Education And Debate

Ageism in cardiology

BMJ 1999; 319 doi: http://dx.doi.org/10.1136/bmj.319.7221.1353 (Published 20 November 1999) Cite this as: BMJ 1999;319:1353
  1. Ann Bowling, professor of health services research (a.bowling.chime@ucl.ac.uk)
  1. Research Unit on Ageing and Population Studies, Centre for Health Informatics and Multiprofessional Education, Royal Free and University College London Medical School, London N19 5NF
  1. Correspondence to: 222 Euston Road, London NW1 2DA

    In assessing the ability to benefit from treatment, chronological age is less important than other factors concerned with the biological ageing process and the presence of associated disease.1

    Any rationing because of limitation of health resources should be on the basis of assessed individual physiological ability to benefit, not on the basis of age any more than on sex or skin colour.2

    Summary points

    The rates of use of potentially life saving and life enhancing investigations and interventions decline as patients get older

    Ageism in clinical medicine and health policy reflects the ageism evident in wider society

    A wide ranging approach is required to tackle ageism in medicine; clinical guidelines should be improved, more specific monitoring of health care should be introduced, and educational and research initiatives should be developed

    Older people could be empowered to influence the choice and standard of health care offered

    Legislation may be required to end ageism in society

    Evidence

    The ageing of the population is one of the major challenges facing health services. The growing number of older people is likely to place increasing demands on health services for access to effective health technology in cases in which this can enhance the quality, not just the quantity, of life. There is some evidence that age has been used as a criterion in allocating health care3 and in inviting participation in screening programmes.4 However, the idea that a patient's age may be used as an explicit basis for priority setting has rarely been acknowledged.5

    Cardiovascular diseases are a common cause of death and disability among older people, and the use of appropriate health technologies for diagnosis and treatment is expensive. Despite the slightly higher risks of perioperative mortality and morbidity in older people, if they are selected appropriately they are likely to gain …

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