalf if necessary. This could even include asking them to attend medical appointments to provide support.