Spotlight on ageism in the health service

With research suggesting the health service may be ageist, staff are urged to look at their own approach

With research suggesting the health service may be ageist, staff are urged to look at their own approach

1 in 5 women over 70 never check their breasts for signs and symptoms of cancer. Picture: Alamy

The ageing population has had a remarkable effect on the care that the NHS needs to provide, whether it is coping with rising hospital admissions or coordinating services for people who often have multiple long-term conditions.

1 in 10

people say they have experienced age discrimination in medical settings

(Source: Lancet Public Health)

Changing demographics have led to a host of new initiatives. Specialist frailty units have been set up in many hospitals, NHS England has developed a toolkit to help GPs manage frailty in the community and the emphasis on moving care out of hospitals is largely driven by the desire to meet the needs of older people.

But this does not mean the health service has cracked it. In fact, two new pieces of research suggest the NHS – and its staff – may be ageist.

The first study, published in the Lancet Public Health journal, looked at the experiences of more than 7,500 people aged over 50 from the English Longitudinal Study of Ageing.

It found one quarter had experienced age discrimination – with just over 40% of those saying it had happened in medical settings. Those who had experienced ageism were more likely to report poor health.

Researcher Sarah Jackson

Lead researcher Sarah Jackson, from University College London, says the findings ‘clearly warrant action’.

Later diagnosis and different treatments

‘There is evidence that older patients tend to be diagnosed with certain conditions later than younger patients and may not be offered the same treatments,’ Dr Jackson says.

Breast cancer is one of those conditions, according to the second study on ageism.

The International Longevity Centre UK found older patients were more likely to have late diagnoses for breast cancer, be denied treatments such as chemotherapy and have poor pain management.

It conceded there were ‘potentially justifiable reasons’ for some of the different approaches, given that older people were more likely to have co-morbidities and decisions not to offer treatments or carry out surgery might be in their best interests.

But the fact that the late diagnosis rate, at 23%, was more than 50% higher in the over eighties than in those aged 60-79 suggested there could be ‘no room for complacency’, according to the study, funded by drug firm Pfizer.


of over eighties with breast cancer are diagnosed late

(Source: International Longevity Centre UK)

Wider societal problem

Age UK Camden chief executive officer Nikki Morris, who has worked as a nurse in the NHS, is not surprised by the findings, although she says ageism is part of a wider societal problem.

‘It can be seen and heard in many different contexts, such as when someone says: “Tell him now, he won’t remember it in a few minutes.”

‘We need to be more aware of when it’s happening, call it out for what it is and then change behaviour.

‘Healthcare professionals can sometimes take a paternalistic approach to care of older people thinking they are being kind, but in reality they are limiting choice and limiting information by omitting or dumbing down conversations.’

However, the International Longevity Centre UK review also acknowledged that the attitudes of older people themselves may be a factor, with its research showing one in five women over 70 never check themselves for signs and symptoms.

More patient education

Sue Cruickshank

RCN cancer and breast care forum chair Sue Cruickshank says this shows there is a need for more patient education.

‘Once screening stops people can fall into thinking they don’t need to keep checking.

‘They think: “If I’m not getting called it’s not important any more.” But they can still put themselves forward for screening. We need to encourage older people to be careful about their health and still look out for signs of cancer.’

Dr Cruickshank says another problem is that clinical trials often exclude people over the age of 65 and those with co-morbidities. ‘We do not always have an accurate idea of what treatments work on these populations.’

Ageism trap

1 in 5

women over 70 never check themselves for signs and symptoms of breast cancer

(Source: International Longevity Centre UK)

But she still believes staff need to consider their own roles. ‘It’s too easy to look at a patient who is 80 and assume they are frail. They may be fit, active and healthy. We need to be careful not to fall into that sort of ageism trap.

‘The key thing is to talk to the patient and go through all the pros and cons of a treatment. Be honest with them so they can make a fully informed decision about their care.’

Dawne Garrett. Picture: David Gee

RCN professional lead for care of older people and dementia Dawne Garrett agrees, saying shared decision-making is crucial to avoiding unfair treatment.

‘As clinicians, one of the most important things we can do is tailor our prevention advice.

Chance for reflection

‘For example, an older person may have had a stroke and may not be able to check their breasts in the way a younger person can. We may need to think about that and talk to their partner or carer to get them to help.’

She says there are other steps that can be taken but they require good management to create the right environment for reflection.

‘We can review the care we provide by talking through cases with others, especially those outside of our specialism. That helps to uncover whether what we did could be improved.

‘Good supervision can help too, and employers should be thinking about this, as older patients are our core business.

‘The trusts that use volunteers – who tend to be older – have a good record on this because they are involving and listening to that demographic.’

Ageism: What you need to know

Age discrimination is prohibited in the European Union through Article 21 of the Charter of Fundamental Rights, which became legally binding in 2009.

There are three fundamental aspects of ageism – stereotypes, prejudice and discrimination.

All three aspects can be displayed consciously or unconsciously – hence the growing interest in the concept of unconscious bias.

Age is further protected from discrimination under UK law.

Circumstances and needs

A ban on age discrimination in the NHS came into effect in 2012 in line with the Equality Act 2010.

Under this legislation it is unlawful for service providers and commissioners to discriminate, victimise or harass a person because of their age.

Age can also no longer be used as a criterion for treatment or as a proxy for whether an individual would benefit from treatment.

Instead, people must be assessed individually, based on their circumstances and needs.

Objectively justified

However, it remains possible for the NHS to use age as a basis on which to provide services where this is ‘objectively justified’.

For example, this might include the targeting of public health campaigns at age groups shown to have particular needs or responding to an individual’s desire to mix with people of a similar age to them.

(Source: International Longevity Centre UK)

Nick Evans is a health writer

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