Ageism in treating the oldest old

This guest blog was contributed by Occupational Therapist, Chrissy Bishop.

As an occupational therapist working in intermediate care, a common predicament occurring in health care environments is the constant battle with prejudices and age discrimination, consequently in meeting the needs of people over age 85: the ‘oldest old’ (or as some refer to this age group, the ‘frail elderly’).

When planning discharge and care for an over-85 client, a fundamental dilemma of the multi-disciplinary team is establishing rehabilitation needs. This means making an informed decision and estimating how they will manage at home, and assessing their ability to regain independence in activities of daily living.

Unfortunately, it is not uncommon for unintentional age discrimination to occur, fundamentally related to the capability of the oldest old of engaging in a rehabilitative treatment plan to maximise their level of independence in their preferred home environment.

In retrospect, why does this age discrimination still occur? We need to challenge our assumptions about people.

Rehabilitation teams need to continually ask questions such as:

  • Exactly what is the reasoning for your 100 year old patient who has recently fallen to go into a care home?
  • Would you consider this change of home environment for a “faller” in their 60s or 70s?
  • Do you consider loneliness when discharging the oldest old back home?
  • Is your patient educated on the effects of the medications they take, and has anyone looked at possible medication interactions?
  • Are they even taking medications correctly?

It is (or should be) impossible for health workers to view older adults as a homogenous group; they are more like a spectrum of individual needs. It would be unrealistic not to acknowledge that older adults are the main users of health and social services.

Additionally, normal ageing can be accompanied by varying degrees of degeneration of physical, physiological and psychological functioning. This may or may not be accompanied by the effects of disease pathology, exacerbated further by stressful life events such as the loss of a spouse.

This being the case, classification of the oldest old as the ‘frail elderly’ will surely indicate that they have increased needs as opposed to an older person in the lower age group aged 65 and above.

On the other hand, as advances in medicine and pharmaceuticals continue to progress, patients’ levels of independence may increase with age.

This poses on interesting question. Are the oldest old more capable than we understand due to advances in medicine, thus offered care plans that by no means fit their needs?

What is required is for health professionals to set aside their assumptions and prejudices, and consider the individual person, and further research into this fascinating area.

Are our prejudices capable of change in order to treat patients aged 85 plus as they are medically capable? How will health professionals be able to confidently engage in the art of persuading and educating (rhetoric persuasion) their patients on the care plans they require if they are unable to change their prejudices and set views on health care needs of the elderly?

Age UK aims to be a centre of expertise on ageing issues and a knowledge hub for all information relating to older people. This blog was contributed as part of our Debates on Ageing.

– Find out more about Age UK’s Knowledge Hub

– Read more about Occupational Therapy guidelines for working with older people.

5 responses to “Ageism in treating the oldest old

  1. hear hear….couldnt agree more.
    as a fast approaching 70 year old (come aug 2012) i have said often enough that its time the authorities and those in certain organisations/jobs etc stopped thinking THEY know whats good for us older people. and started asking US as individuals, what do we feel we need ourselves. what help, what input,what sort of advice etc.we are not thinck and most of us are compus mentis with no sign of senility or alzheimers either present or starting up.
    at 65 years old i came out of hospital after a 6 day stay for suspected heart attack (was a warning only). i had to change my lifestyle completely and for the past few years have felt i was hitting my head against a brick wall because the help I FELT i needed was just not available to me. either it simply wasnt there or i was out of the postal area where it was available. only recently, thanks to my local AGE UK have i found that help finally. though it wasnt available 4.5 years ago it is finally. good for my local AGE UK. well done.

  2. Clare Macmahon

    What a well written and informative blog.

  3. I think this really serves to highlight the unacceptable prejudice which is all too apparent in the health & social care system in this country. With an increasing elderly population who have an increasing life-expectancy, surely it is time that the ‘oldest old’ are not simply written off as a lost cause- it is especially important to prevent this from happening at this time of radical austerity in the NHS.

  4. It astounds me that despite all the focus on individual needs in the health service, the most important people at the heart of everything (patients) and you Dee, are still feeling like their needs are not regarded with the respect they deserve. I then worry further thinking about the health care reforms and a shifted vision towards privatisation. How will health care professionals be able to increase their focus on individual needs when there is which a constant pressure to decide which provider of services to use?? Introducing competition to the health service will, so the theory goes, improve it. And it doubtless would, if businesses behaved like selfless nuns as a recent article in the Guardian stated. How will this improve an older persons streamlined and individualised discharge from hospital….hmmm which care provider to choose, which equipment to buy, why would any older individual want to make this decision? And are health professionals acting for their patients educated Alan Sugar esk techniques? I have absolute faith in the adaptability of the health professionals and workers which hold the health service together in relishing this change, but the governments plans for the health services has not made it easy for us, and is yet another challenge the 85+ will encounter in their care planning. New challenge. Thanks to local Age Uks with services such as social contact schemes which can support and facilitate patients discharge from hospital and offer that short term support in things such as getting shopping in, organising bills, pensions, medications ect in such huge demand when feeling vulnerable or institutionalised with limited or perhaps no family support after hospital discharge.

    Thanks for your comment Dee.

  5. There are people experimenting with a better way and realising just how much the system gets in the way of doing the right thing for people. If you are interested you can read more about it here. http://vanguardinhealth.blogspot.co.uk/2011/10/velcro-man.html. By the way, having trouble changing the name that this comment might be published under. Seems to be linking with an out of date blog.

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