by KIRSTY STEIN
OLDER people fear they are becoming increasingly invisible in our busy hospitals, with financial pressures and ageism leading to sometimes devastating consequences.
The stark realities were highlighted in August when an 89-year-old patient was evicted from her bed in the Prince of Wales Emergency Department under the Inclosed Lands Act.
Retired doctor Elizabeth Rogers was admitted to emergency on a Friday after falling out of bed at her low-care nursing home. Hospital staff read her the eviction notice on the Sunday night. She was later admitted to a different hospital where she died. Prince of Wales Hospital has since launched an investigation into the incident.
Aged Care Crisis advocate Lynda Saltarelli said the scenario was not an isolated incident, but reflected a situation played out regularly in the health system.
“Because some of us are both old and sick, somehow we become lesser beings, demoted to ‘problems to be managed’,” she said. “This can be reflected in the language used in some facilities where the aged are sometimes referred to as ‘bed-blockers’ or by demeaning terms such as GOMERs – Get Out of My Emergency Room.”
Melbourne-based doctor and writer Karen Hitchcock tackled the issue of ageism in health care head-on in her Quarterly Essay in March, accompanied by multiple examples from her experience in major Australian hospitals. “Our collective turning away from ageing is reflected and concentrated in the hospital,” she wrote.
A growing recognition of the ageing population and its fiscal ramifications had translated to fear
. “This perception has infiltrated our health systems and has led to a number of movements within medicine that are either consciously or unconsciously informed by our low regard for the elderly and the fiscal fear they now embody.
“Given our cultural climate, they risk giving sanction to a form of health rationing for our elderly in a system which historically has held them in the lowest regard.
“They are viewed as a homogeneous and ever-growing group with ever-worsening pathology, demanding ever more hospital beds that no one wants to fund.
“It is a terrible thing for a society to discard the weak and the disabled and to justify it by saying they have had their turn. “We must remain aware of our ageism in every program and policy we implement... even if, for now, we believe that we would rather be dead than demented, rather be dead than dependent, rather be dead than grow old.”
In August, Charles Sturt University nursing lecturer Maree Bernoth told the NSW inquiry into registered nurses in aged care that older people in hospital were frequently made to believe they were a nuisance.
“There is a stereotype and an attitude that pervades care that an older person does not have a right to a bed there,” Dr Bernoth said.
She echoed Dr Hitchcock’s comments that hospitals rushed to assume older people were suffering from inevitable age-related deterioration, and rushed to take minimal or palliative measures, instead of treating sometimes easily fixed short-term health issues.
“It takes real skills to be able to differentiate between what is an age-related change and is normal and what is a pathophysiology,” she said.
“A person can look as if they have got an exacerbation of their dementia when really they have some sort of infection.
“They feel that they are being a burden by being in an acute care bed, and then the pressure is on to get them into an aged care facility when maybe a bit longer in acute care, and perhaps with some rehabilitation, they could go home with a community package.”
Australian Catholic University Professor of Ageing Tracey McDonald said clinicians were increasingly making decisions based on economic rationalism.
“I’ve actually heard doctors say to people ‘Have you considered what a burden you are on your family?'” she said. “The pressure on hospitals is so immense, and if you are prejudiced in any way (against older people) that’s going to affect your decision.”
Patients doctor's first priority
AUSTRALIAN Medical Association vice-president Stephen Parnis said the first priority for all doctors should be “the patient in front of them”, regardless of age.
The Victoria-based emergency physician said the discussion on treatment of older people in hospitals was positive, and he believed the need to give young doctors more appropriate training had been recognised.
“There are times as a doctor when you have to advocate for the patient, you have to be their champion,” he said. Dr Parnis acknowledged older people’s cases were often more complex, and systems where doctors were segregated into many sub-specialisations could allow people to fall through the cracks.
“One of the stressors on every emergency physician is you can be so overwhelmed by the volume and urgency that the demands for efficiency mean you can’t give the time you would like to each decision,” he said.
“We get it right the vast majority of the time.”