Legislative Advocacy for Older Adults – Addressing Mezzo- and Macro-Level Issues

Legislative Advocacy for Older Adults – Addressing Mezzo- and Macro-Level Issues

The Elderly

The larger percentage of older adults experience instances of age discrimination in daily life (Allen et al., 2022)

In 2018 alone, the economic cost of ageism in healthcare amounted to 63 billion dollars (Levy et al., 2020).

Medical ageism among healthcare professionals results in both over and under-treatment of illnesses, as well as negative encounters that deter older individuals from seeking medical attention.

Over half of the global population holds ageist attitudes toward older adults, which also leads to adverse health outcomes (Moroianu, A. (2021).

What? (What is the nature of the problem?)

The problem of ageism in healthcare refers to the prejudice, discrimination, and stereotyping experienced by older adults within the healthcare system. This bias can manifest in various ways, including healthcare providers making assumptions about older patients’ abilities, disregarding their concerns, or providing substandard care based on age-related stereotypes. Besides, ageism in healthcare can lead to disparities in access to care, inappropriate treatment decisions, and negative health outcomes for older adults. It undermines the principles of equity and patient-centered care, posing significant challenges to the health and well-being of aging populations (Aronson, L. (2015).

When? (When did this problem arise, when does it manifest itself, etc.?)

Ageism in healthcare has been a longstanding issue rooted in societal attitudes and perceptions towards aging. It likely emerged alongside the development of modern healthcare systems and the aging of populations worldwide. Manifestations of ageism in healthcare can occur at various points along the care continuum, including:

Diagnosis and Treatment: Symptoms displayed by older patients can be dismissed by healthcare providers as a natural part of aging, which can result to delayed diagnosis or inadequate treatment.

Clinical Decision-Making: Healthcare professionals with ageist biases are likely to make medical decisions influenced by these biases, leading to over or under-treatment of medical conditions based on age rather than individual health needs.

Communication and Patient-Provider Interactions: Biased attitudes are known to affect one’s behavior, which would be the case when medical professionals hold ageist stereotypes. Such stereotypes would manifest themselves in behaviors like disregarding the older patient during decision-making for their own health or addressing them in a patronizing manner.

Access to Care: Growing old means that the body is literally breaking down, making one vulnerable to illnesses. Some healthcare providers may be less willing to offer certain treatments or even insurance to older people.

Where? (Where does this problem manifest itself – including national, state and local impact?)

Ageism in healthcare reveals itself across numerous levels, comprising national, state, and local contexts, with repercussions for healthcare provision, policy, and individual patient experiences:

Impact on the National Level: National healthcare policies can unintentionally lead to ageist practices or disparities in care for older adults. American federal agencies, such as the Centers for Medicare & Medicaid Services (CMS), have the responsibility to shape reimbursement policies and quality standards that can affect the care provided to older patients.

Impact on State Level: State-level healthcare systems, such as state Medicaid programs, usually regulate coverage for long-term care services and supports, which can affect older adults’ ability to age in place or access necessary care.

Impact at the Local Level: At this level, various healthcare facilities, such as hospitals, clinics, and nursing homes, can perpetuate ageist attitudes through their organizational cultures and practices. In addition, community-based healthcare initiatives and programs can differ in their inclusivity and ease of access for older adults, depending on local resources and priorities.

Why? (Why does this problem manifest itself, according to literature?)

Ageism in healthcare manifests itself for several reasons, including societal attitudes and stereotypes, biases in clinical decision-making, lack of geriatric training, healthcare system factors, and intersectional factors.

How? (How does it manifest itself?)

Ageism in healthcare can manifest itself in various ways, including underestimation of symptoms, whereby healthcare providers may dismiss or downplay older patients’ symptoms, attributing them to normal aging processes rather than conducting thorough evaluations. This can lead to delayed diagnoses and inadequate treatment. Secondly, older adults may be offered limited treatment options or interventions due to assumptions about their ability to tolerate or benefit from certain medical procedures or medications. Additional manifestations include disregard for autonomy and stereotyping and patronizing communication.

Proposed Solutions

Who (Who is addressing the problem or proposing solutions?)

World Health Organization (WHO): The WHO has recognized ageism as a significant public health issue and has advocated for age-friendly healthcare systems through initiatives such as the Global Campaign to Combat Ageism and the Global Strategy and Action Plan on Ageing and Health. In addition, WHO endorses age-inclusive guidelines and practices to advance healthcare accessibility and quality for older adults on a global scale.

American Geriatrics Society (AGS): This is a professional organization whose main objective is aimed at improving the health, independence, and quality of life of older adults. Similarly, the organization empowers healthcare providers by enhancing their knowledge and skills in geriatric care and combating ageism in clinical practice by providing resources, strategies, and educational programs.

Age-Friendly Health Systems Initiative: Directed by The John A. Hartford Foundation and the Institute for Healthcare Improvement (IHI), this initiative aims to change healthcare delivery, particularly for older adults, by implementing evidence-based practices known as the “4Ms Framework” across healthcare environments.

What? (What is the proposed solution?)

The solution to ageism in healthcare is the adoption of evidence-based models of care whose priority is the unique necessities, preferences, and goals of older patients. An example of such a model is the Age-Friendly Health Systems Initiative’s 4Ms Framework. Notably, this solution strategy underscores centering on what matters to the individual, improves medication use, addresses mentation, and promotes mobility.

Where? (Where have model solutions been implemented?)

There are several healthcare systems in America that have implemented the 4Ms Framework in efforts to improve care for older adults. Examples of these healthcare systems are found in Providence St. Joseph Health Kaiser Permanente, and Ascension Health, which have integrated the 4Ms into their geriatric care programs.

References

Allen, J. O., Solway, E., Kirch, M., Singer, D., Kullgren, J. T., Moïse, V., & Malani, P. N. (2022). Experiences of everyday ageism and the health of older US adults. JAMA Network Open, 5(6), e2217240-e2217240.

Aronson, L. (2015). The human lifecycle’s neglected stepchild. The Lancet, 385(9967), 500-501.

Levy, B. R., Slade, M. D., Chang, E., Kannoth, S., & Wang, S. Y. (2020). Ageism amplifies the cost and prevalence of health conditions. The Gerontologist, 60(1), 174-181.

Moroianu, A. (2021). Global Report on Ageism, World Health Organisation (WHO, 2021). Drepturile Omului, 128.

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LEGISLATIVE ADVOCACY ASSIGNMENT INSTRUCTIONS
OVERVIEW
The Legislative Advocacy Assignment will assist you in advocating for the issues that affect older adults on an individual, community, and broader society or governmental level (mezzo or macro). Your research on current legislative initiatives will allow you to increase your social work competency surrounding challenges, barriers, or upcoming opportunities that may improve the quality of life and aging process for older adults and/or their families.

Legislative Advocacy for Older Adults – Addressing Mezzo- and Macro-Level Issues

INSTRUCTIONS
Using the provided Legislative Advocacy: Fact Sheet Template, identify a current mezzo- or macro-issue that directly impacts older adults. Items to include are outlined as follows: