See each other refuse medical or surgical treatment due to advanced age it is an increasingly common experience, thanks to the aging of the population and the difficulties of our healthcare system, therefore Having to make choices is becoming more and more common. This is a problem common to many countries, with an enormous impact on people’s lives, on which the WHO and the UN have also intervened with a report dedicated to ageism which contains some strategies and recommendations to combat the phenomenon and to create a world for all ages.
According to a study conducted on over 80 thousand people in 57 countries, published inInternational Journal of Environmental Research and Public Healtha every second person has age-based prejudices which also influence one of the key sectors of the life of the elderly, namely healthcare, reducing accessibility to care and the appropriateness of treatments, excluding 4 out of 10 elderly people from the best and most appropriate careand also influencing the perception of aging by the elderly person themselves. With consequences on the individual’s health.
The need to fight age-related stigma and prejudice in the healthcare sector was discussed in Florence at the congress “Anti-ageism Alliance. A Global Geriatric Task Force for older adults’ care”, organized by the Menarini Foundation, with the patronage of Sigg Italian Society of Gerontology and Geriatrics and many other international geriatric societies, which was also attended by representatives of the World Health Organization WHO and the United Nations UN, ethics experts and representatives of patient associations.
The congress was an opportunity to present the Map of Florencepublished on European Geriatric Medicine e The Journals of Gerontologycoordinated by Andrea Ungar, of the University of Florence and president of Sigg, and by Luigi Ferrucci, scientific director of the National Institute on Aging in Baltimore, was developed by an international panel of experts. The document proposes 12 concrete actions to minimize the negative impact of ageism in healthcare and improve the quality of life of the elderly, reducing the costs related to their pathologies. Among the solutions proposed by the experts is training and the so-called geriatricization of medicine, which has been talked about for some time, as it is very complicated to treat the polymorbidities typical of advanced age by turning to a large number of different specialists, who intervene independently and for the part of his competence on the same patient. Then there is the sharing of the treatment path with patient and caregiver, more inclusive trials, as the elderly are generally excluded from clinical trials and therefore deprived of the possibility of having access to innovative treatments, priority paths in the emergency room.
«Based on age-related prejudices and stereotypes, elderly people are considered to already “have a sufficient amount of life”, now burdensome for the social and economic system. Almost a side effect of the medical success that has made the diseases chronicresulting in an increase in the coexistence of multiple pathologies in the same individual” declares Andrea Ungar. «The number of elderly people to be assisted has thus increased and, with it, the most widespread form of ageism, i.e. discrimination against the elderly in the healthcare sector. In fact, despite representing the majority of patients with chronic pathologies that are almost always concomitant, 40% of the elderly he is cut off from the most advanced and appropriate therapies and experimental protocols without valid medical reasons but only on the basis of age».
When resources are scarce, as we saw with Covid, making choices is inevitable; however, an elderly patient treated ineffectively suffers relapses and rehospitalizations and must be treated again with a waste of resources, as well as individual life and suffering.
Ungar continues: «The negative effects of ageism also influence longevity, with a up to 4 times more likely to die in older people who have a negative self-perception of aging compared to those who have a positive view of old age. Internalizing stigma and prejudice could be a new risk factor for a longer life.”
There are many examples: as age increases, pharmacological prescriptions and regular checks recommended by the guidelines are progressively reduced until they are halved in the over-85s, in which substantial under-treatment in up to 40% of cases. «This is demonstrated by the data from national registers which document a marked decline in the prescription of statins, with a drop of as much as 50% in those aged over 85 after coronary syndrome» declares Ungar.
As the United Nations states with concern, enjoyment of all human rights declines with age, due to the negative idea that older people are somehow less productive, less valuable to society and a burden on the economy and younger generations. Ageism, not just healthcare ageism, is an obstacle to older people’s opportunities to contribute to society, realize their full potential and lead fulfilling lives. Fighting these prejudices, which particularly affect women, is good for the whole community and society as a whole.
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