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Look beyond physical limitations when caring for elderly patients
Older patients are often devalued due to their deteriorating health, mental confusion, social disengagement and economic issues.
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Attitudes of professionals and of the general public toward the elderly are very similar. In 1969, Dr. Robert Butler coined the term “ageism” to describe the phenomenon of discrimination against elderly people in American society.
The stereotype of the older person continues to flourish in all segments of society, regardless of profession. Elderly people are considered a low status group because they are not part of the workforce and not functional to society in any meaningful way. They are devalued as people. They are dependent upon others; many are poor and in frail health. Suffering from chronic, long-term ailments, they lack motivation to improve in light of their inevitable, deteriorating condition.
Alfred A. Rosenbloom
Negative attitudes toward elderly people can be traced back to the arrival of immigrants in America. By leaving their homelands, they also abandoned their pasts and their ancestors. Their expectations were toward the future, their children. In our society, identity is attached to “doing,” not “being.” Aging foreshadows dependency. Elderly people lose respect and status in a society based on independence and autonomy. Death has been relegated to old age. While elderly people were once considered survivors, they are now reminders to all of our common fate.
Professional education
Professionals, despite training in medicine, nursing, social work, psychology, dentistry, public affairs and religion, have received little education about the aging process and elderly people. Possible reasons for their professional attitudes toward the elderly include:
- Few professionals understand what it means to grow old in a physical, social and psychological sense. More is commonly known about older adults with serious problems rather than those who are aging normally and well.
- Professionals themselves harbor fear of death and distaste for aging.
- Professionals’ personal feelings about their own parents or older relatives can conflict with their dealings with an elderly patient.
- The efficient management of an institution such as a nursing home or hospital is accomplished most easily if all patients are treated similarly in the daily regimen.
Beginning in the 1960s, the professions have attempted to debunk the prevailing myths about elderly people by improving education in gerontology and geriatrics in professional schools.
Several years ago, I sent the heads of all schools and colleges of optometry a questionnaire seeking information on whether vision and aging issues were covered in general optometry courses or in a special course on vision and aging. The results verified the general conclusion that all schools did, indeed, provide such instruction.
Optometric educators should also recognize prevailing trends in allied health fields. Browser found that continuing education in gerontology for nurses of all ages improved attitudes toward elderly people. Professional organizations have appealed to their members to apply professional tenets to their work with elderly patients. For example, social work and rehabilitation associations stress each patient’s autonomy and uniqueness in treatment; psychologists remind counselors that people continue to learn and evolve throughout life; medical associations emphasize the importance of quality in an individual’s life.
Actions taken by the professions to ameliorate problems in practice stemming from negative attitudes are varied.
On-the-job training
Most professions have encouraged staff development on the job through ongoing staff training and education in the aging process. Staff members learn that treatment is effective for elderly patients. In rehabilitation treatment, therapists are learning to tailor treatment differently for older adults.
When working directly with an elderly patient, the optometrist may find it more difficult to develop a more positive outlook because elderly people often fit many stereotypes, such as physical decline, mental confusion, social disengagement and economic problems, which may cause the optometrist to view these people in negative ways. These negative attitudes and low expectations may be transmitted to patients, resulting in a diminished quality of care.
The optometrist may truly believe that older individuals should not expect to see, hear, walk, think or communicate very well in their later years. Unknowingly, the optometrist may pass on these attitudes to their patients, who may fulfill these prophesies that may diminish the nature and quality of their vision care.
To overcome these tendencies, the optometrist must view elderly patients in a different way and not define them in strictly physical terms. Physical loss and decline are human realities and, if emphasized, may inevitably lead to negative stereotyping.
The professional outlook is predominantly optimistic. Professionals believe that increased knowledge will eventually alter negative attitudes and eliminate false beliefs about older people. In the human services, more students are choosing to work with older people than ever before. Professional involvement with elderly people offers many interdisciplinary career opportunities for staff in health and human services. Our professional commitment to the elderly patient is recognition that an older person has a right to comprehensive and quality care.
Reference:
- Browser HT. Social organizations and nurses’ attitudes toward older persons. J Geront Nursing. 1980;7(5):293-298.
- Butler RN. Ageism – another form of bigotry. Gerontologist. 1969;9:243.
For more information:
- Alfred A. Rosenbloom Jr., OD, MA, DOS, FAAO, is Distinguished Professor Emeritus at the Illinois College of Optometry in Chicago and served as its dean and then president for more than 25 years. He holds the Donald Krumrey Chair in Low Vision at the Chicago Lighthouse for People Who Are Blind or Visually Impaired and is one of the founders of its Low Vision Rehabilitation Service. Dr. Rosenbloom is also a member of the Primary Care Optometry News Editorial Board. He can be reached at 910 North Lake Shore Drive, Chicago, IL 60611; (312) 664-3550; aarlvpro@sbcglobal.net.