When a patient in her late 60s who was suffering from anxiety and depression came to see Dr. Katayoun Khalighi recently, the woman, who spoke little English, was astonished that the UCI Health SeniorHealth Center physician took time to actually listen to her.
“She said her previous primary care doctor had been very impatient and dismissed her concerns because she was older,” recalls Khalighi, who quickly learned that the woman was being both mentally and physically abused by her husband.
Khalighi, a specialist in geriatric medicine, sees patients like this woman every day, people who have felt devalued, disrespected or dismissed when talking with doctors and other healthcare professionals, even their own family members and caregivers.
“Thankfully, she had separated from her husband," Khalighi says. "I was able to prescribe an antidepressant and refer her to one of the psychologists on our team.”
Ageism in healthcare is an all-too-common problem that has been documented in numerous studies over the last decade. One recent study estimates that the annual health cost of ageism in the United States — including overtreatment and undertreatment of common medical conditions — totals $63 billion.
For the last 20 years, UCI Health geriatricians have worked tirelessly to improve the health of older adults as well as eliminate ageism in healthcare. U.S. News & World Report regularly recognizes the SeniorHealth Center among the top 50 geriatric programs in the country. It was also one of the nation’s first to be recognized as a patient-centered medical home for geriatric care.
What is ageism?
Ageism occurs when people face stereotypes, prejudice or discrimination because of their age. One common stereotype is that all older people are frail and helpless. Prejudice may also manifest in perceptions that “older people are difficult and unpleasant.”
These assumptions can lead to discrimination — a reluctance to recognize and respect the needs of older adults or to treat them less favorably than younger people.
One study reported that nearly 1 in 5 Americans age 50 and older say they have experienced discrimination in healthcare settings, which can result in inappropriate or inadequate care. About 29% of respondents who reported frequent healthcare discrimination developed new or worsening disabilities over a four-year period.
In healthcare settings, ageism can be overt, for example, in plans that call for rationing medical care, such as specifying the treatment of younger adults before older adults as some hospitals did during the COVID-19 pandemic. Embedded in these plans, is a value judgment that young peoples’ lives are worth more because they presumably have more years left to live.
Ageism can also be implicit. For instance, a doctor may assume that an older patient who speaks slowly is cognitively compromised and incapable of relaying their medical concerns, or when an older patient is accompanied by a loved one, the healthcare provider directs questions and comments to the other person instead of the patient.
“Failure to include the senior patient in their own medical care can lead to serious misunderstandings, which may affect treatment,” says UCI Health SeniorHealth Center Director Lisa Gibbs, MD, who also is a professor and chief of the UCI School of Medicine’s nationally regarded Division of Geriatric Medicine & Gerontology.
Meeting the needs of older patients
With the nation’s 65-and-older population projected to nearly double in size in coming decades, from 49 million in 2016 to 95 million people in 2060, their care will become central to future healthcare policies.
UCI Health is already at the forefront in defining those policies and practices. The SeniorHealth Center is staffed by the largest group of board-certified geriatricians in Orange County and the region. They also are faculty members of the geriatrics division, which has been training new doctors to care for the unique needs of aging patients for nearly two decades.
All second-year family medicine residents are required to perform a four-week geriatric rotation that is split between outpatient and long-term care. What sets the program apart is a whole-person approach to healthy aging combined with the latest evidence-based medical practices and clinical research.
“Our goal is to teach them to deliver compassionate care to older patients,” says Khalighi, an assistant professor of family medicine.
Because Orange County has such a diverse population, the residents are taught to understand each patient’s culture, socio-economic background, level of education and their support system.
“We encourage them to look at each patient as an individual, to listen carefully and, most importantly, to avoid judgment,” she adds. “In this way, we can more effectively address their concerns and medical issues.”
Dr. Katherine M. De Azambuja, who recently completed her geriatric medicine fellowship at UCI and is the newest physician to join the geriatrics team, agrees. “Every patient has a unique story,” she says. “It’s important to give our patients space and time to tell us their stories and medical concerns, and to share what quality of life means to them.”
The UCI fellowship is crucial to training geriatricians who will stay and practice in Orange County. “There is a serious lack of access to geriatric care right now and that will continue in the future for our burgeoning population over 65 years of age,” says Gibbs.
Asking the right questions
Invariably the geriatrics team asks each patient, if you could change one aspect of your healthcare, what would it be?
“This is one of the most important questions we ask during an annual wellness visit,” says Gibbs, because it prompts a discussion about what matters most to each patient. It also helps the provider outline realistic and relevant healthcare goals.
“The answer can be as simple as a patient wanting to be able to walk her dog again because it brings her joy,” she adds.
With this information, the provider and patient can develop a plan for managing her arthritis so that she can walk her dog for 10 minutes a day. It may also mean reviewing medications to ensure that they are age-friendly, don’t interfere with the patient’s mobility or cause cognitive impairment.
Gibbs says evidence shows the added benefit of this approach is that when you include patients, their families and caregivers in healthcare decisions, it’s more likely that their healthcare goals will be met.
Making healthcare age-friendly
In 2021, UCI Health was named an age-friendly health system — the highest designation for excellence in caring for older patients from the Institute for Healthcare Improvement (IHI). An age-friendly health system is guided by a set of evidence-based practices to organize care with a focus on an older adult’s wellness and strengths rather than solely on a disease.
Because the SeniorHealth Center is a total-care center for older adults, it makes primary care, consultations, memory assessment and health assessment programs available all under one roof.
“We also have a collaborative team of senior-care experts including psychologists, social workers, pharmacists, nurses, neurologists and psychiatrists,” says Gibbs.
The future of age-friendly care will depend on innovations in team-based treatment, telehealth and clinical research combined with a unique understanding of the transitions people face in their later years that affect health and well-being.
"As people age, they diverge more and more in terms of function, ability and health — and ageism has no place in the SeniorHealth Center,” says Gibbs.
“It’s ironic that as geriatricians we focus our care on older adults, yet we only see individuals, not age," she says. "Age is really our last concern. Our aim is to promote optimal living and empower longevity through comprehensive, compassionate care.”