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Ageism as a Deterrent to Quality Clinical Management

September 13, 2021 • Geriatric • Heidi Moyer

If It Looks Like an Older Adult, but Doesn’t Act Like an Older Adult, Is It an Older Adult?

Unless you work exclusively in a pediatric or a sports specialty clinic, chances are you are going to have some percentage of Medicare patients on your caseload. When I introduce myself as a Board-Certified Specialist in Geriatric Physical Therapy at conferences or other gatherings, I get the same knee-jerk reaction time and time again: “Oh I work in outpatient, I don’t treat older adults.” Then, when I follow up on that statement, asking “Do you have any Medicare beneficiaries on your case load,” I’m startled by the responses I receive:

“Oh yeah, I see mostly Medicare.”

“At least 50%, they are the insurance I see the most.”

“Yeah, but they aren’t like what you think they are.”

There is a disconnect between realizing and accepting that you treat older adults.

Confusing, right? How can such highly educated health care professionals be so oblivious to their own patient demographic? This critical disconnect between realizing you treat older adults, and accepting that you treat older adults, arises from many different factors. The main contributing factor, however, is ageism. Society (through pop culture, social media, and other learned behaviors) teaches us that old people are sad, lonely creatures. People simply do not realize that they are treating older adults when those individuals live in the community, are physically active, and still perform all their own ADLs and IADLs independently. According to the CDC in 2015, only 1.3 million older adults live in Nursing Homes, or roughly 2.7% of the older adult population1. However, many people hold the opinion that “old” is synonymous with sick, frail, or nursing home. So what gives?

The Baby Boomer Generation is single-handedly redefining successful aging.

Responsible for the rise in health clubs and wellness trends, the Baby Boomer Generation is wealthier, more active, and more physically fit than any preceding generation2. With a lengthier life expectancy, they are staying in the workforce longer, maintaining connections with their communities, and are more physically active. So, when a clinician sees a relatively healthy, mobile, and active older adult walk through their doors, it doesn’t register who the individual is because the person standing in front of them doesn’t match the age-bias that they developed in their head when they saw on the intake paperwork that the patient is 92 years old.

We aren’t born ageists, but through social conditioning, we develop the construct that growing old is a terrible process to be feared. Think about marketing for anti-aging creams, life alert buttons, and how many older adults are portrayed in movies and other media. The cranky older person sitting in a wheelchair in a run-down home, staring out the window, letting the rest of their lives pass them by? No wonder we are all so afraid of getting older. And no wonder there is such a disconnect.

We don’t see ourselves as geriatric specialists and/or qualified to treat that population.

Despite many clinicians often seeing up to, if not more than 25% of their case load as Medicare beneficiaries2, I still hear time and time again at conferences and other gatherings “I work in outpatient, I don’t treat older adults.” But this just isn’t true. We ARE seeing older adults in our clinical practices. The problem is that we don’t see ourselves as geriatric specialists and/or qualified to treat that population. I as a licensed physical therapist in the state of Illinois am legally capable of performing an evaluation on a 4-year-old child tomorrow. It would be a terrible evaluation, as my clinical skills in pediatrics are extremely rusty, but I would still technically be treating this patient as part of my caseload. Despite physically seeing the patient, I wouldn’t consider myself a pediatric therapist, when though I am seeing pediatrics on my caseload. Why? Because I know that I don’t have a skill set for this patient population to yield good clinical outcomes.

Whereas I can recognize my strengths and weaknesses, and acknowledge when I may need to transfer a patient to a colleague’s caseload, other people are dug into a bunker of denial, and refuse to even recognize that their patients are in fact, older adults. Whether it comes from ignorance, feeling overwhelmed with the complexities of care of the older adult patient, or a terrible case of imposter syndrome, failing to acknowledge the unique needs of a patient population is dangerous.

The problem therein lies in inappropriate clinical management of the older adult population. If you, as a clinician, are not registering that your patient has unique needs and conditions, then you aren’t managing them to your fullest potential and providing the quality of care that your patient deserves. Are you screening for falls risk? Asking about annual vision checkups? Following through on medication reconciliation needs?  Monitoring patient response and adjusting dosing of therapeutic exercise appropriately? It’s not that you aren’t seeing older adults in your clinical practice, but deep down, you know that you aren’t meeting their needs on some level.

Ageism is alive and well in the health care setting.

In the physical therapy field, ageism contributes to under-dosing of exercise, demeaning comments made by clinicians, lack of respect for patient’s input, decreased attention to patient’s concerns, and lack of empathy by clinicians4. These factors can be devastating to not only clinical outcomes, but also greatly impact patient-centered care and attainment of patients’ personal goals.

Age is not a determining factor in providing care for a patient.

Common clinical reasoning I will hear often from co-workers and other professionals include:

“Well, he cannot go home because he is 78 years old.”

“I only worked on gait training with her because she isn’t young enough to handle leg strengthening exercises.”

“No one who is 100+ wants to be that old anyways.”

Treat what you see and meet your patients where they are in their physical capabilities.

Here is a pro-tip: if you change age to gender, race, religion, or another demographic, and the statement sounds wrong to you, then it’s wrong to use age as well. Treat what you see and meet your patients where they are in their physical capabilities, not your preconceived notion of where they should be based on an arbitrary number based in the Gregorian Calendar. Not all older adults have the same needs, which is why, just like any other population, an individualized approach is absolutely essential to managing the needs of all of your patients.

Want to learn more about how to better manage the needs of older adults in your clinical practice and avoid some of the common pitfalls of ageism when treating this population?

Join us on Wednesday, October 13th at 7:30 PM CST for a webinar titled But I Don’t Treat Older Adults: A Survival Guide on Treating the Older Adult for the Outpatient Orthopedic Therapist.

Register Now

 

References
  1. Nursing Home Care. Published March 1, 2021. Accessed September 1, 2021. https://www.cdc.gov/nchs/fastats/nursing-home-care.htm
  2. Berkowitz EN, Schewe CD. Generational cohorts hold the key to understanding patients and health care providers: coming-of-age experiences influence health care behaviors for a lifetime. Health Mark Q. 2011;28(2):190-204.
  3. Fritz JM, Hunter SJ, Tracy DM, Brennan GP. Utilization and clinical outcomes of outpatient physical therapy for medicare beneficiaries with musculoskeletal conditions. Phys Ther. 2011;91(3):330-345.
  4. Blackwood J, Sweet C. The influence of ageism, experience, and relationships with older adults on physical therapy students’ perception of geriatrics. Gerontol Geriatr Educ. 2017;38(2):219-231.

Heidi Moyer

Dr. Heidi Moyer, PT, DPT (they,them) is a physical therapist based in the Chicagoland area. As a Board-Certified Clinical Specialist in Geriatric Physical Therapy (GCS) and a Certified Exercise Expert in Aging Adults (CEEAA), Heidi is the Program Director for the Evidence In Motion Geriatric Certification Program as of August 2021, having spent the past...

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