Older Type 2 Patients Feel Discriminated Against

Are you over the age of 65? Do you have type 2 diabetes? How many other health conditions (comorbid) do you have – hypertension, arthritis, retinopathy, hypercholesterolemia, coronary artery disease, and neuropathy? Now for the most important question – do you feel that the doctor(s) you are seeing is listening to you or even care to see that you are being treated properly?

More people are becoming very discouraged with their physician and feel that they are being treated poorly and herded through their appointments like cattle. It is understandable that the study I am now referring to is so small, but in many ways is typical of what is happening to the elderly needing health care today. It is my opinion that this is only going to become worse as the government intrudes further into health care decisions to cut cost and manage health care.

Considering that type 2 diabetes has increased in recent years, and is expected to increase even more in the coming years, where are the elderly going to find caring physicians that will help them manage their conditions. Most adults and especially the elderly have at least one comorbid condition and almost half have three or more. I admit I am becoming tired of the platitudes being handed out about developing effective management and individualized management to reduce each patient's diabetes risk of complications and lower the economic cost of this disease.

While this is true and what is sorely needed, many physicians are turning away from the elderly and not meeting their needs. The study involved 32 patients with type 2 diabetes and at least one other chronic health condition. All patients were 60 years of age or older and had diabetes for at least one previous year. The patients were divided into eight focus groups of 2 to 6 patients each. The interviews centered on the patient's experiences and opinions about their health care plans for their diabetes and other chronic conditions.  The following link is to a PDF file relating the findings of the study.

Older adults perceived a general unwillingness from their providers to treat their multiple health conditions and address their individual preferences for care. Older adults may require more in-depth communication with their providers in addition to individualized treatment plans that address their preferences for comorbidity management. Patients reported -

1. A general unwillingness of their providers to treat their diabetes and other chronic conditions.
2. Experiences of limited support and empathy from their providers.
3. Some felt that their providers were insensitive to their remaining years of life because of their older age.
4. Patients felt that their preferences for care were not considered by their provider.
5. Patients felt their care was not tailored to their individual needs and medical history.

The patient population in this study was extremely homogenous, as all the patients were white, highly educated, and community dwelling. These patients also had good glycemic control, which may have affected some of their responses. The responses obtained from the patients in this study point to a "disconnect" between patients with these conditions and their providers.

The authors stated that future research should aim to incorporate data from physician-patient pairs to assess communication properly from both sides. Effective patient-provider communication and shared decision-making have been shown to not only improve patient satisfaction, but also increase adherence to treatment plans and improve health outcomes.

For those of us with diabetes, we need to be aware of the above to measure our own satisfaction and help us determine if we need to consider seriously changing doctors. I know that I have a decision to make in the near future about one of my doctors.