King Calls for Study on Hidden Costs of Ageism on Health Care

WASHINGTON, D.C. - U.S. Senator Angus King (I-Maine), along with a number of Senate colleagues, is requesting the Agency for Healthcare Research and Quality (AHRQ) examine the impact of ageism on quality and equity of care, patient safety and health outcomes. Ageism in health care is associated with a decreased likelihood that older adults will receive care that meets medical guidelines, as well as an increased likelihood that they are not properly reimbursed for care, and exclusion from clinical trials and other research that is available to the public generally. On a percentage basis, Maine leads the nation with the largest 65 and older population.

"While ageism is often subtle, it is woven into our workforce, our health care system, and our everyday interactions. Ageism undermines older adults and their contributions to our communities. Research shows that 81 percent of adults aged 50-80 report experiencing internal ageism, 65 percent are exposed to ageist messages, and 45 percent face ageism in interpersonal interactions. These staggering statistics demonstrate how ingrained ageism is in our society," wrote the senators.

"Ageism within health care leads to poorer health outcomes, avoidable morbidity, and costly preventable adverse events. Ageism costs the health care system $63 billion annually. In health care, ageism is expressed in our policies, the practices of health care providers, and negative assumptions held by older adults themselves. At the macro level, ageism is complex and reflected in health care access issues which result in older adults being less likely to receive care consistent with medical guidelines, payment policies that do not adequately reimburse for complex care needed for older adults, and exclusion or underrepresentation of older adults in clinical trials and other research," continued the senators.

"With AHRQ's mission to improve the quality, safety, and equity of health care, we believe your organization is well suited to support Congress' effort to address ageism in health care. Results of the requested review will help inform practice, quality improvement efforts, education of health professionals, and policy," concluded the senators.

In addition to King, the letter was signed by Senators Tim Kaine (D-Va.), Bob Casey (D-Pa.) and Bernie Sanders (I-Vt.).

Representing one of the oldest states in the country, Senator King is consistently working to address the issues facing Maine seniors. In the American Rescue Plan, which passed 50 to 49 in 2021, King secured $10 billion in broadband funding to help more Maine seniors access life-saving services like tele-health. The legislation also contained funding to quickly vaccinate older Americans, and to lower the costs of healthcare. Senator King has also worked to increase prescription drug price transparency, expand tele-health services, and spoke on the Senate floor in support of expanded homecare services in the Build Back Better proposal. He also has introduced bipartisan legislation to help improve critical quality-of-life service and programs for American seniors, and bipartisan legislation to cut costs for volunteers in Maine who deliver meals to seniors. This past fall, alongside Senator Mike Rounds (R-S.D.), he introduced the Stand Strong Falls Prevention Act to help prevent painful and costly falls. He also introduced a 'Stand Strong' legislative package that would encourage proactive home modifications and increase access to preventative screenings for older Americans.

The full text of the letter can be found here or below.

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Dear Dr. Valdez:

We write to express our concern about the complexity and pervasive nature of ageism in health care and request that the Agency for Healthcare Research and Quality (AHRQ) examine the impact of ageism on quality and equity of care, patient safety, and health outcomes.

While ageism is often subtle, it is woven into our workforce, our health care system, and our everyday interactions. Ageism undermines older adults and their contributions to our communities. Research shows that 81 percent of adults aged 50-80 report experiencing internal ageism, 65 percent are exposed to ageist messages, and 45 percent face ageism in interpersonal interactions. These staggering statistics demonstrate how ingrained ageism is in our society.

Ageism refers to stereotypes, prejudice, and discrimination directed towards people on the basis of their age. While ageism is often subtle, it is woven into our workforce, our health care system, and our everyday interactions. Ageism undermines older adults and their contributions to our communities. Research shows that 81 percent of adults aged 50-80 report experiencing internal ageism, 65 percent are exposed to ageist messages, and 45 percent face ageism in interpersonal interactions. These staggering statistics demonstrate how ingrained ageism is in our society.

Ageism within health care leads to poorer health outcomes, avoidable morbidity, and costly preventable adverse events. Ageism costs the health care system $63 billion annually. In health care, ageism is expressed in our policies, the practices of health care providers, and negative assumptions held by older adults themselves. At the macro level, ageism is complex and reflected in health care access issues which result in older adults being less likely to receive care consistent with medical guidelines, payment policies that do not adequately reimburse for complex care needed for older adults, and exclusion or underrepresentation of older adults in clinical trials and other research.

At the micro level, practices such as the use of ageist language and elder speak, exclusion of older patients from plan of care conversations, and variations in treatment practices due to a patient's age all affect patients' quality of care. Self-directed ageism can also lead to adverse outcomes for a patient if their beliefs on aging lead them to believe that the symptoms they are experiencing should be considered a "normal" part of aging. For example, while some cognitive decline is expected as we age, memory loss, confusion, changes in behavior, and inability to complete activities of daily living are all signs of changes in cognitive ability that need to be evaluated by a medical professional. Moreover, people who internalize ageist societal messages tend to have poorer physical, cognitive, and mental health. The reverse is also true-individuals who internalize positive aging messages are likely to exhibit benefits in physical, cognitive, and mental health-highlighting the need to promote age inclusivity.

We respectfully request that AHRQ examine this issue and provide a synthesis of existing evidence on ageism in health care to inform efforts to reduce ageism within the health care system. Specifically, we request your assistance to answer the following questions:

• What is the full scope of ageism within health care?
• What is the impact of ageism and intersectionality on both the micro and macro levels of health care related to health equity and outcomes?
• What is the evidence for interventions to address ageism and promote age inclusivity in health care?

With AHRQ's mission to improve the quality, safety, and equity of health care, we believe your organization is well suited to support Congress' effort to address ageism in health care. Results of the requested review will help inform practice, quality improvement efforts, education of health professionals, and policy.

Sincerely,

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