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.