Two stories caught my eye this week. First, that the elderly are being left hanging about in A&E waiting rooms while younger people “with simpler needs” get seen more rapidly, within the four-hour target. “Our study demonstrates older people living with frailty may not be appropriately prioritised within the acute care pathway,” the authors wrote.
And second, a revealing pair of quotations from the Covid inquiry, which has been rooting its way through diary entries by Sir Patrick Vallance. Boris Johnson, according to Vallance, was “obsessed with older people accepting their fate and letting the young get on with life and the economy going”. Later — worse — the notes suggested Johnson had agreed with a suggestion that “we should let the old people get it and protect others”. Forget letting nature take its course — Johnson apparently wanted those most in danger pre-emptively offered up for sacrifice. Perhaps he felt that this would somehow sate the virus, and it would leave the rest of us alone.
This rather Darwinistic approach to the old is not confined to emergencies such as Covid, nor even the rolling crisis in which the NHS now finds itself. There is a broader theme here — a bias against the elderly when it comes to medical care: they are “bedblockers” absorbing valuable resources which should go to someone else. We often fail to notice it, but that’s only because ageism permeates the rest of society too. The majority of older people tend to think of themselves as being in good health (less than one per cent are in hospital at any given time) but there is an unshiftable stereotype about what old age looks like — passive, with failing mental and physical health. “Quality of life” is taken to be low. And what is more, the old tend to be generalised into one homogenous block: unlike at 30, or 50, at 80 you’re assumed to be like everyone else in your age bracket.
There are cut-off points for cancer screenings; invitations for breast screenings, for example, stop at 71
The effect of this is that doctors may be less willing to perform surgery or give “aggressive” treatments to prolong the lives of older people (is it, after all, worth it?). A hospital that leaps at the chance to prolong the life of a young but terminally ill person with all sorts of restrictive symptoms might not offer the same to an 85-year-old who could end up living healthily for much longer.
There are “cut-off” points for cancer screenings — invitation for a cervical cancer check ends at 64, for breast screenings the cut-off is 71, and for bowel examinations it is 74. Older people who want to be checked for these cancers must push for it themselves.
What is the reason for this? The incidence rate of breast cancer gets higher over 80. Almost half of all bowel cancer cases turn up in people over 75. Cervical cancer still gets diagnosed in people over 65.
In response to a campaign to end these age caps last month, a Department of Health spokesperson said that there was a risk “unnecessary” testing could “be a source of anxiety” to old people. But this doesn’t hold up — studies suggest the elderly may in fact cope better psychologically with a cancer diagnosis than other age groups. Is there an assumption that once you are over a certain age, getting cancer doesn’t really matter? “There’s no pleasure worth giving up for two extra years in a nursing home in Weston-super-Mare,” wrote Kingsley Amis. But old age doesn’t have to be like this.
Medical research meanwhile tends to group everyone from 65 to 100 in the same bracket, and exclude them from trials, which means they can suffer from unexpected side effects — after all, bodies change as we get older: veins get weaker and drugs are more likely to cause bleeding. GPs are less likely to refer patients for treatment because of their age. Mental health problems are missed. And this ageism drifts even into the minds of the elderly themselves. A skewed idea of what “normal” ageing looks like has led some patients to miss the early symptoms of Alzheimer’s disease.
But here’s a surprising fact. In some places the number of over-65s in hospital beds has fallen even as this population has grown. Why? Because over time this population has got healthier, and has shorter recovery times. There is an irony to all this — better, quicker treatment of old people might end up putting less of a burden on the NHS, not more.
