Dr Lisa Mitchell1
1Barwon Health, Geelong, Australia
The Royal Commission into Aged Care Quality and Safety in Australia identified ageism as a ‘systemic problem’ with attitudes and assumptions about age affecting delivery and quality of both aged care and healthcare. The experience of ageism can lead to poorer health outcomes in older people and possibly shorten life expectancy. Age may be used as a criterion to exclude older Australians from treatment despite the likelihood of benefit for conditions like cancer, heart disease and stroke. At the same time, age has biological significance. Distinct physiological changes occur with ageing, and the prevalence and mortality of many medical conditions increase with age. Age is often the first information sought from a patient and then shared in clinical handover. Whether worse outcomes in older people is due to biology or the impact of stereotypes and discrimination on treatments offered is unclear.
This paper considers the use of age in clinical decision making by recruiting the principles of beneficence and autonomy, noting that internalised ageism may interfere with an older person’s preferences and that systemic ageism such as the exclusion of older people from clinical trials may cloud the understanding of best interests in the older person. It explores the tension between the biological relevance of age versus the social impact of ageism and their influence on clinical decisions. Relying on a combination of empirical evidence and the author’s experiences as a geriatrician, the paper will demonstrate the difficulty in separating a justifiable use of age from ageism in health decisions.
Lisa Mitchell is a doctor specialising in the care of older people, a clinical ethics consultant and researcher in ageism.