It’s true: age is just a number

TAUREEF MOHAMMED

SIX YEARS ago, I had convinced myself that I wanted to do paediatrics. I was an intern at Port of Spain General Hospital, working in adult medicine. Most of the patients were old – as is the case on all adult medicine wards – and, to an intern, fresh out of medical school, seemed unfixable, their diseases incurable and irreversible.

After weeks of what seemed like Sisyphean tasks, I had made up my mind that a career in paediatrics – treating people between zero and 18 years old – would be more fulfilling. I explained my rationale to a friend: children had their entire lives ahead of them. We can change their trajectories; we can save their lives. Older people, on the other hand, especially those on a medicine ward with multiple, advanced chronic diseases, appeared to have one trajectory: down.

In my simple mind, filtering out older people was an easy solution – is there anything more ageist than this?

So, a few years later, when I told a physician that I was specialising in geriatric medicine and he replied, with a perplexed expression, “I guess someone has to do it,” I felt I could not judge him. And I wasn’t shocked when a geriatrician recently told me what someone – a “respectable” person, she said – had told her: “What a waste.”

A WHO report on ageism, published in 2021, referenced a survey that found one in two people had ageist attitudes. It also pointed out “healthcare rationing” by age was widespread. The report confirmed what many older people and geriatricians already knew: ageism crept in everywhere.

Why is it so prevalent? Do we even know how to recognise it?

Dr Sheri-Lynn Kane, chair of geriatric medicine at Western University, knew she wanted to be a geriatrician before she started medical school.

As a kinesiology undergrad, she conducted a study on falls in the elderly, and the result was her falling for geriatrics.
“I loved it…I had this realisation that this is a population so experienced and wise. So I thought, how can I do it as a career?”

A geriatrician for over 20 years, Dr Kane has seen ageism in all its forms.

“I have had patients who were told by a healthcare practitioner, ‘It’s your age.’ And my question is, ‘You didn’t have this problem four months ago, and you were 85 then, so why would it be just your age?’ It doesn’t make any sense – that’s ageism.

“When someone has white hair and a blue gown, and healthcare workers talk to their family instead, as though the patient isn’t capable of receiving information, that’s ageism.”

Too many times, Dr Kane added, decisions on whether to offer a test or treatment were based solely on age. “Of course, there are times when not to be aggressive, and the outcomes are worse, but there are also times when treatments are not offered because of the patient’s age.”

When making treatment decisions, she said, the focus must be on frailty – defined as a person’s overall vulnerability, and based on multiple domains, including mobility, cognition, functional dependence, comorbidities – not age.

“Everybody knows we can have a very, very frail, say, 64-year-old.”

So why do people, particularly some of us healthcare workers, seem to just not get it?

“It has to do with the complete lack of understanding of the heterogeneity of the older adult population. In paediatrics, we teach the changes that happen with age well, but somehow from 18-85 years old, we expect everyone to be the same.

“Older adults speak slower. Walking speed slows. Understanding what is normal ageing physiology versus abnormal is important to make correct diagnoses and treatment decisions.

“And, you know what? Assessing an older adult is going to take longer than a younger adult.”

She added: “The complexity of older people’s situations, whether medically or psychosocially, can be overwhelming, and you get discouraged if you don’t feel the capacity to help.”

Unprepared for these realities, which were never emphasised enough in medical school, I was tempted to choose what appeared to be the easier path – the one that didn’t require any understanding of older people.

But with time and good mentorship, I started to appreciate the meaning of the adage, age is just a number – that age was not a label, that labels were for objects, not humans. And once these truths sunk in, I settled on my career path: geriatric medicine.

Taureef Mohammed is a graduate of UWI and a geriatric medicine fellow at Western University, Canada