GERIATRIC EM
Ageism in the Emergency Department By Anita Chary, MD, PhD; Lauren Cameron-Comasco, MD; Anita Rohra, MD; Scott Dresden, MD, MS; Alden Landry, MD, MPH; Shan W. Liu, MD, on behalf of the SAEM Academy of Geriatric Emergency Medicine and the Academy for Diversity and Inclusion in Emergency Medicine
SAEM PULSE | MARCH-APRIL 2022
This article summarizes content from an inaugural webinar jointly sponsored by the Academy of Geriatric Emergency Medicine and the Academy for Diversity and Inclusion in Emergency Medicine. A recording of the webinar is accessible to SAEM members at: https://youtu.be/cJWO3fIf73I
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Older adults, often defined as those aged 65 and older, represent a vulnerable patient population in emergency medicine. While many adults age healthily, others develop comorbidities that may limit their functional status and ability to independently perform activities of daily living. Physiologic changes that occur with aging lead to geriatric syndromes such as frailty, falls, and delirium, while changes in social position and relationships may lead to elder abuse and neglect. These issues necessitate a thoughtful approach to evaluation, treatment, and disposition of older patients in the emergency department (ED). While older adults have unique clinical and social needs, we must also be wary of the differential treatment they may receive based on their age.
Ageism is defined by the World Health Organization as “the stereotypes, prejudice, and discrimination towards others or oneself based on age.” While it can affect people of any age, in the world of medicine, we have particular concern about the impact of ageism on older adults. Clinicians may conflate increasing age with frailty, comorbidity, and disability. We may dismiss pathology due to old age, conceptualize physiologic changes associated with aging as disease, or make assumptions about our older patients that do them a disservice. Consider these examples: • A clinician omits a sexual history when interviewing a 74-year-old patient with dysuria, because the clinician doubts the patient is sexually active. • A clinician decides to shave the head of a long-haired older patient to repair a scalp laceration, neglecting the value the patient may place on their appearance. One strategy for combating ageism in emergency medicine is reflecting on and responding to our own biases. Implicit association tests and careful interrogation of our interactions with geriatric patients
can reveal our unconscious biases about older adults. A common manifestation of ageism in medicine which implicates many clinicians is “elderspeak,” a form of communication that uses inappropriately juvenile and overaccommodating lexical choices. Examples include referring to older patients as “dear” or other terms of endearment, speaking slowly with short sentences, using an over-nurturing or high-pitched voice, or directing one’s gaze at a bedside caregiver rather than the patient. Elderspeak arises from implicit or unconscious bias. Those who employ elderspeak often intend to express care or facilitate communication. Instead, elderspeak works to exert a clinician’s control over the patient, reinforcing the old-age stereotype, and perpetuates negative self-perceptions among older patients. Studies show that older adults generally find elderspeak from health care workers patronizing and makes them feel incapable and impaired. Recognizing the negative impact that elderspeak can have on our patients, regardless of our intentions, can motivate us to change our communication styles for the better.
