- The Washington Times - Monday, December 1, 2003

Growing evidence suggests American seniors are being shortchanged by the nation’s medical system.

Although they have the greatest risk of dying from such diseases as heart disorders, cancer and influenza/pneumonia, numerous studies show that the aged are often passed over for the most aggressive forms of treatment and diagnostic and preventive care that is standard for younger patients.

Informed observers blame the disparity on what they perceive as a long-standing bias against older Americans by medical personnel. They say this bias is based on misconceptions that this patient population cannot tolerate certain treatments, such as chemotherapy, or doesn’t want them.

“Studies show that older people can tolerate chemotherapy and radiation therapy and do just as well as younger people,” said Dr. Charles A. Cefalu, president of the Louisiana Geriatric Society.

Critics also blame doctors for failing to prod older patients to be screened for life-threatening conditions such as breast, cervical, prostate or colon cancer or to be immunized against the flu. While the elderly account for 80 percent of all flu-related deaths in the United States yearly, two-thirds of older Americans fail to get annual flu shots.

“Older people are very disadvantaged by the U.S. medical system. Only about 40 percent of their costs are covered by Medicare and Medicaid. … Care of older people needs to be dramatically improved,” Dr. Robert N. Butler, head of the New York-based International Longevity Center, said in a telephone interview.

“I concur 100 percent,” said Dr. Cefalu, a former board member of the American Geriatric Society. He said Medicare has cut reimbursement of primary care physicians who treat the elderly by 17 percent in the past three years.

More than 60 percent of doctors who offer such care are threatening to end it, if a threatened 4.5 percent reduction in Medicare reimbursement goes through in fiscal 2004, according to Dr. Cefalu.

“Elderly patients take a lot more [of a physicians] time,” he said in a telephone interview.

Dr. Butler, the founding director of the National Institute on Aging, is one of many specialists on aging who criticized the U.S. medical establishment for age discrimination in the November edition of AARP Bulletin.

The report is titled “Discrimination Against Older Patients Still Permeates Nation’s Health Care System.” Dr. Butler first made this accusation 30 years ago and notes he also made it again last fall at a hearing of the Senate’s Special Committee on Aging. The hearing was the first ever to examine the issue of possible bias against seniors in the health care system.

The AARP report cites close to a dozen research studies that document older Americans getting “short shrift” by the medical system.

A survey last year by the American Society of Aging found that two out of three doctors questioned said undertreatment of older cancer patients is common.

In another study, Dr. Wes Ely of the Vanderbilt University Medical Center, said he found evidence of age bias in hospital intensive-care units.

“Although older ICU patients could potentially require more interventions and consume more health care resources, recent studies have shown that older patients actually receive less-aggressive care than do younger patients,” Dr. Ely writes in his report.

According to the American Cancer Society, three-fourths of the 500,000 Americans who die of cancer each year are over 65. Yet ACS says seniors are less likely to be screened for cancer than younger people.

“Studies show that a wide range of other diseases and conditions often go unscreened and undetected, including osteoporosis, glaucoma and even hearing loss,” said the report in the AARP Bulletin by Elizabeth Pope,

She mentioned a study reported by the federal Centers for Disease Control and Prevention earlier this year that found nine of 10 adults over 65 go without the appropriate screenings.

What’s more, a recent survey of students at the Johns Hopkins University School of Medicine found that more than 80 percent said they would admit a 10-year-old girl with pneumonia to the hospital’s ICU and treat her aggressively. But only 56 percent said they would do the same for an 85-year-old woman.

The report in AARP Bulletin also alluded to studies that show many older patients are not given clot-dissolving medications during heart attacks or beta blockers upon hospital discharge that might prevent irreversible cardiac damage.

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