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Ageism endemic in health services

Underinvestigation and undertreatment of carotid disease in elderly patients with transient ischaemic attack and stroke: Comparative population based study BMJ Volume 332, pp 525-7


Ageism is endemic in health services, argues a senior doctor in this week's BMJ.

His warning follows a study published online last month, and appearing in this week's print journal, that found substantial undertreatment of stroke and mini-stroke (transient ischaemic attack) in patients over the age of 80, despite good evidence that older patients benefit from treatment. The authors concluded that the older patients were discriminated against.

In England, decades of health service underfunding have provided an environment in which ageism has flourished, writes Professor John Young in an editorial.

Whenever a clinical stone is turned over, ageism is revealed, he says. For example, in cancer services, coronary care units, prevention of vascular disease, and in mental health services. To this list, we must now add the management of transient ischaemic attacks and minor strokes.

He believes that education is key and suggests redesigning stroke services and integrating specialist and primary care responses to the management of transient ischaemic attacks in a similar way to the approaches developed for coronary heart disease, which have led to a welcome reduction in the degree of related ageism.

Ageism will always prosper when resources are inadequate for the target population, and governments have a responsibility here, he adds. Tackling institutionalised age discrimination more broadly in health services will require national leadership, with governments and health services openly acknowledging the presence of ageism.

In England some early progress has been made through the National Service Framework for Older People since 2001. Deaths from coronary heart disease and cancer declined between 1993 and 2003, and access to elective surgery increased between 2000 and 2003.

Some will argue, however, that ageism is so deeply embedded in our health service that policy initiatives will never represent more than a tinkering round the edges, says the author.

Don't be surprised if older people lose trust in their health service and lobby for protection through anti-discrimination legislation. The result would indeed be a patient led health service, he concludes.


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