Essays

Essays April 2018

Don't Call Me "Dear"

Tricia Harvey

Old jogger 

In Canada, those over the traditional retirement age of 65 now, for the first time, outnumber those under 30. This needn’t be bad news; the process of aging can prove to be as rewarding as it can be challenging, and we are, after all, the generation to have discovered the value of gyms, cycling and running. The generation that followed current diets religiously, and generally had very active, healthy lifestyles is now consequently living longer than ever before. We have always been around, so the sudden alarm at our numbers and the care we might require should not come as a surprise to either the healthcare sector or to governments at provincial and federal levels. Now, however, we are considered to be responsible for the high cost of healthcare.

There are other reasons for healthcare costs appearing to be excessive, though, and this really isn’t our fault! That may sound pathetic when one considers the various recent initiatives focusing on the elderly that all the political parties have included in their campaign promises, but we are the majority, the ones who actually turn out to vote, so why not?

Other initiatives for improvement are being designed in the healthcare sector. Some recently listed in the Hospital News1 are the following:

  1. Senior Friendly Strategies for an Accessible Hospital
  2. Digital Health to Improve Care for Canadian Seniors
  3. Supportive Housing for Seniors
  4. Gaining the Patient Perspective through Age Related Training.

All excellent initiatives, to be sure, but the main problem for many seniors is accessing these services. Apart from visits to your GP, it can be extremely difficult to navigate the systems in Emergency, In-Patient Care, Specialist Appointments and other services, without encountering blatant ageism from the “gatekeepers” -  receptionists, triage nurses and those healthcare providers responsible for organising/providing care and appointments as directed by the physician or surgeon.

This ageism includes many demeaning assumptions:

  • We have no name after the initial introduction. We are addressed thereafter as “dear.”
  • We all have at least mild dementia so there is the regular and automatic use of the Mini Mental Status examination2
  • We don’t have a “real life” so waiting is not a problem.
  • We do not have a real understanding of our condition, remember our medications with any accuracy or previous health related encounters.
  • We are “hard of hearing.”

The overall feeling that the healthcare professional considers younger patients to be more deserving of their care and time becomes obvious at the initial encounter.

These assumptions and approaches to patient care for the elderly frequently result in increased costs for the healthcare system, as patients not treated appropriately often end up requiring admission, deteriorating, and being referred to as “bed blockers.” In addition, the closure of most services over weekends and holidays has a major impact on the ability to provide emergency surgery and other necessary interventions, resulting in a huge cost of patients waiting for care in hospital beds. The patients who wait the longest are usually the elderly.

Simple, basic changes to training for front-line staff in what is variously described as Patient-Focused Care or Client-Centered Care, would make a significant positive improvement to any healthcare experience. This would entail including the patient in their initial care plan, including the family or patient supports in in the development of future care plans, listening to the patient, and taking the time to explain procedures rather than simply expecting the patient to be submissive, and using technology to acquire the patient’s medical history.

The elderly patient also has some responsibility. Take an interest in your own situation, and if possible, take a family member or friend with you to appointments. Prepare for appointments, taking a list of questions with you if necessary. Be responsible in taking whatever medications and other treatments are recommended, and never be afraid to ask questions if you don’t understand. Be assertive with medical professionals, and refuse to be patronised or treated in a dismissive manner.

To benefit all patients, staff and hospitals, schedules must be designed around patient needs rather than staff shifts. Hospital staff must be able to make time for all patients. This imbalance of service and workforce availability over the weekend has a significant effect on treatments available for patients and is often referred to as “the weekend effect.”3

The level of care available should be the same for everyone, every day of the week, but this costs money, so remember – make your voice heard at the ballot box and, if you are over 65, remember how to count backwards from 100 by sevens...4

1 Hospital News. March 2018 Edition.

2 Mini Mental Status Examination: 30 point questionnaire to measure cognitive impairment.

3 Examining the “weekend effect” at Canadian Hospitals, recent report by Canadian Institute for Health Information.

4 Mini Mental Status Examination question. 

About the Author

Tricia Harvey, MCSP, MCPA, Healthcare Consultant

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