Senate hears report on bias against elderly in health care




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Senate hears report on bias against elderly in health care

By Cory Reiss

Washington Bureau, May 22, 2003

WASHINGTON -- A Senate panel on Monday began to wrestle with mounting evidence that the American medical establishment is biased against the elderly.

Seniors often don't receive health screenings, preventive care, or proper diagnoses because most doctors lack geriatric training that could defeat the common assumption that medical problems are a natural part of aging, experts and senators said at a hearing.

"Seniors are falling through the cracks," said Sen. John Breaux of Louisiana, the ranking Democrat on the Senate Aging Committee.

A report the Alliance for Aging Research released Monday cites dozens of studies that point to a pervasive, unconscious discrimination in health care. Experts predict the problem will worsen as 77 million baby boomers begin to turn 65 in 2011.

"If it doesn't change quickly, we are going to be engulfed by these problems when that demographic tsunami hits," said Sen. Ron Wyden, D-Oregon.

A dearth of doctors trained in geriatrics, the specialty that deals with the elderly, is a root of the problem. Breaux said there are about 9,000 geriatric specialists in the United States, compared with 42,000 pediatricians.

Five medical schools -- Mount Sinai, the University of Arkansas, Oklahoma University, Florida State, and the University of Hawaii -- have geriatrics departments. Only 14 medical schools, or 10 percent, require course work or rotations in geriatric medicine, and only 3 percent of graduates from other medical schools opt to take elective classes in geriatrics, the report says.

The shortage of doctors trained to deal with the often complex medical and social aspects of aging leads to many shortcomings, the report says. Failings that can hurt or kill the elderly, according to the report, include:

· Lac k of preventive care and screening for cancer, heart problems, and other conditions.

A report this year by the Centers for Disease Control and Prevention said that 90 percent of people over 65 do not receive appropriate screening. Monday's report compares that figure with statistics showing that 80 percent of fatal heart attacks and 60 percent of cancer deaths are among people 65 and older. One in three seniors don't get flu shots, and fewer receive vaccines that would prevent pneumococcal infections.

· Substance abuse, smoking, and other problems go unchecked. Doctors often overlook prescription drug misuse and alcoholism because they don't consider it as urgent a problem as in younger people. They similarly don't address smoking among older patients because they deem the damage already done or believe the habit is too old to break, but statistics show quitting benefits health at all ages.

· Older patients are left out of clinical trials of drugs that they ultimately are likely to consume the most. The report cites several studies that show seniors are included in drug trials in low numbers even though they are the most likely to have conditions that those drugs are intended to treat.

· The elderly commit suicide at rates four times the national average. The report says doctors consider depression normal late in life. But almost 40 percent of seniors who commit suicide do so the same week they see a primary care doctor, and 75 percent kill themselves within a month, says the report, citing a 2000 study published in the Journal of the American Geriatrics Society.

"This is a shameful tragedy," Dr. Joel Streim, president of the American Association for Geriatric Psychiatry, told the committee.

Breaux said the hearing was the first step in congressional efforts to deal with these wide-ranging concerns. One possibility is for Congress to use its power over Medicare, the federal medical program for the elderly, to emphasize geriatric medicine and inclusion of seniors in drug trials.

Daniel Perry, executive director of the Alliance for Aging Research, said the report reveals a dangerous form of ageism.

"Like other patterns of bias -- such as racism and sexism -- these attitudes diminish us all, but they can be downright deadly to older persons," he said.