I am happy at least one doctor is on
our side. I knew this would happen one day, but Stephanie E. Rogers,
MD states that, “For the first time in human history,
adults older than age 65 will outnumber children younger than age 5.”
Then she continues, “In medical school, we receive training
in treating young patients during the pediatrics lecture series and
later in an extended clinical rotation, yet the training we receive
for treating geriatric patients is significantly lacking.”
This is sad, but it helps explain why
our doctors know so little about treating the people above 60 or 65
years of age. Despite recommendations of international regulatory
agencies, exclusion of older individuals from ongoing trials
regarding type 2 diabetes mellitus is frequent, higher than reported
for other age-related diseases. This exclusion limits the value of
the evidence that clinicians use when treating old, frail, and
complex patients with diabetes mellitus.
“Pediatric units are common at
most hospitals, where multidisciplinary teams including nurses and
pharmacists are specialized in treating children and most children
have access to an outpatient pediatrician. In contrast, few health
systems have adopted the specialized models that exist to provide
cost-effective care for older adults in hospitals, clinics, and at
home. Furthermore, plenty of research literature exists regarding
the care and treatment of children, while it is commonplace to
exclude older adults from clinical trials due to age or multiple
comorbidities, despite the fact that they are likely to benefit from
the study interventions.”
The presence of ageism (age
discrimination) is a glaring deficiency in our current health care
system. Ageism is the “systematic stereotyping of and
discrimination against people because they are old, in the way that
racism and sexism discriminate against skin color and gender.” Dr.
Rogers said. “In our study published online today in the
Journal of General Internal Medicine, we report that this systematic
discrimination by doctors and hospitals leads to earlier functional
decline in patients. Using the Health and Retirement Study, a
nationally-represented sample of 6,017 adults older than age 50, we
found that 1 in 5 older adults reported experiencing discrimination
in the healthcare setting. Those who reported the most frequent
discrimination were more likely to have developed new or worsened
disability over the next 4 years. The most common reason reported
for this discrimination was age.”
Promoting health and well being for our
diverse population cannot be achieved without paying attention to the
precise needs of our aging nation. As a healthcare system, the U.S.
has neglected our future selves long enough. Our older patients
deserve devotion, in particular because of their age. Their long
life experience and contribution to society should allow them the
same attention and quality of care we offer to our children.
Clinical practice guidelines rarely
address the treatment of patients with three or more chronic
diseases, and such patients make up half of the population greater
than 65 years of age in the United States. When other aspects of
chronic disease management (e.g., dietary or other lifestyle
modifications, attending regular office visits, and laboratory
monitoring) are added, the burden on elderly patients and their
caregivers becomes onerous and, in many cases, unsustainable over
time.
Guidelines
and quality assurance initiatives largely ignore the issue of
marginal benefits of multiple medications as recommended by various
sets of treatment guidelines. The guidelines are all set up for
people under 60 years of age with only one chronic condition. The
elderly are discriminated because no research has been done to
determine how to treat people with multiple chronic conditions. Yet,
the so-called “experts” could care less about treating the
elderly.
By not
including the elderly in diabetes trials, our doctors have clinical
practice guidelines that rarely address the treatment of patients
with three or more chronic diseases, and such patients make up half
of the population greater than 65 years of age in the United States.
When other aspects of chronic disease management (e.g., dietary or
other lifestyle modifications, attending regular office visits, and
laboratory monitoring) are added, the burden on elderly patients and
their caregivers becomes onerous and, in many cases, unsustainable
over time. Guidelines and quality assurance initiatives largely
ignore the issue of marginal benefits of multiple medications as
recommended by various sets of treatment guidelines.
The guidelines are all set up for
people under 60 years of age with only one chronic condition. The
elderly are discriminated because no research has been done to
determine how to treat people with multiple chronic conditions. Yet,
the so-called “diabetes experts” and researchers could care less
about treating the elderly.
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