What's the first statistic that medical professionals mention when they talk about patients?
It's the patient's age, Rebecca Trotta, a Ph.D.-level nurse, pointed out in a lecture Monday to colleagues at the Hospital of the University of Pennsylvania.
She urged them to consider how differently they would think about these two patients: a 57-year-old man who had fallen and had a change in mental status, and an 87-year-old man with the same symptoms. Chances are, she said, that they would instantly make unconscious assumptions about where those two patients were headed. They were much more likely to assume that the older man was frail, had dementia, and would wind up in a nursing home. Could it be that what she called "intrinsic ageism" makes such a negative outcome more likely?
Trotta spoke as part of Penn Medicine's Health Equity Week, a series of lectures on aspects of diversity and prejudice within medicine. The program premiered last year. "This is a big priority for the organization as well as for the HUP senior team," said Regina Cunningham, the hospital's chief executive officer.
Elders are revered in many cultures. America isn't one of them, said Trotta, who is director of nursing research and science at HUP. "Ageism is one of the most socially condoned and institutionalized forms of prejudice in our country. ... There's a belief that older adults can't meaningfully contribute to society anymore."
Trotta, who worked as a geriatric nurse-practitioner before getting her doctorate, urged her audience not to "talk over" elderly patients, by which she meant talking across the hospital bed to a family member without trying to speak directly to the patient first. She's also not a fan of "elderspeak," using words like "honey" and "babe" when talking with older patients. While such words are meant to be warm and kind, they are also dismissive. "I wouldn't obviously walk up to Regina and call her honey," she said of the CEO, who was in the front row. "If anyone has asked a patient what they want to be called, has anyone ever said 'honey' or 'Oh, just call me sweetie'?"
Elders do have special needs, Trotta said. But surgeons can perform heart procedures on 90-year-olds. Elderly patients can make it through chemotherapy. She thinks that making assumptions about abilities may keep doctors and nurses from exploring ways to help them. If, for example, you think that delirium is unavoidable, you might also think "it's not worth the effort" to try to prevent it.
There's a connection, she said, between "having those presumptions about older people and their likelihood of achieving the best possible outcomes and quality."