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Journal ArticleDOI

Ageism in cardiology.

20 Nov 1999-BMJ (British Medical Journal Publishing Group)-Vol. 319, Iss: 7221, pp 1353-1355
TL;DR: The argument that ageism exists in health care, particularly on the equity of access to cardiological services, is supported and a wide ranging approach is necessary if equity in the provision of health care services is to be ensured which includes improvement of clinical guidelines and more specific monitoring of health Care.
Abstract: 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 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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Citations
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Journal ArticleDOI
TL;DR: A crucial gap in the literature, potential intergenerational tensions, is identified, speculating how a growing-older population-and society's efforts to accommodate it-might stoke interGenerational fires, particularly among the younger generation.
Abstract: Age is the only social category identifying subgroups that everyone may eventually join. Despite this and despite the well-known growth of the older population, age-based prejudice remains an understudied topic in social psychology. This article systematically reviews the literature on ageism, highlighting extant research on its consequences and theoretical perspectives on its causes. We then identify a crucial gap in the literature, potential intergenerational tensions, speculating how a growing-older population-and society's efforts to accommodate it-might stoke intergenerational fires, particularly among the younger generation. Presenting both sides of this incipient issue, we review relevant empirical work that introduces reasons for both optimism and pessimism concerning intergenerational relations within an aging society. We conclude by suggesting future avenues for ageism research, emphasizing the importance of understanding forthcoming intergenerational dynamics for the benefit of the field and broader society.

400 citations


Cites background from "Ageism in cardiology."

  • ...For instance, ageism appears in medicine, where medical schools underemphasize geriatrics (Levenson, 1981) and older people often face less aggressive treatment for common ailments, which are dismissed as a natural part of aging (Bowling, 1999, 2007)....

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BookDOI
01 Dec 2005
TL;DR: The Cambridge Handbook of Age and Ageing, first published in 2005, is a guide to the body of knowledge, theory, policy and practice relevant to age researchers and gerontologists around the world.
Abstract: The Cambridge Handbook of Age and Ageing, first published in 2005, is a guide to the body of knowledge, theory, policy and practice relevant to age researchers and gerontologists around the world. It contains almost 80 original chapters, commissioned and written by the world's leading gerontologists from 16 countries and 5 continents. The broad focus of the book is on the behavioural and social sciences but it also includes important contributions from the biological and medical sciences. It provides comprehensive, accessible and authoritative accounts of all the key topics in the field ranging from theories of ageing, to demography, physical aspects of ageing, mental processes and ageing, nursing and health care for older people, the social context of ageing, cross cultural perspectives, relationships, quality of life, gender, and financial and policy provision. This handbook will be a must-have resource for all researchers, students and professionals with an interest in age and ageing.

385 citations

Journal ArticleDOI
TL;DR: Using structural equation modeling, the authors found support for the hypothesized direct negative link between perceived age discrimination and well-being among older adults, with increased age group identification partially attenuating this effect.
Abstract: The authors examined the consequences of perceived age discrimination for well-being and group identification. The rejection-identification model suggests that perceived discrimination harms psychological well-being in low status groups but that group identification partially alleviates this effect. The authors hypothesized that this process model would be confirmed among older adults because their low status group membership is permanent but not confirmed among young adults whose low status is temporary. Using structural equation modeling, the authors found support for the hypothesized direct negative link between perceived age discrimination and well-being among older adults, with increased age group identification partially attenuating this effect. For young adults, these relationships were absent. Differences in responses to discrimination appear to be based on opportunities for leaving a low status group.

296 citations

Journal ArticleDOI
TL;DR: There is a large relative decrease in utilization of coronary angiography among patients with CKD, and alteration in practice because of an aversion to the risk of radiocontrast-associated nephrotoxicity ("renalism") is inappropriate, even if the true relative benefit of invasive strategies is a fraction of what is estimated here.
Abstract: Higher risk patients (including the elderly) receive more conservative therapy for cardiovascular diseases, even though the relative benefits of therapy tend to be greater. The perceived risk of radiocontrast-associated nephrotoxicity may influence the provision of coronary angiography and subsequent revascularization, especially among individuals with chronic kidney disease (CKD). The aim of this study was to determine whether there is excessive variation in the provision of coronary angiography after acute myocardial infarction on the basis of the presence of CKD and whether there is an association between angiography and mortality. Elderly (age 65 to 89 yr) individuals with acute myocardial infarction from the Cooperative Cardiovascular Project were classified by the presence or absence of CKD (defined as a baseline serum creatinine of 1.5 to 5.0 mg/dl). In CKD patients, the propensity to undergo coronary angiography was determined and the effect of coronary angiography on mortality was estimated using multivariable logistic regression and stratification. Mortality was significantly higher with CKD (52.6 versus 26.4%). Fewer patients with CKD underwent coronary angiography (25.2 versus 46.8%) despite the observation that a similar proportion of patients were deemed appropriate for angiography by standard, published criteria. When limiting the analysis to CKD patients who are considered appropriate, the multivariable estimate of the odds of death associated with coronary angiography was 0.58 (95% confidence interval, 0.50 to 0.67). With adjustment using propensity scores, the odds ratio averaged across propensity score quintiles was 0.62 (95% confidence interval, 0.54 to 0.70). Results were qualitatively similar when patients were stratified by CKD stage IV (estimated GFR <30 ml/min per 1.73 m(2)). There is a large relative decrease in utilization of coronary angiography among patients with CKD. Alteration in practice because of an aversion to the risk of radiocontrast-associated nephrotoxicity ("renalism") is inappropriate, even if the true relative benefit of invasive strategies is a fraction of what is estimated here.

264 citations

Journal ArticleDOI
TL;DR: The results of structural equation modeling corroborate previous findings on the importance of beliefs about aging and suggest that aging-related cognitions affect health changes irrespective of control beliefs.
Abstract: We examined the influence of individual views of aging on health changes in later life. We hypothesized that aging-related cognitions affect health changes irrespective of control beliefs and that the impact of aging-related cognitions on health is higher than for the reverse direction of causality. We based our analyses on data from the longitudinal part of the German Aging Survey (N = 1,286; participants were 40-85 years of age at baseline). Because of the selectivity of the sample, we also computed the same analyses for the baseline sample (N = 4,034) with estimated Time 2 data for those individuals who dropped out. The results of structural equation modeling were concordant with our hypotheses, and therefore they corroborate previous findings on the importance of beliefs about aging.

253 citations


Cites background from "Ageism in cardiology."

  • ...SUBSTANTIAL research on ageism has shown that agestereotypes and age discrimination by younger age groups affect the life of older people in multiple areas (e.g., M. M. Baltes & Reisenzein, 1986; Bowling, 1999; Glover & Branine, 2001)....

    [...]

  • ...SUBSTANTIAL research on ageism has shown that age stereotypes and age discrimination by younger age groups affect the life of older people in multiple areas (e.g., M. M. Baltes & Reisenzein, 1986; Bowling, 1999; Glover & Branine, 2001)....

    [...]

References
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Journal ArticleDOI
16 Sep 1992-JAMA
TL;DR: To determine the extent to which the elderly have been excluded from trials of drug therapies used in the treatment of acute myocardial infarction, to identify factors associated with such exclusions, and to explore the relationship between the exclusion of elderly and the representation of women, a systematic search of the English-language literature was conducted.
Abstract: Objective —To determine the extent to which the elderly have been excluded from trials of drug therapies used in the treatment of acute myocardial infarction, to identify factors associated with such exclusions, and to explore the relationship between the exclusion of elderly and the representation of women Data Sources —We conducted a systematic search of the English-language literature from January 1960 through September 1991 to identify all relevant studies of specific pharmacotherapies employed in the treatment of acute myocardial infarction To accomplish this, we searched MEDLINE, major cardiology textbooks, meta-analyses, reviews, editorials, and the bibliographies of all identified articles Study Selection —Only trials in which patients were randomly allocated to receive a specific therapeutic regimen or a placebo or nonplacebo control regimen were included for review Data Extraction —Studies were abstracted for year of publication, source of support, performance location, drug therapies to which patients were randomized, use of invasive diagnostic tests or therapeutic procedures, exclusion criteria, size and demographic characteristics of the randomized study population, and principal outcome measures Data Synthesis —A total of 214 trials met inclusion criteria, involving 150920 study subjects Over 60% of trials excluded persons over the age of 75 years Studies published after 1980 were more likely to have age-based exclusions compared with studies published before 1980 (adjusted odds ratio, 492; 95% confidence interval, 233 to 1054) Trials of thrombolytic therapy involving an invasive procedure were more likely to exclude elderly patients compared with other studies (adjusted odds ratio, 245; 95% confidence interval, 110 to 547) Studies with age-based exclusions had a smaller percentage of women compared with those without such exclusions (18% vs 23%; P =0002), with the mean age of the study population significantly associated with the proportion of women participants ( P =0001, R 2 =29) Conclusions —Age-based exclusions are frequently used in clinical trials of medications used in the treatment of acute myocardial infarction Such exclusions limit the ability to generalize study findings to the patient population that experiences the most morbidity and mortality from acute myocardial infarction ( JAMA 1992;268:1417-1422)

517 citations

Journal ArticleDOI
TL;DR: Blacks with coronary disease were significantly less likely than whites to undergo coronary revascularization, particularly bypass surgery - a difference that could not be explained by the clinical features of their disease.
Abstract: Background Studies have reported that blacks undergo fewer coronary-revascularization procedures than whites, but it is not clear whether the clinical characteristics of the patients account for these differences or whether they indicate underuse of the procedures in blacks or overuse in whites. Methods In a study at Duke University of 12,402 patients (10.3 percent of whom were black) with coronary disease, we calculated unadjusted and adjusted rates of angioplasty and bypass surgery in blacks and whites after cardiac catheterization. We also examined patterns of treatment after stratifying the patients according to the severity of disease, angina status, and estimated survival benefit due to revascularization. Finally, we compared five-year survival rates in blacks and whites. Results After adjustment for the severity of disease and other characteristics, blacks were 13 percent less likely than whites to undergo angioplasty and 32 percent less likely to undergo bypass surgery. The adjusted black:white od...

515 citations

Journal ArticleDOI
10 Apr 1996-JAMA
TL;DR: Among patients presenting with acute ischemic chest pain without persistent ST-segment elevation, blacks appeared to have less severe coronary disease, received revascularization less frequently, and had less recurrent ischemia compared with nonblacks, which suggests that more aggressive strategies should be directed to those patients with the greatest likelihood of adverse outcomes.
Abstract: Objective. —To investigate the natural history and response to treatment of patients with unstable angina or non—Q-wave myocardial infarction (MI). Design. —Inception cohort. Setting. —Patients in general community, primary care, or referral hospitals. Patients. —All patients with an episode of unstable exertional chest pain or chest pain at rest presumed to be ischemic in origin lasting 5 minutes or more but without persisting ST-segment elevation greater than 30 minutes or the development of Q-waves were identified and enumerated in 18 participating hospitals. A subset of enumerated patients was selected to be followed prospectively using specific sampling strategies that would provide adequate numbers of black, women, and elderly (aged ≥75 years) patients for comparison with their respective counterparts. Main Outcome Measures.—The primary analysis compared the incidence of death or Ml at 42 days after entry into the prospective study according to race, sex, and age. Other outcomes considered were recurrent ischemia and the combined outcomes of death, Ml, or recurrent ischemia by 42 days after entry. Results. —A total of 8676 admissions with unstable angina or non—Q-wave Ml were enumerated and, of these, 3318 patients were selected for the prospective study. The direct adjusted mean age of the 3318 patients was 63.8 years. There were 943 blacks and 2375 nonblacks. Compared with nonblacks, blacks were less likely to be treated with intensive anti-ischemic therapy for their qualifying anginal episode and less likely to undergo invasive procedures (risk ratio [RR], 0.65; 95% confidence interval [CI], 0.58 to 0.72;P Conclusions. —Among patients presenting with acute ischemic chest pain without persistent ST-segment elevation, blacks appeared to have less severe coronary disease, received revascularization less frequently, and had less recurrent ischemia compared with nonblacks. Women also were found to have less severe coronary disease and were treated less intensely than men, but experienced similar outcomes. Elderly patients had more severe coronary disease than younger patients on coronary angiography, but were more likely to be treated medically, and they experienced far more adverse outcomes. These data suggest that more aggressive strategies should be directed to those patients with the greatest likelihood of adverse outcomes. (JAMA. 1996;275:1104-1112)

361 citations

Journal ArticleDOI
TL;DR: Higher rates of invasive and revascularisation procedures were associated with lower rates of refractory angina or readmission for unstable angina, no apparent reduction in cardiovascular death or myocardial infarction, but with higher rates of stroke.

357 citations

Journal ArticleDOI
TL;DR: Use of lifesaving therapies for eligible patients with AMI is higher than previously reported, particularly for aspirin and thrombolytic use in nonelderly patients and increased adherence to AMI treatment guidelines is required for elderly patients and women.
Abstract: Background: Evidence-based guidelines for the treatment of patients with acute myocardial infarction (AMI) have been published and disseminated by the American College of Cardiology and the American Heart Association. Few studies have examined the rates of adherence to these guidelines in eligible populations and the influence of age and gender on highly effective AMI treatments in community hospital settings. Methods: Medical records of 2409 individuals admitted to 37 Minnesota hospitals between October 1992 and July 1993 for AMI, suspected AMI, or rule-out AMI, and meeting electrocardiographic, laboratory, and clinical criteria suggestive of AMI were reviewed to determine the proportion of eligible patients who received thrombolytic, β-blocker, aspirin, and lidocaine hydrochloride therapy. The effects of patient age, gender, and hospital teaching status on the use of these treatments were estimated using logistic regression models. Results: Eligibility for treatment ranged from 68% (n=1627) for aspirin therapy, 38% (n=906) for lidocaine therapy, and 30% (n=734) for thrombolytic therapy to 19% (n=447) for β-blocker therapy. Seventy-two percent of patients eligible to receive a thrombolytic agent received this therapy; 53% received β-blockers; 81% received aspirin; and 88% received lidocaine. Among patients ineligible for lidocaine therapy (n=1503), 20% received this agent. Use of study drugs was lower among eligible elderly patients, especially those older than 74 years (thrombolytic agent: odds ratio, 0.2; 95% confidence interval, 0.1 to 0.4; aspirin: odds ratio, 0.4, 95% confidence interval, 0.3 to 0.6;β-blocker: odds ratio, 0.4; 95% confidence interval, 0.2 to 0.8). Female gender was associated with lower levels of aspirin use among eligible patients (odds ratio, 0.7; 95% confidence interval, 0.6 to 0.9); and there was a trend toward lower levels of β-blocker and thrombolytic use among eligible women. Conclusions: Use of lifesaving therapies for eligible patients with AMI is higher than previously reported, particularly for aspirin and thrombolytic use in nonelderly patients. Lidocaine is still used inappropriately in a substantial proportion of patients with AMI. Increased adherence to AMI treatment guidelines is required for elderly patients and women. (Arch Intern Med. 1996;156:799-805)

297 citations