Vail Daily column: Elderly patients are treated differently
In our world of Western medicine, being outside the boundaries of the norm is considered to be a bad thing and, as such, must be treated and corrected or you may be labeled “disabled.” The federal government has established guidelines for nearly every aspect of our health, and our culture has set guidelines to be as perfect looking as movie stars and models.
As you gain weight, lose hair, need to wear glasses or even just age, you drift further and further away from those guidelines and become out of favor in the public’s eye. Could this be happening in the field of medical services? Is it possible that as you age the method of care giving, whether intentionally or unintentionally, is slanted towards the young, creating a bias towards older patients?
The National Institutes of Health and the U.S. National Library of Science offered a series of brief studies conducted at the Beth Israel Hospital and Medical Center in Boston from 1996 and 1999. The studies focused on various interactions between the medical profession/services and the age of their care recipients.
Specifically, the areas of research were:
• Old age, aggressiveness of care and survival for seriously ill, hospitalized adults.
• Patient age and decisions to withhold life-sustaining treatments from the seriously ill, hospitalized adults.
• Whether we spend less on older patients.
Although no study is perfect, these studies do lean toward identifying a difference in the manner in which services are given or even offered based on age.
For example, according to an article posted in the National Center for Biotechnology Information, the decision to withhold ventilator support, surgery and dialysis, “older age was associated with higher rates of decisions to withhold ventilator support, surgery and dialysis.” A more specific example in this study illustrates that “for ventilator support, the rate of decisions to withhold therapy increased 15 percent with each decade of age, for surgery, the increase per decade was 19 percent, and for dialysis, the increase per decade was 12 percent.”
In the study of spending preferences, the findings indicated “seriously ill older patients receive fewer invasive procedures and hospital care that is less resource-intensive and less costly.” Perhaps this may be due in part to the fat that often, patients with a terminal prognosis that necessitate further curative and expensive care treatments find that their Medicare/Medicaid/private insurance often do not reimbursed well.
Over the past decade, pay-for-performance reimbursement protocols have been transitioned into fee for service Medicare reimbursement protocols. While the intent of this transition is to drive improvements in the delivery of care, there are fundamental drawbacks. As number of commercial payers continues to shrink, the amount of payer types with lower reimbursement rates will increase. This will affect the bottom line of hospitals and medical providers and thus presents a substantial financial challenge to our health care system.
Can we make sound conclusions from studies such as these?
Well, perhaps you are still skeptical that Western medicine treats older patients differently than its younger patients. However, it does appear that given our cultural bias (i.e., youth over age, beauty over average, thin over heavy, etc.), why would we find it implausible to see our medical profession follows the cultural guidelines?
Look at the dispensing of medications. Wander through nearly any nursing home and spot-check the medications that elder folks are taking vs. those of younger folks with similar illnesses. You may likely find residents in nursing homes are far more medicated than people living at home with the same afflictions. We have treated our elderly different than we treat our less mature populations.
Is this bad?
Do our elderly require such variations in treatment? Are there financial components driving this difference in treatment? Are there staffing and training factors? How does Medicare factor in? How have each of us prepared for our aging and has our country in general prepared for what lies ahead?
In next week’s post, we will review some of the more hidden philosophical underpinnings that drive our care giving system for our senior citizens. Stay tuned.
Judson Haims is the owner of Visiting Angels Home Care in Eagle County. For more information, go to http://www.visitingangels.com/comtns or call 970-328-5526.
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