Clare Bostock is a consultant geriatrician in Aberdeen. In this blog, she looks at issues around ‘date of birth’ and ageism.
It sounds very clichéd to say that I ignore date of birth, and it is not strictly true. I routinely check the date of birth of patients for two key reasons: identification, and as a test of cognition (4AT). The truth is, however, that I don’t think age is important and so I often don’t know how old my patients actually are!
I became acutely aware of this fact when a GP returned my telephone call to discuss a patient with advanced dementia and dependency on others for activities of daily living, who was moving to a care home. I had been keen to discuss anticipatory care planning. Obviously, I had given the date of birth to the receptionist when making the call, but at the time the GP called me back I was not on the ward and I had no notes. The GP asked me how old the patient was and I didn’t have a clue. Initially I felt a bit inadequate, but does it even matter how old a patient is?
I do know that the average age of the acute patients I look after is 84. But, the only time I seem to take notice or remember age is when a patient is very old (say 97 or older) or very young (say 68 but looks 88). It is great fun to be looking after a 108 year old lady who looks 80 and to ask a medical student to play the ‘end-of-bed-age-estimation game.’ As Geriatricians we have a role to play in abolishing ageism and educating others. We need to set an example by treating in a person-centred fashion and according to physiological age, not chronological age.
I was shocked to hear quoted on the radio that the upper-age limit for the ‘Bake Off’ was 95. I was relieved that the entry criteria on the website had no upper-age limit. At home, we have an arts and crafts set with an age range of 5-95. I am delighted to say that my children, aged 5 and 7, cannot give me a single reason why a 100 year old person couldn’t use the set. This may be due to innocence, or is it education? It may also be because they are very small for their age, yet very capable and they appreciate the importance of treating everyone according to their capabilities rather than age. (“Mummy, why can’t I go on the water slide at the swimming pool by myself just because I’m not 8 when I can swim 50m front crawl?”)
I try to make a point of not focusing on age when speaking with relatives. I had a difficult conversation with a family who were visiting on the rehabilitation ward who were very worried that their 95 year old father, and husband, might die soon. The wife was so anxious that it was affecting her ability to drive to the hospital to visit him.
I asked the family what they had noticed about his condition. They knew that he had been in hospital for many months, and tragically had fallen in hospital and broken a hip. They could tell me that his dementia was progressing and he did not recognise his family. They could describe the limited progress he had made with physical therapy and that he was spending (despite our best efforts) most of his time in bed. They were fully aware of his dependence on nursing care for daily activities including eating and drinking.
We could talk about the things they had noticed and we discussed that he was indeed towards the end of his life. The Palliative Performance Scale (PPS) would confirm this and could be shared with them. I never once mentioned his age – to do so could be ageist, and was irrelevant. Besides, the PPS does not mention age, (fortunately).
In stark contrast, on the same rehabilitation ward I have been confronted with non-disguised ageism – from relatives! I have had the pleasure of looking after two memorable nonagenarians. Both females had been assessed by the multidisciplinary team, and there was no reason that either of them could not return home. I was met by a very angry son: “You said my mother could return home and she is 92! Where do you draw the line?!” The answer is that I don’t draw the line on the basis of age, ever. What about you? Where do you draw the line?