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Telling a patient, “It’s part of getting older,” or “It’s because you’re getting older,” is often perceived as an insult — even when the doctor knows it’s simply the truth. It’s probable that the patient knows there is truth in that statement as well, but no one wants to hear it and own it.
The doctor can show a patient the report on an x-ray that clearly documents the changes of arthritis. It might even say, “Consistent with patient’s age.” Still, the patient may reject the explanation that it should be attributed to “older” age. Never say “old” age!
Patients are rejecting that physical and cognitive decline is expected with aging. Aging differs a lot from individual to individual. It seems counterintuitive on the part of the patients to believe that age has no effect on functioning. Maybe it’s just that no one wants to admit that they’re old.
Ageism vs. aging
Robert Neil Butler, MD, coined the term “ageism” in 1969 to describe discrimination against senior citizens. It was necessary to have such a term in our society, obsessed with youth and beauty. Negative age-related beliefs about seniors are common, leading to rejection and isolation.
Thanks largely to advances in medicine, longer lives have become the norm. Longer lives, however, are not necessarily happy or fulfilling. Although there is optimism about aging and its fulfilling possibilities, too often, progressive frailty makes the “golden years” not so golden.
Aging has its inevitable and undesirable biological and physiological processes: nuclear and mitochondrial DNA damage, defective DNA repair, telomere shortening, and cells becoming senile. There is unavoidable tissue and organ atrophy and loss of function. Aging is inevitable, but most of us prefer it to the alternative.
Navigating age
What do we do about these conflicts of interest – ageism and what feels like your own body betraying you versus the desire for longevity? It’s no wonder some people hold tight to denial. Doctors aren’t helping their patients, however, if they encourage or collude with patients living in dense, unreasonable denial, with disregard for blatant evidence.
The truth must be told, especially by your physician. Although labeling a condition with a specific disease seems more socially acceptable or a better-tolerated situation to some patients, wasteful and exhaustive quests for obscure ailments are not a reasonable path to acceptance. Some patients keep changing doctors until they hear what they want to hear. If you see enough rheumatologists, immunologists, or neurologists, eventually, you will get a thinly supported diagnosis and a prescription to go with it. Those are tough fields in which diagnosis with certainty can be difficult.
Pursuing these alternative diagnoses can be a path to anxiety and depression, endless testing and doctor’s appointments, and escalating costs. The pursuit can lead to finding new living situations, such as assisted living or even nursing home placement. If your symptoms include pain, as they often do, you will eventually find a physician who will give you narcotics. Those can lead you to desperation to get back to times, places, and physicians who insisted on the truth and cared enough to risk your dislike.
Your doctor should be your best advocate. That requires honesty, integrity, and objectivity. It includes your physician acting in your best interests rather than giving you what you want. I hope that your healthcare providers will have tough conversations with you — with empathy and compassion. Your doctor must not be part of the problem.
