Content area
Full Text
Not all differences are ageist inequities.
To say that ageism exists in Healthcare or long-term care implies that older people are specifically disadvantaged or treated in a less than desirable way because of their more advanced age. Although there are clear instances of ageism in healthcare and long-term care, the situation does not permit treating all differences as ageist inequities. First, some agerelated differences in utilization of health services reflect appropriate variation. second, on some parameters, old people are advantaged compared to people under age 65. That said, ageism does persist, is more pronounced for long-term care than acute care, and is often quite subtle in both spheres.
DISPARITIES
Disparities in the way older people compared to younger people are treated can be divided into access to healthcare services in a general way, which is often related to insurance coverage, and access to particular treatments, specialists, surgeries, and diagnostic tests once the older person is under care. The latter might be considered "internal access" and could be influenced by age-related differences (perhaps clinically appropriate or perhaps due to ageism) in the likelihood of a primary care provider referring to a specialist, or the likelihood of any healthcare provider ordering a particular test or treatment. This aspect of access is closely linked to agerelated disparities in quality. Such disparities may focus on technical aspects of care or the manner of care, including the extent to which the physician spends time on a differential diagnosis, or the extent to which the physician interacts directly with the older person rather than through a younger family member. Even the thoroughness of the primary care evaluation might be different based on age. It is also possible that a primary healthcare provider might make false, ageist assumptions that various symptoms are natural attributes of old age radier than signs of disease.
In health, the term disparity has a disparaging connotation, meaning inequality, unlikeness, or unfairness, yet differences in utilization among subgroups of patients do not necessarily imply disparity or inequity if the rationale behind the difference makes clinical sense. Disparity is closely linked to, but separate from, practice variation. The wide extent of variation in practice has been well documented (Wennberg, 1984,1996). However, differences in the rates of performance for...