A Nihilist Attitude Diminishes Opportunities For Old People

The Industrial Revolution birthed the start of a longevity revolution as advances in medicine and technology began to influence a rapid rise in average life expectancy. In 1900 average life expectancy in the United States was 47.3 years of age, and by 2000 it was 76.8.[14] Technological advances that improved sanitation and health care and sharply decreased the incidence of infant mortality were significant drivers of growing life expectancy. But the development of the smallpox vaccine by Edward Jenner in 1798 played perhaps the greatest role.[15] Other vaccinations followed in the wake of the triumph over smallpox, as did a range of other medications. Fluorinated water, a focus on nutrition, safety practices, and modern heating and refrigeration extended the longevity trend with safer and healthier home and work environments. The early twentieth century also formalized medicine’s biomedical model, the dominant model driving advancements in health for the century that followed. The biomedical model views health as the absence of disease, infirmity, and disability, focusing on curative solutions. The biomedical model became the dominant framework for shaping our understanding of aging and disability. Disability, and therefore aging by proxy, was viewed as the result of pathology, impairment, or dysfunction of the body. This view spurred the medicalization of aging and disability, circulating the damaging narratives that enabled ageist and ableist thoughts and practices to proliferate.

Stop Whispering

The biomedical model was endorsed as the gold standard of medical training by Abraham Flexner in 1910 when he outlined his vision for the future of academic medical education in what became known as the Flexner Report. Flexner’s work was incredibly influential, resulting in the transformation of medical educational institutions. However, the biomedical model was reductionist with its approach to health as the absence of disease, to disease as the precursor to symptoms and illness, and to symptoms and illness as indicators of an underlying abnormality. We are mortal beings and will all eventually decline and die. However, aging and dying are distinctly different processes. The emergence of the biomedical model meant that growing older was something to be treated. As the focus on curative medicine increased, older and disabled people were often dismissed as a lost cause not worth treating. Although this transition occurred a century ago, these narratives continue to have a colossal impact today. The view of aging as a medical problem had consequences for the overall shaping of the discipline of medicine, from research to training to the structures and missions of organizations.[17] Perhaps most importantly, the biomedicalization of aging profoundly shaped public perception. Aging was officially socially constructed as a medical problem to be diagnosed, treated, and managed. We now recognize the importance of social factors and policies and understand that they are inextricably linked to health outcomes.

In A World Of Pain

Health starts in our homes, schools, and jobs. Health is affected by housing, transportation, the walkability of neighborhoods, education, access to healthy food, access to health care, social support, and the impact of discrimination and stress. Therefore, the opportunities for healthy aging and longevity are shaped in large part by our families, neighborhoods, and all of the external systems that we count on to get the things we need. Without access to safe housing, adequate health care, and healthy food, disadvantages accumulate over the years and disproportionately affect people already at risk, such as people of color and women. This intersectionality, or cumulative discrimination, is exacerbated further as disenfranchisement based on racial and gender identity combine with age oppression. Personal, rather than collective, responsibility for aging was exacerbated further by the fact that during the nineteenth century two schools of thought had emerged to transform ideals of sickness and bodily health. But a British surgeon, Marjory Warren, is considered the mother of geriatric medicine. In the 1940s, Warren advocated for creating a medical specialty focused on the needs and rehabilitation of older people and educating medical students about the care of older people. Warren’s vision provided the seminal theoretical underpinnings of modern geriatrics, which flourished as an interdisciplinary field over the next seventy years. Despite enormous advances in research and practice, the specialty of geriatric medicine remains one of the least favored areas by medical students. Yet there is currently a critical shortage. The most commonly cited reason? Moreover, the roots of ageism within health care are deeply embedded in the health care system itself and extend broadly from the training medical professionals receive to the health care policies that dictate their practices.

Don't Worry About A Thing

Since the 1980s, tremendous progress has been made incorporating specific geriatrics training into medical education. Hartford Foundation facilitated developing core competencies in geriatric domains for medical school curriculums. Yet despite the tremendous need for practitioners and the growing population of older people, interest in geriatrics as a specialization continues to wane. One reason for this lack of interest is an inadvertent hidden curriculum that enculturates medical students’ bias against older people.[28] The hidden curriculum represents the socialization process whereby medical students learn through communication and patient interactions modeled by preceptors. This is where the rubber meets the road in learning about how to be a physician. Ageist biases may lead medical professionals and older patients to believe that pain and suffering are expected aspects of old age. This nihilist attitude diminishes opportunities for older people to seek treatments to improve their quality of life. Socialization in medical training is a powerful influence that should not be underestimated. A 2001 study demonstrated that patterns of treatment recommendations vary solely based on age. I cringe when I think about how many conversations I have witnessed in which a medical professional doesn’t directly address an older person. Several years ago, my dad was having back pain that limited his ability to walk long distances. On one sunny, warm summer day, my family decided to take an outing to a festival to enjoy the weather and the activities. We knew we were taking a chance with my dad walking from the parking lot to the venue, but we risked it. As we were making our way through the crowd, the searing back pain became too intense for my dad to continue and we had to stop. Only there was nowhere to sit.