Although older adults use the lion’s share of health care services, treatment is often geared toward younger patients. More positive eldercare focuses on the benefits of aging.

People over age 65 occupy about 50 percent of all hospital beds, represent 25 percent of all physician office visits and consume about 60 percent of all health care dollars. For these reasons, quality eldercare should be seen as a major initiative of health care providers.
 

Yet, according to Patricia Franklin, program manager at the American Academy of Nursing Coordinating Center, less than one-third of baccalaureate-level nursing programs had even one geriatric nursing faculty member in 2006. In addition, older patients are often treated less aggressively or in ways that are appropriate for younger patients. Health care institutions must better accommodate these elders; one way is to use an approach that focuses on the strengths of aging rather than its downsides.

Ageism Negatively Impacts Eldercare

Ageism remains rampant in our culture and a significant barrier to quality eldercare. Sharon Inouye, M.D., says, “Time and again I saw older people (usually over 70) admitted to the hospital for acute problems and then, almost invariably, these people would do very poorly. I asked myself, ‘What is it that we are doing that causes hospital care to become almost toxic for an older person?’” (Henry and Henry 2007).

She found that treatment practices often are based on assumptions of younger patient protocols and frequently performed more for staff convenience rather than on clear medical or clinical indicators. The Hospital Elder Life Program (HELP) she developed at Yale University School of Medicine and tested at Yale-New Haven Hospital addresses six risk factors for delirium in older people. Among the notable outcomes is a significant reduction in the development of delirium and functional decline. More than 50 health care organizations nationally have adopted HELP.

A 2003 report by the Alliance for Aging Research outlines five key dimensions of ageist bias in health care:

- Many health care professionals do not receive enough geriatric training to properly care for older patients.
- Older patients are less likely than younger people to receive preventive care.
- Older patients are less likely to be tested or screened for diseases and other health problems.
- Proven medical interventions for older patients are often ignored, leading to inappropriate or incomplete treatment.
- Older people are consistently excluded from clinical trials, although they are the largest users of approved drugs.

Notes Neal Flomenbaum, M.D., F.C.A.P., F.A.E.P., of New York-Presbyterian Hospital, who heads the first geriatric emergency medicine fellowship, “People at the extremes of age--very old, neonates and infants--present with significant illnesses, but signs and symptoms may not be consistent with the illness’s seriousness” (Henry and Henry 2007). The aging process affects an older person’s ability to respond to acute medical and physical changes.

Elaine Gould, M.S.W., director of programs at the Hartford Institute for Geriatric Nurses, reminds us, “Older adults are the core business of health care.” Therefore, health care workers can’t afford to cling to unfounded myths about aging (see table 1 below).

Combating Pervasive Stereotypes

Unfortunately, many of these myths tend to become self-fulfilling prophecies on the part of young and old alike. Joseph Heller once said, “Be careful how you interpret the world; it is like that.” Cultural ageism creates lifelong attitudes leading to negative behaviors on the part of elders and the health care providers who serve them.

Fortunately, a growing amount of research suggests the opposite can also be true. In his book, What Are Old People For?, Bill Thomas, M.D., founder of the Eden Alternative movement, documents a transformational approach to elderhood and eldercare. It can be a time of ripening, of reflecting upon one’s life experiences and of capturing periods of richness that help formulate a sense of one’s life purpose and legacy (Thomas 2004).

Gerotranscendence, a term coined by gerontologist Lars Tornstam, Ph.D., instructor of social gerontology at Uppsala University in Sweden, means elders rising above the cultural demands of adulthood and moving in the direction of maturation, wisdom and spiritual growth. The concept of gerotranscendence was based on qualitative and quantitative research from 1990 involving interviews and surveys with thousands of older adults ages 65 to 104 (Tornstam 2005). These elder characteristics and strengths are born out by many of the health care providers interviewed for our books.

In his chapter in Religion, Spirituality and Aging, Eugene Bianchi, Ph.D., reports the results of interviews with more than 100 creative elders. Their strengths compare quite favorably with the research of Tornstam, as highlighted in table 2 below.

Tapping Personal Strengths

Strengths-based care management is based on the premise that elders have a tremendous capacity for continued growth and autonomy and provides techniques and tools to help care managers focus on a patient’s strengths and abilities instead of their pathology, illness or problem. Patients are viewed as competent and able to participate in the planning and delivery processes of the care plan, thus gaining a sense of control over their lives.            

When Longmont (Colo.) Memorial Hospital opened a senior wellness center, the director formed an advisory group of elders named “the wise ones.” Based on their input, traditional wellness classes and activities gave way to more complementary and alternative healing modalities. Today the PrestigePlus Center offers a wide array of healing practices, including tai chi, reminiscence classes, reiki, healing touch acupuncture and Chinese herbal medicine; 70 percent of the clients are over 60.

Granted, not all aging is positive. Many elders encounter health challenges from arthritis to diminished mobility. They often experience financial difficulties, cognitive decline and loss of family and friends. However, when we focus on a person’s strengths, problems may diminish somewhat. It is also true that many elders have more time to volunteer, bestowing blessings on others as well as themselves. Former president Jimmy and first lady Rosalyn Carter are examples of life expansion, not diminishment.

In addition, while we believe the seed of growth toward maturity and gerotranscendence exists in all people, it may never germinate for some because of social, psychological and environmental dynamics. Some elders limp grumpy, stubborn, narrow-minded and decrepit to death’s door. Others display flickers of growth and, if observed over a longer period of time, show flashes of the attributes of holistic aging.

Not Just Older Adults

Elders are not just older adults any more than children are young adults. “Today we have a foundational understanding of what it means to age, and it needs to be shared with almost all caregivers,” states Sarah Kagan, Ph.D., R.N., gerontological associate professor at the University of Pennsylvania School of Nursing. This holds true not only for the clinical issues surrounding the aging process, but for the social, psychological and spiritual dimensions of elderhood; not just to promote competence but because there is no “we and they.” Physicians and nurses are both elder caretakers and future elders. Therefore, attention to clinical indicators is not enough. It becomes imperative to learn as much as possible about holistic aging.