It's not surprising that older adults have more health problems than young people. What is 1 surprising is how poorly this older population is served by our health-care system.

This is partly due to medical ageism, a subtle type of age discrimination that makes it harder to navigate the health-care system as you get older. In a Duke University survey, nearly 80% of respondents older than 60 had been told at least once by their doctors that their ailments were due to age-the implication being that the ailment is simply a result of getting older, so the doctor isn't going to treat it.

Many of the conditions that get more common with age, such as pain, hearing loss and depression, are never fully investigated. Similarly, a doctor might feel that a little knee pain or the leakage of urine is "normal" in older adults. This attitude means that underlying problems might never be diagnosed.

Undertreatment is one consequence of medical ageism...overtreatment is another. Doctors who practice what is known as "cookbook medicine" tend to recommend the same tests and procedures for everyone.

Your doctor should treat you, not your age. Here's what to watch out for-and what to do to make sure that medical ageism doesn't hurt you or a loved one...


Rationing health care is among the most common forms of medical ageism. A doctor looks at the patient's medical record, notes the birth date and then makes certain assumptions.

Example: A patient who complained that he hurt his knee during a tennis match might be advised to take up a less physically demanding sport, such as golf. Or he might simply be told to "take it easy."

I know plenty of 70- and 80-year-olds who are in great shape and play a tough game of tennis, and a few 40-year-olds who are frail. The doctor's job is to address the problem, not to ignore the problem with age-based assumptions.

Self-protection: Don't let your doctor brush off any health issue with a reference to age. Be wary if he/she performs a perfunctory exam or rushes through your history. You should be asked detailed questions such as, "When did the pain start?"..."How many days are there when it doesn't hurt?". "How's your range of motion?" etc.

It's possible that there won't be an easy solution, or any solution, for your problem. If that's the case, make sure that your doctor tells you why. "You're just getting older" is not an acceptable answer.

Outdated Exam

The traditional office exam is not effective for older adults. It was created more than 100 years ago, when people didn't live as long, Information about blood pressure, reflexes, heart sounds, etc., is helpful, but it tells little about how well you function in daily life.

Example: A patient who appears perfectly healthy based on the standard medical exam might be falling every day at home.

Self-protection: Don't wait for your doctor to discover things. Make a list before you go, which might include balance problems, declines in muscle strength, poor hearing or even social isolation, which can lead to depression. These and other functional issues often are more important for long-term health than what is revealed by an exam.

Ideally, your doctor also will perform tests to see how you actually function. He might speak at different volumes to check your "reallife" hearing. You might be asked to walk or to stand up and then sit down. You might be given a list of words and numbers and asked to repeat them.

Helpful: Ask friends and family members if they've noticed things that you haven't. Maybe you keep turning up the volume on the television or asking people to repeat themselves. You might be getting tired more easily or forgetting names more often.

Are You Depressed?

Depression is common in the elderly, but doctors often fail to diagnosis it. This is partly because it takes time to perform a mental health evaluation, so most doctors don't routinely do it. It's also because older adults often experience different symptoms of depression than those who are younger.

Self-protection: Tell your doctor if you've been feeling more irritable lately... have been losing weight...or are eating less regularly. These are common signs of depression in older adults.

Important: If you're suffering from depression, ask for a referral to a gerontologist (an internist who specializes in treating older patients) or a geriatric psychiatrist. Medicines can be helpful, especially when used in conjunction with supportive psychotherapy, but older people respond differently to antidepressants. They may require different doses and/or durations of treatment than younger adults.


Too much medical care is just as dangerous as too little, particularly for those who are taking multiple medications, have underlying health problems and generally are frail.

Example: The mother of a friend of mine has Alzheimer's disease and dementia, as well as diabetes. The doctors and nurses who care for her always are tracking her blood sugar. This requires multiple daily blood sticks...which she thinks is a sign that they're trying to kill her, making her agitated and unhappy. For a patient like this, treating the diabetes this aggressively doesn't make a lot of sense.

Similarly, I would hesitate to subject an 82year-old woman to the inconvenience and stress of a mammogram, particularly if she has had many negative mammograms in the past, no history of breast problems and no family history of breast cancer.

Self-protection: Don't agree to any test or procedure without asking your doctor if the results will change or improve your outcome. You also should ask questions such as, "What will happen if I do nothing?"..."Will the results of this test lead to more tests?"..."What are the side effects of testing?"

A patient might reasonably decide that he wants every possible test and treatment-it's just as reasonable to do the opposite in some cases.

Avoid The Er

According to 2007 data from the National Center for Health Statistics (the most recent data available), about 25% of Americans older than 75 went to the emergency room at least once that year. That's the last place that you want to be except in a real emergency.

In the ER, there's too much care-and too little. Examinations are rushed. There's often a lack of communication among doctors. Patients may be given tests that they don't really need. It's an extremely stressful environment.

My advice: Ask your doctor how you can contact him, or an assistant, at any hour. Certainly don't delay in getting to the ER if you have serious symptoms, such as those of a stroke or heart attack, but other conditions might wait until the next day if you can get the over-the-phone OK from your doctor.

"You're just getting older" is not an acceptable response from a doctor.

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