In Italy one person in four is at least 65 years old, and the population will continue to age. But what happens when an elderly patient crosses the threshold of a hospital? The risk is that age becomes a shortcut for interpreting symptoms, deciding on treatments, and talking to the patient. Thus old age risks transforming from a personal data into a diagnosis and becoming a stigma
When entering the hospital, an elderly person brings with him much more than his years. It brings a history, habits, desires, illnesses but also resources and the ability to react. Yet one number can be enough, 85, 90, for everything else to fade into the background. Even before the person, you can see the age. Even before the patient, the old man. It is one of the subtlest forms ofageismthe set of age-related stereotypes, prejudices and discrimination that can creep into the very place created to cure: the ward. A symptom is attributed to age, a fall to fragility, a therapy is considered too risky before even asking who that person really is and what possibilities he or she has. In Italy one in four people is at least 65 years old and the population will continue to age.
When age becomes a shortcut
The WHO distinguishes betweenageism stereotypes, prejudices and discrimination. A systematic review published in 2020 and cited byWHO in the Global Report on Ageism examined 149 studies on older people’s access to healthcare services and treatments: in In 127 cases, equal to 85 percent, age was decisive in accessing certain procedures or therapies. The report cites a study conducted on approximately 9,000 patients in five US medical centersin which, as age increased, the probability that some life-sustaining therapies were withdrawn or not offered also increased. For every additional decade of age, the probability of not offering ventilatory support increased by 15%, that of surgery by 19% and that of dialysis by 12%.
Age, of course, matters in medicine: can modify risks, comorbidities and prognosis. The problem arises when it stops being a clinical variable and becomes the variable that decides everything.
«The concept of ageism, as I understand it, is a form of racism towards age: as if the years automatically gave a value, generally negative, to a person’s life» explains to Panorama Renzo Rozzini, psychiatrist, geriatrician and director of the “Wellbeing, Health, Longevity” program of the Poliavventura Foundation-Hospital Institute of Brescia. «But age is only a personal data. A person’s life is made up of genetics, the social conditions in which they grew up, the education they received, the access they had to care, their lifestyles. All these elements produce a state of health which, in many cases, is much less linked to chronological age than we think. Saying “he’s an old man” means nothing. Being ninety doesn’t mean you’re worth less. The problem is that we often see the age first and only then the person».
This is exactly where it comes in geriatricswhich evaluates not only diseases but autonomy, functional capacity, cognitive status, nutrition, therapies and social conditions. «Considering age as a factor that limits access to medical care is not tolerable» continues Rozzini. «If I see a centenarian and simply think “he’s super elderly, so I don’t do this, I don’t proceed with this surgery, I don’t study the case properly”, without asking myself who that person is and what his real chances of recovery are, I risk making a serious medical error.”
The symptom that is attributed to age
THE’ageism in hospital it can be even more subtle when it comes into reading the symptoms. A confused person is dismissed as “senile”, a fall as an inevitable consequence of age, a weight loss as something that “happens over the years”. But age is not a clinical explanation: sudden confusion can be delirium, a fall can be the first sign of a neurological or cardiovascular problem, weight loss is a symptom of malnutrition, depression or cancer. It is not a question of treating the elderly as if they were young, but of recognizing the specificities of age without automatically transforming them into diagnoses. Then there is the way of speaking to the patient. The family member can become the main interlocutor when necessary, but Age alone does not allow one to be excluded from decisions that affect them. Paternalism can be gentle: one speaks slowly, one simplifies, one decides “for his own good”. Or we talk about the patient in front of him. “This attitude can be internalized by the elderly themselves” explains Rozzini further. “If we continue to communicate to a person that, because they are of a certain age, they are less valid, less capable, less interesting and inevitably sicker, sooner or later they may begin to think the same way. And this even happens in hospital. Calling elderly patients “grandparents” it is not a harmless form of kindness: it is a reduction of the person to his simple chronological age.”
It is not for nothing that the WHO considers theageism a serious problem with possible serious repercussions on physical and mental health.
Personalized medicine: Even at ninety, every patient is different
And then there is a contradiction that is difficult to ignore. Contemporary medicine has built increasingly sophisticated tools to precisely describe a disease, establish its severity, evaluate its prognosis and choose therapy, with increasingly personalized methods. But when the patient is very old, that same precision seems to dissolve: age ends up becoming an indistinct clinical category. We know how to stage a tumor perfectly, but when we talk about an elderly person we go back to using vague labels. «If I have prostate cancer, I go to the urologist, I do the tests, I do the staging of the disease and, whether that staging is done in Brisbane, London, Rome or Naples, all the doctors understand perfectly what we are talking about» concludes the psychiatrist. «We have a common language. When we talk about older people, this language becomes much more vague: “the grand old man”, “the grandpa”. But these are labels, which replace the evaluation of the person. The age it cannot become a shortcut to decide how much it is worth treating a person. Medicine has the tools to distinguish these situations, you need to have the culture to use them.” The issue, therefore, is not to eliminate age from medicine, nor to pretend that ninety is equivalent to fifty. It’s exactly the opposite: look at the elderly person with a precision at least equal to that with which we look at his illness. And perhaps it is precisely here that theageism in hospital it becomes more dangerous: not when someone openly declares that an elderly person does not “deserve” a certain type of care, but when they stop asking questions to understand whether that care can help them. When the label takes the place of the evaluation, age becomes not a data in the medical record, but the diagnosis itself: an elderly person enters the hospital bringing with him much more than his years. The task of those who take care of it is to notice it before reading the date of birth.
