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Why Doctors Shouldn’t Treat All Older People the Same

By Grace Birnstengel for Next Avenue

Health care systems have very distinct doctors and procedures for treating children vs. adults — but the division often stops there. People ages 65 and older are largely lumped into the category of geriatric, without considering the vast differences between those in their late 60s or 70s and those in their 80s or 90s.

In a recent New York Times opinion piece, Louise Aronson, author and professor of medicine at the University of California San Francisco (UCSF), argues that the experiences of older adults are much more nuanced than currently considered. Aronson cares for older adults in the UCSF’s Care at Home Program and directs the Northern California Geriatrics Education Center.

Consider vaccine guidelines from the Centers for Disease Control (CDC), for example. Aronson points out children from birth to age 18 have more than a dozen subgroupings of vaccine recommendations, but adults have only five. Most striking: Everyone over 65 is considered within the same subgroup. That means a 65- or 70-year-old is viewed essentially interchangeable health-wise with someone in their 80s or 90s. And this is regularly how older adults are seen through a medical lens.

“Those two groups — the ‘young old’ and the ‘old old’ — don’t just differ in how they look and spend their days; they also differ biologically,” Aronson writes. “As a result, it’s likely that we are incorrectly vaccinating a significant number of the 47 million Americans over 65.”

Acknowledging Age Differences Is Key

In her story, Aronson illustrates ways the health of people in varying stages of their older years are different and unpredictable.

Immune systems change drastically as we age, she notes, and there are substantial variations in immune functions between a 70- and 90-year-old. This affects how bodies handle vaccines (the effectiveness fades faster in older people). Aronson says people over 85 might need additional doses and perhaps shouldn’t be vaccinated at all during end-of-life years due to unproven benefits. This is also the case for urological, chemotherapy and radiation treatments.

Treatment guidelines for older adults also fail to recognize the other factors that affect how we age.

Next Avenue recently explored longevity inequality, showing that the way people age is heavily affected by their socioeconomic status — their level of education, access to health care, city of residence and more. When health care professionals treat all older people the same and ignore longevity inequality, they erase these important factors and experiences that make up a person’s health and well-being, potentially leading to inadequate or inappropriate medical care.

“Human diversity reaches its apex in old age,” Aronson writes.

It All Comes Down to Ageism

Nearly all physicians will work with the elderly at some point, but, these days, fewer medical students are studying geriatrics. With this in mind, it comes as no surprise that health care hasn’t properly acknowledged the nuances in the health of older adults. It also makes sense that ageism is common in medical environments.

For improving this misguidance and fighting against ageism, Aronson recommends the CDC start by dividing people not just into childhood and adulthood, but adding “oldhood” to their radar as well.

The first step in proper treatment and care is resisting generalizing an entire group and beginning to recognize the crucial and telling differences in the health of older adults.

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