Discussion: Ageism in Healthcare and Diagnosis of Mental Disorders
Our group decided to research ageism in healthcare, particularly as it relates to the diagnosis and treatment of mental disorders.
We will now for the first time have more people in the United States who are over the age of 65 than we will have children under the age of 5. Despite that, there are still much more dedicated pediatric units than there are geriatric units, and more research and literature on pediatric medicine as well. This will have to change soon (Rogers, 2015). Worse still, there is noticeable ageism in hospitals and doctor's offices (Rogers, 2015). We discussed the fact that the elderly generally need more medical care than any other population, so it seems crazy to think that they are being treated unfairly. We discussed that there are negative stereotypes that doctors may have, and that patients might therefore get discriminated against without realizing it. Particularly because the elderly seem to be quicker to accept a diagnosis than other people might be (Age Discrimination, n.d.). Some of the negative stereotypes of the elderly might be that they are stubborn or unwilling to change, or that they must have some kind of memory loss (Dittman, 2003). We discussed how scary it is to think that someone's course of care might be dictated by a doctor's pre-existing assumptions.
It seems that younger women are more likely to receive chemotherapy than older women, and that is partly due to discriminatory thinking that because they will die "soon" anyway, they might as well not bother with it (Age Discrimination, n.d.). We discussed the fact that another reason for this finding could be that people might be too frail or weak when they are very old to withstand chemotherapy.
Depression can present itself differently in the elderly than it does in other people. Particularly important is that older people will often not report feeling "sad", but will more likely report cognitive or somatic symptoms (Alexopoulos et al., 2001). Compounding this problem is that many symptoms of depression can be attributed to chronic illnesses or disabilities, which a lot of elderly people have. Because of that it can be very hard for doctors to know whether an elderly patient is depressed or not (Alexopoulos et al., 2001). And unfortunately it is up to the primary care doctors to detect a problem, because elderly patients will go to them and not to a mental health professional (Alexopoulos et al., 2001). The reason that it is so important for doctors to be able to detect depression in the elderly is because it is very treatable, and when not treated can lead to terrible things such as suicide. In 2000, 18% of suicides in the United States were people ages 65 and older (VanItallie, 2005).
As we said, it can be difficult to diagnose mental illness in the elderly (Baker, 1995). One study found that when 13 psychiatric patients were interviewed post-diagnoses, 6 of them had their diagnoses partially or completely changed based on that interview, which shows how tricky it can be to diagnose mental illness in seniors (Baker, 1995). Delirium can compound the issues of depression, as some patients who actually have delirium may be diagnosed with depression instead. This can be dangerous because the two illnesses are treated differently, so people might not be getting the right treatment for them (Farrell & Ganzini, 1995).
We discussed the fact that on the one hand, older adults may be afraid to argue with a doctor's diagnoses, but on the other hand they will probably be unlikely to accept a diagnosis of depression when they are complaining of a loss of appetite, sleep, etc., and not what they perceive to be classic signs of depression (feeling "sad").
References:
Age discrimination: Older patients in the healthcare system (n.d.)
Alexopoulos, G.S., Borson, S., Cuthbert, B.N., Devanand, D.P., Mulsant, B.H., Olin, J.T., & Oslin, D.W. (2001). Assessment of late life depression. Biological Psychiatry, 52(3), 164-174. doi:10.1016/S0006-3223(02)01381-1
Baker, F.M. (1995). Misdiagnosis among older psychiatric patients. Journal of the National Medical Association, 87(12), 872
This was what my peer's comments based on the research paper. Called Ageism in Healthcare and Diagnosis of Mental Disorders
You to please make 3 comments in the following 3 peers where you have to: make a minimum of one short paragraph. Whether you agree or disagree, explain why with supporting evidence and concepts from the readings or a related experience. Include a reference, link, or citation when appropriate. Be aware of grammar and stay on topic.
Peer-1
Very interesting topic. One thing that I considered when diagnosing depression in older adults was potential antidepressant drug interactions. Seniors end up taking way too many medications as it is, and some antidepressants may lead to bone loss. That being said, I was just reading an article in this weeks New Yorker magazine about the overabundance of medical testing and procedures in America, seemingly wasting billions of dollars. Seniors could be seen as a cash cow for medical billing, with longer than average hospital stays, for example. I remember whenever my grandmother would need to go to the rehabilitation building in her assisted living facility, they had some fishy insurance billing rule where they needed to bill and keep people there for a minimum of 2 weeks.
Reference: Gawande, A. (n.d.). America's Epidemic of Unnecessary Care. Retrieved May 10, 2015,
Peer-2
Great job group. Your first sentence was a shocker to me, I never realized that there are more people age 65 and older than children! You would think there would be much more children with the amount of pediatric facilities, but from your studies I now know that is not the case. It is really unfortunate that the elderly is treated so unfairly in the medical industry. Discrimination and ageism is a real problem and it is horrid that they have to go through that just because they are older. I agree that it is really scary that someone's course of care may be dictated by a doctor assuming a pre-existing condition. I also agree with you on elderly woman not wanting to accept chemo therapy because they feel like they are "too old and are going to die anyway. I have seen this first hand with my great aunt who died at 92 year of age did not want to accept chemo therapy because she felt like she had lived her life, and the doctor told her that chemo treatment would be hard on her body and she would suffer. She decided to not go through with chemo and live out the last days of her life in less pain.
Peer-3
I think that you picked a really great and important topic. With the Baby Boomer generation now getting older, doctors will need to change their attitude and quick as such a large population will be needing medical care.Hopefully, this shift in population will also shift attention and cause more people to research mental disease in old age, and more doctors will be given training on how to treat the elderly with the dignity and respect that they deserve.
It is scary to think that medication or care would be denied to someone just because they're older. Life is not a numbers game. Just because you may have lived longer than someone else, doesn't mean that they deserve to live more than you. I think that this is really indicative of the lesser value that society places on the elderly in general. This disregard for human life is really disturbing and I'm glad that you chose to shed some light on this topic!
Response should be 1 page for the 3 comments .