Recently, my 90-year-old mother was diagnosed with breast cancer. A biopsy following a mammogram showed a small tumor. She wanted me to accompany her on her doctor visit to discuss next steps. I’m guessing some of you are thinking, “Why do anything? It’s small. She’s 90. Surgery and/or radiation or chemotherapy is a lot at any age, let alone at 90.” You may even be wondering why she had a mammogram at her age.
But let me tell you about my mom. She still lives on her own in a split-level townhome requiring her to go up and down a flight of stairs to do her laundry and to get to her garage when she wants to go somewhere. Yes, she still drives, albeit only a 3-block radius from her home. She attends the senior center 3 times per week for exercise classes, and her social calendar would make your head spin. She is as sharp as a tack and stays current on the news. She’s on Facebook daily, staying connected with friends and family when not talking with them on the phone. She says she plans to live to be 115 and stays current on all preventive services and vaccines. She shows up at medical appointments with a list of medications, dosages, and why she’s taking them. It’s a short list. She also brings a list of questions she wants answered while she’s there. In spite of living on a fixed income, she has an amazingly positive attitude, and her smile and sharp wit charms everyone. Bottom line, she will not go gentle into that good night.
So why do we think that doing nothing is the best option for a 90-year-old? According to the World Health Organization (WHO), 1 in 2 people are ageist against older people. Even in healthcare. A 2015 study published by Rogers et al found that nearly 20% of Americans aged 50 and older say they have experienced discrimination in health care settings. Another study estimates that the annual health care cost of ageism in America, including over- and undertreatment of common medical conditions, totals $63 billion according to KFF.
…the annual health cost of ageism in America, including over- and undertreatment of common medical conditions, totals $63 billion according to KFF.
In 1968, Dr Robert Butler coined the term “ageism” to describe the systematic discrimination against older people. Tad Friend wrote in The New Yorker in 2017, “Like the racist and the sexist, the ageist rejects an Other based on a perceived difference. But ageism is singular, because it’s directed at a group that at one point wasn’t the Other—and at a group that the ageist will one day, if all goes well, join. The ageist thus insults his own future self.”
And for those who do hold an ageist attitude, Friend goes on to say, “Karma’s a bitch: the Baltimore Longitudinal Study of Aging reports, ‘Those holding more negative age stereotypes earlier in life had significantly steeper hippocampal volume loss and significantly greater accumulation of neurofibrillary tangles and amyloid plaques.’ Ageists become the senescent figures they once abhorred.” In other words, those most ageist are setting themselves up for less than desirable outcomes as they themselves become older.
Admittedly, aging does contribute to some health issues. But how those show up in each individual and at what age they show up, if at all, varies tremendously… It all comes down to what we always say—look at the person in front of you.
The AMA asks, “How many physicians have told aging patients that their medical complaints may be the result of aging, not specific conditions that require appropriate treatment?” According to gerontologist Karl Pillemer, PhD, “It’s too common.” The WHO reported that a 2020 systematic review showed that in 85% of 149 studies, age determined who received certain medical procedures or treatments, concluding “Ageism seeps into many institutions and sectors of society including those providing health and social care, in the workplace, media and the legal system. Health care rationing based solely on age is widespread.”
Aging does contribute to some health issues. But how those show up in each individual and at what age they show up, if at all, varies tremendously. How age impacts one’s health is also in the context of who that person is. Social determinants of health and access to care add to the complexity of the issue. It is clearly not a one size fits all. The ADA Clinical Recommendations for Older Adults states “Providers caring for older adults with diabetes must take this heterogeneity into consideration when setting and prioritizing treatment goals”. It all comes down to what we always say—look at the person in front of you.
Many people continue to live active, creative lives well into their 80s, 90s, and beyond. Mick Jagger at the age of 80 and the Rolling Stones are touring again. Morgan Freeman is 83. Jane Fonda is 86 and Rita Moreno is 91. Betty White was actively working until her death at the age of 99 and Dorothy Hoffner parachuted out of a plane at 104. The list goes on. All these people remain active and creative. While their physical appearances change with time, their attitudes, and their minds, remain strong. Clearly, these individuals are privileged. Yet, the fastest growing age groups for marathoners are both the 55 plus and the 65 plus groups. And the National Diabetes Prevention Program was found to be most successful in those over age 60, regardless of socio-economic status and race/ethnicity.
It is all about treating our patients as the individuals they are. Focus on what they can do as opposed to making assumptions about what they can’t do based on their age alone. Let them speak for themselves. Offer help if they need it and provide the support they need if they are able to do it on their own.
As for my mom, she’s doing well. She had a lumpectomy. A second tumor was discovered but no involvement of the lymph nodes, thankfully. Then tamoxifen and a short stint of radiation. She has been actively involved in every decision about her care. She is back to her usual activities, and just yesterday, she told me how she had helped an “elderly person” get their groceries into their car while at the store for herself. You gotta love that.
Happy New Year!!