Ageism in Clinical Practice: A Reflection

Training and ethical practice require that all patients are treated equally, despite their gender, culture, age, and living conditions. Nonetheless, in nurse practice, these aspects tend to impact how nurses view patients, mainly due to previously underlying assumptions on specific issues of people. Effective communication with patients is critical in the best care, and such underlying assumptions about persons have an impact on how nurses communicate with people.

Part one

As earlier described, patients’ differences in race, age, culture, gender, and social-economic status contribute to how the nurse interacts with patients. The underlying assumptions and prejudice ultimately impact on communication, which arguably influences patient care either positively or negatively. Take instance age; nurses consider to be empathetic to older adults and children, which may increase the level of care compared to the middle-aged individual. As a professional, nurse understands that care should individualize, but factors such as age should not comprise care.

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Older adults highly respected in my community, and the older you are, the more respect you get. Individuals with grandchildren, mostly above the age of fifty years, are shown respect barely regarding age. For instance, it is upon the younger people to greet older adults and not vice versa. Also, a person cannot argue with older adults no matter how wrong you think they are. To raise your concerns, a person needs to talk to another older individual, especially their age mates or more former, to increase the person's’ matter. Elders can only confront individuals above sixty years. Older adults are synonymous with “wise.”  

Studies have indicated that such factors indeed impact on patient care. For instance, according to Friedman et al. (2019), the current opioid endemic is heavily concentrated in low-income white communities. The racial/ethnicity disparity has not yet adequately explained. Arguably from a personal perspective in my practice, whites are more likely to be prescribed opioids for pain relief. There is an ungrounded assumption they are less likely to abuse drugs compared to other ethnicities. As an observation, black patients are less likely to get opioids for pain relief, even when the prescriber deems lit fit due to assumptions that they will abuse the drug. Besides, expression of pain tends to be taken more seriously in whites, and thus the tendency to prescribe opioids.

On the contrary, studies have shown that African-American and Hispanics demonstrate lower pain tolerance compared Caucasians. Nonetheless, African-American children suffer more post-operative pain than Caucasian children. Additionally, Caucasian children have higher opioid-related adverse effects after tonsillectomy (Sadhasivam & Chidambaran, 2012). 

It is from such studies that the nurse draws self-reflection into her practice, and admittedly address her assumptions so that they do not interfere with the quality of care nurse provides. As earlier described, a nurse has a prejudice that Caucasians easily complain about their care. Thus, a nurse is more likely not to question their opioid prescriptions so that they do not complain about inadequate pain relief. Additionally, communicating, especially with older Native Americans, often leads to better care. Gender identity in patients has indeed impacted on my practice, particularly with the patient that do not identify with their biological sex. A nurse tends to be more cautious, not to offend them, ideally hindering communication. As a result, it has led to increasing consultations and studying (legal and ethical requirements) on how to handle such patients. Economic status has also influenced nurse judgment in clinical decisions, with the assumption that patients from the low financial background only visit the hospital when it is necessary. Thus, a nurse tends to be through, given that they may live out details to keep the cost of treatment at the minimum.

Through self-reflection, the nurse goes through the patient cases to ensure that nurse prejudice and assumptions do not interfere with the quality of care. The nurse has shortlisted her bias and always do a critical analysis of her clinical decisions.

Part two

 Indeed, the nurse has age bias and have witnessed it in her clinical practice. Ideally, due to her upbringing, unconditional respect accorded to older adults even when they are wrong. It is a deeply rooted bias; thus, nurse more accommodative to older patients compared to younger persons, arguably providing better care. In the USA, older adults above 65 years make up less than 15% of the population, but they account for over 36% of total healthcare costs. Thus, older adults are significant consumers of healthcare.

Nonetheless, the Institute of Medicine (2008) reported that ageism (discrimination towards older persons) across all healthcare disciplines and settings. It argued that such prejudice, stereotypes, and discrimination are potential barriers in the provision of quality healthcare (Wyman, Ezra & Bengel, 2018).  Ageism is related to other forms of discrimination, like racism and sexism. Whereas these rely on unchangeable biological attributes, ageism will affect everyone if they live long enough.

The American Society of Aging categorizes ageism as either implicit or explicit. As a practitioner, it is critical to understand these forms. Implicit ageism occurs in terms of “suggestive” misconceptions and beliefs about older persons, such as they are frail, unsalvageable, or demented. Explicit ageism is outright discrimination. In nurse experience, implicit ageism is far most common, given that it has sometimes guided nurse clinical decisions. The American Society of Age states that ageism puts older patients at risk of overtreatment or under treatment.

Additionally, despite the growing demand for geriatric expertise, it is often viewed as less rewarding, uninteresting, and frustrating. From personal observation, colleagues inclined towards helping younger adults in a higher agency than older adults. An observation Higashi et al. (2012) affirms, “it’s always a time saving when helping a 35-year-old woman with children than it is to bring an altered 89-year-old with a urinary tract infection back to her semi-altered state” a quote from interviewing inpatient care team.

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In the nurse practice, she has indeed perpetrated and observed ageism. However, contrary to the general perspective, nurses concentrate care on older persons. Arguably, it is also a flawed approach in inpatient care, as it could easily result in overtreatment, the same to the nurse healthcare team. Another observation is regarding children, where a nurse tends to be more empathetic with her colleagues included. Admittedly, the nurse has not observed explicit ageism in her practice.

Part 3

Aging is not optional, in fact, from the moment of birth, people are continually aging, and if they are lucky, they get old. Arguably, there is no set age for “old” as getting older is a process, and the biggest issue is how people perceive growing old, which often is not a positive attitude. Even stock quotes like “age is just a number” are often quoted to give “feel good” feeling where people are perceived to be “too old” for certain activities. Thus, it is essential to engage the community to change their perspective towards aging and older adults. As Louis Armstrong stated, “The best age is the age you are.”

According to Bosak (2019), the aging process is complex and can define in terms of personal perspective, legal, chronological, psychological, physiological, and social/cultural. Notwithstanding the definition, attitude towards aging is most critical-and education is the key.

Concerning stereotypes towards older adults (mostly acquired during childhood), one of the nurse strategies would educate younger individuals for a positive attitude towards older adults. Programs to address students and their parents would create a platform to understand misconceptions held against older adults in the community. Grandparents are a living model of older persons, and it essential to encourage both parents and children to spend time with them. Also, encourage the children to visit older persons either in their homes or care facilities. According to Cadieux et al. (2019), positive contact with at least one older adult reduces prejudice. Lytle & Levy (2017) indicate that misinformation and stereotypes about aging perpetuated by insufficient positive intergenerational communication. Levy suggests that students enrolled in aging knowledge courses improved attitudes towards older adults. Thus, nurse strategy in the community would be engaging in community education as part of our outreach program. Therefore, such a program instills positive attitudes in children while eliminating negative attitudes in adults.

One proposed strategy is the PEACE model (Positive Education about Aging and Contact Experiences) (Levy, 2016).

Retrieved from:https://academic.oup.com/gerontologist/article/58/2/226/2632116

As mentioned above, effective communication plays an essential tool in patients’ best care. Because age, race, gender, culture, and social-economic status can contribute to how nurse interacts with patients. Adequate communication helps health nurses to deliver the quality of attention to the patients, which conducts patient satisfaction and health and improves nurse-patient-relationships. As discussed, ageism bias puts older patients at risk of overtreatment or under treatment.it is essential for health nurses to engage the community to change their perspective towards aging and older adults.

References

• American Society of Aging. (2019). Not for Doctors Only: Ageism in Healthcare. Retrieved from https://www.asaging.org/blog/not-doctors-only-ageism-healthcare
• Bosak, S. V. (2019). Addressing Ageism. Retrieved from https://www.legacyproject.org/guides/ageism.html
• Cadieux J et al. (2019). Intergenerational Contact Predicts Attitudes Toward Older Adults Through Inclusion of the Outgroup in the Self. - PubMed - NCBI.
• Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/29401242
• Friedman, Joseph, et al. (2019, April. Assessment of Racial/Ethnic and Income Disparities in the Prescription of Opioids and Other Controlled Medications in California.
• Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6450285/
• Higashi et al., R. T. (2019). (PDF) The worthy patient: Rethinking the hidden curriculum in medical education. Retrieved from https://www.researchgate.net/publication/236197831_The_worthy_patient_Rethinking_the_hidden_curriculum_in_medical_education
• Levy, S. R. (2016, August 10). Toward Reducing Ageism: PEACE (Positive Education about Aging and Contact Experiences) Model. Retrieved from https://academic.oup.com/gerontologist/article/58/2/226/2632116
• Lytle, A., & Levy, S. R. (2017, November 19). Reducing Ageism: Education About Aging and Extended Contact with Older Adults. Retrieved from https://academic.oup.com/gerontologist/article/59/3/580/4641808