By Elizabeth
A Power Point presentation titled “Ageism and Health” from the Waterloo-Wellington Older Adult Council crossed my desk recently and caused me to reflect on my own experience of breast cancer diagnosis and treatment. I was diagnosed in 2024 when, at the age of 74, a routine mammogram identified an anomaly in my left breast. So started the long process of referrals, tests, diagnosis and treatment.
I’ve worked in health care all my life and serve on the board of a seniors’ association. I knew what “ageism” meant …. or did I? Did I experience ageism while being treated for breast cancer? After careful consideration, I’m afraid the answer is “yes”.
According to the Ontario Human Rights Commission, “the term "ageism" refers to two concepts: a socially constructed way of thinking about older persons based on negative attitudes and stereotypes about aging and a tendency to structure society based on an assumption that everyone is young, thereby failing to respond appropriately to the real needs of older persons”.
According to the Power Point presentation from the Waterloo Wellington Older Adult Council, ageism impacts older adult health in four main ways:
- Mental and Physical Health Impacts (anxiety, depression)
- Emotional Challenges (anger, fear, frustration, shame)
- Structural Challenges (being dismissed by self, community, healthcare system; inaccessibility of care; lack of mechanisms or forums to discuss ageist concerns)
- Existential Considerations (start to believe they are out of options to address health concerns; no longer valued/worthy; or at the end of their lives).
The first and most obvious example of “structural” ageism in breast cancer care is cut-off dates for routine screening. Just a few months later I would have been too old for routine screening. My cancer may have gone undiagnosed. Why is there an upper age limit for self-referred breast screening when there is overwhelming evidence to suggest that the risk of breast cancer increases with age?
Another experience of ageism was that of being talked down to. For example, a clerk at the family doctor’s office was giving me misinformation about several upcoming appointments. I pointed out that she had it wrong and she replied “”Don’t worry m’dear. It’ll be alright”. It’s a good job I trusted my own records because I’d have missed several appointments or not prepared for them appropriately. On another occasion, a nurse saw that I was doing the Times Crossword. In a condescending manner, she said, “Oh good for you. That’ll keep your brain working”. Another example was that I attended two different chemo suites. The second had staff who were more mature, more empathetic and better able to communicate with older adults. Not only that, the nurses in the second chemo suite were the only health care professionals to recognize that I was at a very low ebb and acknowledged that I was feeling dismissed as a person. This indicates that perhaps younger staff, while quite capable of giving physical treatment, need better training in how to communicate with older adults in a respectful manner.
In general, I experienced structural challenges such as no explanation as to why my treatment was different to that of younger people. Several symptoms I asked about were dismissed as being due to my age, although I’d had no such symptoms prior to treatment. I didn’t have the energy to question these responses, but I found I had to do a great deal of my own research in order to address significant gaps in my knowledge. I was lucky that I was able to access my health records through the patient portal and knew how to identify reliable online information, but I suspect some older adults may find this a challenge and, as a result, are poorly informed and unable to advocate for themselves.
Under the impact of existential considerations, I felt that many health care professionals assumed that I wasn’t very “bright” and undermined my feelings of self-worth. A surgeon actually gave me two pieces of misinformation (including an incorrect diagnosis) but, when challenged, just shrugged saying he had read the “wrong report”. This certainly contributed to my feelings of anger, uncertainty and depression. I frequently found I had to drop my work history into conversations with numerous health professionals. The change in attitude was stunning, but no one should have to prove their worth.
One, perhaps surprising, indication of ageism was that of applying for travel health insurance. Apart from the fact that I found the application extremely invasive, when I mentioned that I would turn 76 during my proposed trip, the price shot up.
In general, I was given very little information or resources. I don’t, however, think this relates specifically to ageism. I suspect that the system is so overloaded with addressing physical treatment that it is unable to slow the pace and give people the time they need or to address individual social and emotional needs such as agism.
Finally, The Discussion Guide on Ageism in Canada states “One in 5 older adults experiences ageism in healthcare. It is demeaning & disrespectful. It can be dangerous, causing over- and under-treatment and misdiagnosis”. Yes, I’m afraid that the evidence and my personal experience indicate that ageism is alive and well in the treatment of breast cancer.
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