“Too old and expensive” to receive the most advanced treatments, from which they would benefit the most, and to be included in clinical trials to test drugs that they are the first to use. Four out of 10 elderly people are excluded from the best care due to their age. This stigma also shortens life: the risk of mortality is up to 4 times higher. Geriatricians highlight this by raising the alarm about the health needs, especially of the elderly, in which the NHS does not invest enough resources. “A paradox – they point out – the result of a serious and unacceptable stigma based on age, which also reflects on the negative perception of one's own aging, inducing the same elderly person to give up adherence to therapies, screening and preventive behaviours, with serious health effects”.
Ageism is an issue of global significance. According to a study conducted on over 80 thousand people in 57 countries, published in the International Journal of Environmental Research and Public Health, one in two people has age-based prejudices which also influence one of the key sectors of elderly life, namely healthcare, reducing accessibility to care and the appropriateness of treatments.
This is where the Florence Charter was born, the first global manifesto against health ageism, exposed and strengthened also by the pandemic, presented on the occasion of the 'Anti-ageism Alliance' congress. A Global Geriatric Task Force for older adults' care', organized by the Menarini Foundation with the patronage of the Italian Society of Gerontology and Geriatrics (Sigg), which sees the presidents of the major geriatric societies in the world, together with representatives of the World Health Organization and the United Nations, ethicists and representatives of patient associations. The document – coordinated by Andrea Ungar, professor of Geriatrics at the University of Florence, president of the congress and of Sigg, and by Luigi Ferrucci, scientific director of the National Institute on Aging in Baltimore – was developed by an international panel of experts . Published in the European Geriatric Medicine and in the Journal of Gerontology, it focuses on 12 concrete actions to minimize the negative impact of ageism in healthcare and improve the quality of life of the elderly, reducing the costs related to their pathologies.
“Based on age-related prejudices and stereotypes, the elderly are considered to already 'have a sufficient amount of life' and are now burdensome for the social and economic system. Almost a side effect of the medical success which has made illnesses chronic, causing an increase in the coexistence of multiple pathologies in the same individual – states Ungar – The number of elderly people to be assisted has thus increased and, with it, the most widespread form of ageism, i.e. discrimination in the healthcare sector. In fact, although they represent the majority of sick with almost always concomitant chronic pathologies, 40% of elderly people are cut off from the most advanced and appropriate therapies and experimental protocols without valid medical reasons, but only on the basis of age”.
The negative effects of ageism, he points out, “also influence longevity, with older people who have a negative self-perception of aging being up to 4 times more likely to die than those who have a positive view of old age. Internalizing stigma and prejudice could be a new risk factor for a longer life.” This is proven by the results of a study conducted on 5,483 people aged between 50 and 74, published in The Gerontologist by researchers from the New Jersey Institute for Successful Aging, according to which elderly people who have ageist attitudes have a risk of mortality within 9 years up to 4 times higher (45%) than those who have a positive perception of ageing, even taking into account demographic variables of health and lifestyle.
“In the medical community – Ferrucci points out – mental barriers persist which make the use of new drugs and the most innovative therapies considered inappropriate beyond a certain age. We must therefore protect the elderly from healthcare discrimination and ensure that they receive the best care” . “It is inevitable – the experts admit – that where resources are limited, choices are made, but an elderly patient treated ineffectively faces relapses and rehospitalizations and must be treated again with a waste of resources, as well as of life and individual suffering”.
The actions proposed in the manifesto to reverse the trend aim first and foremost at training. The theme of aging – it is asked – must become an integral part of the training path of healthcare personnel and social workers. “A paradigm shift is also necessary in the approach to the care of the elderly – continues Ungar – who cannot be treated 'piecemeal', from time to time by the cardiologist, the neurologist, the diabetologist, but must be followed with It is necessary to take an overall look from the geriatrician as a doctor of complexity. It is also necessary to give priority to the elderly in emergency rooms – he points out – who represent a risk factor due to long waiting times and inadequate care, which can contribute to cognitive decline and worsening of physical conditions”.
The doctor must also seek greater sharing of the treatment path with the patient and his caregivers by correctly informing them of the possible alternatives, listening carefully to their experiences. “Elderly patients – comments Ferrucci – should be included in clinical trials for the testing of drugs from which they are excluded because they are considered too 'polluted' by their frailties, which would involve more sophisticated and complex studies and greater controls. Instead, they are excluded when they are the first to use drugs and therapies. It is equally necessary to redesign hospital environments to make them more age-friendly, reducing patients' isolation and immobility in bed and creating healthcare devices that can be easily used even by those who are older” .
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