A Lack of Training for Practicioners

A lack of training for geriatricians......


Part of the problem with combating the issue with ageism in the mental health field is the lack of proper training for those who are working with older adults.  This lack of training is more serious than just a lack of knowledge on the part of the practicioner; it is actually harmful and puts older adults in serious peril.

Entrenched Ageism in Healthcare Isolates, Ignores and Imperils Elders

By Daniel Perry

The late Dr. Robert N. Butler did more than simply name the prejudicial attitude that values young lives over old ones. He taught us that ageism is the original sin of societies blessed with greater longevity: it is the snake in the garden corrupting the monumental social achievement of longer lives for more people. Despite being sought fervently since antiquity, greater human longevity, once achieved, seems to trigger an illogical self-loathing of our future selves, cruelly robbing the victory of its purpose, dignity and worth.

Dr. Butler identified ageism as a deeply ingrained distemper in American culture, and called it out where it thrives: in politics and government, the media, popular entertainment and the workplace. But he saved his sharpest criticism for medicine, medical education and healthcare.
Documenting Ageism
In 2003, the Alliance for Aging Research, guided by Dr. Butler’s concerns, published a report to the U.S. Senate Special Committee on Aging called Ageism: How Healthcare Fails the Elderly. The report examined the following domains of ageism in healthcare:

• Healthcare professionals do not receive sufficient training in geriatrics;
• Older patients are less likely to receive vaccines and other preventive care;
• Older patients are less likely to be t ested or screened for common health problems;
• Effective medical interventions beneficial for older patients are often ignored, leading to inappropriate or incomplete treatment; and
• Older people are consistently excluded from clinical trials, though they are the largest users of tested and approved drugs and devices.

The Alliance documented how these manifestations of ageism take a serious toll and harm older patients by exacerbating and prolonging illness, isolation, unnecessary institutionalization, loss of independence and premature death.
Negative stereotypes of older people are internalized early in life: they operate on the subconscious, and are as virulent in elders as in younger people. Ageist attitudes among healthcare providers lead to missed or delayed diagnoses, poor management of multiple chronic conditions, lost independence, overuse, under-use and misuse of prescription drugs, and more.
Ageism and the Sin of Omission
Ageism begins with the sin of omission in medical and health education. Stinting on geriatric orientation at all levels of professional education creates a fertile breeding ground for bias, insensitivity, misdiagnosis and poor care of older patients.
“Train wreck,” “nightmare on a stretcher,” “dotty old guy in bed three” and “Gramps down the hall”— these are just a few of the derogatory terms used by emergency care workers as reported by Richard Currey, a certified physician assistant and freelance journalist, in the winter 2008 issue of AgingWell magazine.
In 1978, the first of what would be four major studies by the prestigious Institute of Medicine (IOM) cited a shortage of specialized training in geriatrics as a serious problem, given that people ages 65 and older are the largest and fastest growing group of health services users. Each IOM study, up to the most recent in 2008, made the same point and proposed solutions ranging from centers of excellence to retooling the healthcare workforce.
But IOM reports by themselves do not make policy. Without garnering significant political support, they lack the power to break through ingrained prejudicial attitudes.
In 2003, there were a total of five full departments of geriatrics out of 144 medical schools in the United States. Today there are seven. Divisions for aging and geriatrics exist within many departments of family practice, psychiatry and internal medicine; but only a handful of schools require coursework or rotations in the topic.
The total number of certified geriatricians is 7,162—less than 1 percent of America’s medical workforce. Ageism is both a cause and a by-product of this dismal statistic.
Programs administered by the federal government—Geriatric Academic Career Awards, Geriatric Education Centers and Geriatric Training Programs—are drastically undersupported and struggle to carry out their missions with flat or declining funding year after year.
Hope Hangs in the Balance
Progress against systematic ageism in healthcare has been slow to take root. But reforms in the 2010 Affordable Care Act (ACA) signal a major counter-offensive against the prevailing ageist dynamic. The ACA’s benefits, however, have been largely obscured by the raging debate over an individual mandate for health insurance and other factors.
Often overlooked are the ACA’s steps to change Medicare to focus more on chronic disease prevention and care coordination. Provisions seek to reduce re-hospitalizations, explore new models of care, enable patient-centered comparative effectiveness research and screen for cognitive impairment in the Medicare Annual Wellness Visit. All of this hangs in the balance as the U.S. Supreme Court takes up challenges to the constitutionality of the ACA itself.
As a trained psychiatrist, Dr. Butler realized that ageism must be opposed with political and organizational reforms. He also recognized the deep psychological roots of the prejudice. He wrote, “the underlying basis of ageism is the dream and fear of growing older, becoming ill and dependent, and approaching death. People are afraid, and that leads to profound ambivalence.”

---

Daniel Perry is president and CEO of the Alliance for Aging Research in Washington, D.C.


 Retrieved from http://www.asaging.org/blog/entrenched-ageism-healthcare-isolates-ignores-and-imperils-elders