Unmasking bias and perception of lead surgeons in the operating room: A simulation based study

BACKGROUND

Perception of a surgeon based on physical attributes in the operating room (OR) environment has not been assessed, which was our primary goal.

METHODS

A common OR scenario was simulated using 8 different actors as a lead surgeon with combinations of age (<40 vs. >55), race (white vs. black), and gender (male vs. female). One video scenario with a survey was electronically distributed to surgeons, residents, and OR nurses/staff. The overall rating, assessment, and perception of the lead surgeon were assessed.

RESULTS

Of 974 respondents, 64.5% were females. There were significant differences in the rating and assessment based upon surgeon's age (p = .01) favoring older surgeons. There were significant differences in the assessments of surgeons by the study group (p = .03). The positive assessments as well as perceptions trended highest towards male, older, and white surgeons, especially in the stressful situation.

CONCLUSION

While perception of gender bias may be widespread, age and race biases may also play a role in the OR. Inter-professional education training for OR teams could be developed to help alleviate such biases.

Ageism in the COVID-19 pandemic: age-based discrimination in triage decisions and beyond

Ageism has unfortunately become a salient phenomenon during the COVID-19 pandemic. In particular, triage decisions based on age have been hotly discussed. In this article, I first defend that, although there are ethical reasons (founded on the principles of benefit and fairness) to consider the age of patients in triage dilemmas, using age as a categorical exclusion is an unjustifiable ageist practice. Then, I argue that ageism during the pandemic has been fueled by media narratives and unfair assumptions which have led to an ethically problematic group homogenization of the older population. Finally, I conclude that an intersectional perspective can shed light on further controversies on ageism and triage in the post-pandemic future.

The twin faces of ageism, glorification and abjection: A content analysis of age advocacy in the midst of the COVID-19 pandemic

While the government responses to the COVID-19 pandemic have varied across the globe, there has been a unifying cry from academia and public health professionals warning of the detrimental effects of attaching our understanding of this new threat to our already ageist attitudes. What is inescapable is that COVID-19 has an age-related risk component and the latest data shows that risks start to rise for people from midlife onwards. As governance agencies, professional practice, and academia work towards assessing, communicating, and addressing this risk, we ask: are existing gerontological conceptualisations of ageism appropriate for this exceptional situation and what is being (re)produced in terms of an aged subjectivity? Following van Dyk's (2016) critique of gerontology's 'othering' through both 'glorification' (third age) and 'abjection' (fourth age), a content analysis of statements and policy documents issued in response to COVID-19 provides evidence of well-meaning and inadvertent ageism through homogenizing language, the abjection/glorification binary within 'old age', and the power binary constructed between age and an age-neutral midlife. The paper concludes with reflections on future directions for ageism research beyond COVID-19.

Racial/ethnic disparities in colorectal cancer treatment utilization and phase-specific costs, 2000-2014

BACKGROUND

Our study analyzed disparities in utilization and phase-specific costs of care among older colorectal cancer patients in the United States. We also estimated the phase-specific costs by cancer type, stage at diagnosis, and treatment modality.

METHODS

We used the Surveillance, Epidemiology, and End Results (SEER)-Medicare database to identify patients aged 66 or older diagnosed with colon or rectal cancer between 2000-2013, with follow-up to death or December 31, 2014. We divided the patient's experience into separate phases of care: staging or surgery, initial, continuing, and terminal. We calculated total, cancer-attributable, and patient-liability costs. We fit logistic regression models to determine predictors of treatment receipt and fit linear regression models to determine relative costs. All costs are reported in 2019 US dollars.

RESULTS

Our cohort included 90,023 colon cancer patients and 25,581 rectal cancer patients. After controlling for patient and clinical characteristics, Non-Hispanic Blacks were less likely to receive treatment but were more likely to have higher cancer-attributable costs within different phases of care. Overall, in both the colon and rectal cancer cohorts, mean monthly cost estimates were highest in the terminal phase, next highest in the staging phase, decreased in the initial phase, and were lowest in the continuing phase.

CONCLUSIONS

Racial/ethnic disparities in treatment utilization and costs persist among colorectal cancer patients. Additionally, colorectal cancer costs are substantial and vary widely among stages and treatment modalities. This study provides information regarding cost and treatment disparities that can be used to guide clinical interventions and future resource allocation to reduce colorectal cancer burden.

Perception of Old Age by the Inhabitants of Poland

Introduction: People's self-esteem and public perception of senior citizens both play important roles in perceiving old age. The public perception manifests itself in adopting specific attitudes toward the elderly. Aim of the work: The work aimed at attempting to specify how adults and the elderly perceive old age. Material and method: The diagnostic poll method was employed as the main research tool, whereas the Rosenberg Self-Esteem Questionnaire by Morris Rosenberg and the Kogan's Attitudes toward Old People Scale, as well as authors' own sociodemographic variables metrics, were used as research tools. The investigation was administered in a cohort of 206 people living in Poland. Results: The average number of points on the Rosenberg Self-Esteem Questionnaire by Morris Rosenberg (SES) was 29.01 (SD = 4.24). People over the age of 60 (M = 30.07 points), males (M = 32.05 points), those in a relationship (M = 30.22 points), declaring higher education (M = 30.33 points), and a good material situation (M = 30.12 points) enjoyed higher self-esteem. The average number of points on the Kogan's Attitudes toward Old People Scale (KAOP) in the research cohort was 126.48. The assessment of the elderly was higher among those below 60 (M = 127.06), females (M = 127.29), those in a relationship (M = 129.78), those declaring higher education (M = 128.56), and those in a good material situation (M = 126.99). Conclusions: Respondents perceived old age positively, albeit at a low level. It is necessary to review activities undertaken in the sphere of social policy in Poland because activities undertaken to date are failing to improve old age perception. Actions need to be undertaken aiming at raising self-esteem level in Polish senior citizens, and available financial, social, and psychological resources from the government and community associations should all be used to this end.

Effect of Discrimination on Presenteeism among Aging Workers in the United States: Moderated Mediation Effect of Positive and Negative Affect

This study aimed to examine how perceived everyday discrimination influences presenteeism and how conscientiousness moderates the relationship between discrimination and positive affect among older workers. Structural equation modeling (SEM) was used to examine the mediating effect. The moderated mediation model was examined by PROCESS. The results of the final SEM model showed that discrimination was directly positively associated with presenteeism. Furthermore, positive affect was significantly inversely correlated with discrimination and presenteeism. In addition, negative affect was significantly positively correlated with discrimination and presenteeism. The significant indirect effect between perceived everyday discrimination and positive affect was significantly mediated by positive and negative affect. In addition, the results of the moderated mediation model indicate that positive affect was more likely to be influenced by perceived everyday discrimination among older workers with less conscientiousness, as compared with those with greater conscientiousness. To enhance work outcomes of aging workers in the United States, managers should foster highly conscientious aging workers, award those who are hardworking and goal-oriented, and combine personal goals and organizational goals through bonuses, holidays, and benefits. Policymakers should be mindful of the negative impact of discrimination on presenteeism and should target lowly conscientious older workers.

COVID-19 Amplifiers on Health Inequity Among the Older Populations

The coronavirus disease 2019 (COVID-19) is affecting the population disproportionately and is continuously widening the health gap among the population. Based on some recent studies on COVID-19 and the older population, the various cascades toward health inequity have been projected. This study highlights how the COVID-19 is met by health inequity triggers, such as global trade inequality, ageist social regulations, and the existing social inequity. While those triggers are applicable to all the populations, there seems to be specific amplifiers for health inequity among the older populations. In particular, six types of amplifiers have been identified: (1) expansion of riskscape, (2) reduction of social ties, (3) uncertainty of future, (4) losing trust in institutions, (5) coping with new knowledge, and (6) straining on public spending. While the fundamental mitigating responses to health inequity among the older population is tackling existing inequalities, this study may help to shed light on emerging vulnerabilities among the older population to alleviate far-reaching consequences of COVID-19 of the identified inequity amplifiers.

Wellbeing and older adults in primary health care in Poland

INTRODUCTION AND OBJECTIVE

The Polish health service is in need of improvement because of the increasing number of geriatric patients. Identifying the resources available to patients is important for ameliorating deficits. The goal of this research was to measure the health and wellbeing of seniors and to investigate to what extent health services meet their needs. Differences in access and scope of received services between patients from different localities (i.e villages, small towns and big cities) were analysed.

MATERIAL AND METHODS

Questionnaires (Satisfaction with Life Scale; VAS Numeric Pain Distress Scale) and a structured interview assessing the quality of healthcare were carried out in 2015 on a sample of 459 seniors. Each candidate gave consent for participation in the study. Statistica 12.5 software was used for analyses.

RESULTS

The overall measure of satisfaction with life of the respondents (M=22.34 SD=5.78) was good. Inhabitants of small towns had a significantly lower sense of quality of life than seniors from big cities (Tukey HSD = 0.047, p<.05). Multimorbidity and polypharmacy were present to a limited extent. The issue of discrimination of older individuals by medical personnel affected a fifth of seniors living in villages, and one- third of those living in big cities. Geriatric patients did not have equal opportunities for access to medical services.

CONCLUSIONS

State-provided geriatric care is insufficient and does not meet the real needs of patients. A holistic care approach and/or individualized care for older adults are often indicated but are only theoretical constructs in Poland. This inefficient system places the burden of caregiving on the family of the ageing patient. Anxiety among geriatric patients is growing regarding exclusion and lack of care.

Experience with age discrimination and attitudes toward ageism in older patients with cancer and their caregivers: A nationwide Korean survey

OBJECTIVE

It is not clear whether age-related differences in treatment and treatment decision-making are the result of age discrimination or just a reflection of older patients' elevated risk and their own preferences. Therefore, it is critical to understand older patients' own views toward their care in regard to its relationship to age.

MATERIAL AND METHODS

439 older patients with cancer (age ≥ 60) and 358 family members from eleven cancer centers participated in this cross-sectional survey.

RESULTS

Almost all patients (91.2%) and caregivers (92.7%) thought that older patients should be treated equal to younger patients, across all questionnaire items. The proportions of patients who reported having experienced age discrimination according to each item were: disease information (12.3%), treatment information (11.0%), participation in treatment decision (10.7%), attention from healthcare professionals (6.2%), supportive care (5.2%), and treatment (3.2%). Increasing age was the only demographic characteristic that was associated with greater ageism experience (p < .001). Patients' ageism attitudes, as well as caregivers' ageism attitudes, were negatively associated with ageism experience. Ageism experience was associated with a higher depression score, as well as a lower quality of life.

CONCLUSION

Discrimination in treatment and the treatment decision process based on age was not justified. Interventions that address ageist attitudes in older patients, family caregivers, and healthcare professionals are needed to reduce age discrimination, and thereby improve the quality of life of older patients with cancer.

The effect of ageing on health inequalities

The final article in this five-part series on the relationship between sociology and nursing practice discusses age-related health inequalities. Age has a direct influence on individuals' health and wellbeing. From a sociological viewpoint, individuals' health status in old age is a reflection of experiences throughout their lifetime, which means that health inequalities accumulate.

Exclusion of older patients from ongoing clinical trials for hematological malignancies: an evaluation of the National Institutes of Health Clinical Trial Registry

INTRODUCTION

Cancer societies, research cooperatives, and countless publications have urged the development of clinical trials that facilitate the inclusion of older patients and those with comorbidities. We set out to determine the characteristics of currently recruiting clinical trials with hematological patients to assess their inclusion and exclusion of elderly patients.

METHODS

The NIH clinical trial registry was searched on July 1, 2013, for currently recruiting phase I, II or III clinical trials with hematological malignancies. Trial characteristics and study objectives were extracted from the registry website.

RESULTS

Although 5% of 1,207 included trials focused exclusively on elderly or unfit patients, 69% explicitly or implicitly excluded older patients. Exclusion based on age was seen in 27% of trials, exclusion based on performance status was seen in 16%, and exclusion based on stringent organ function restrictions was noted in 51%. One-third of the studies that excluded older patients based on age allowed inclusion of younger patients with poor performance status; 8% did not place any restrictions on organ function. Over time, there was a shift from exclusion based on age (p value for trend <.001) toward exclusion based on organ function (p = .2). Industry-sponsored studies were least likely to exclude older patients (p < .001).

CONCLUSION

Notably, 27% of currently recruiting clinical trials for hematological malignancies use age-based exclusion criteria. Although physiological reserves diminish with age, the heterogeneity of the elderly population does not legitimize exclusion based on chronological age alone. Investigators should critically review whether sufficient justification exists for every exclusion criterion before incorporating it in trial protocols.

Perceived age discrimination in older adults

Objectives: to examine perceived age discrimination in a large representative sample of older adults in England.

Methods: this cross-sectional study of over 7,500 individuals used data from the fifth wave of the English Longitudinal Study of Ageing (ELSA), a longitudinal cohort study of men and women aged 52 years and older in England. Wave 5 asked respondents about the frequency of five everyday discriminatory situations. Participants who attributed any experiences of discrimination to their age were treated as cases of perceived age discrimination. Multivariable logistic regression analysis was used to estimate the odds ratios of experiencing perceived age discrimination in relation to selected sociodemographic factors.

Results: approximately a third (33.3%) of all respondents experienced age discrimination, rising to 36.8% in those aged 65 and over. Perceived age discrimination was associated with older age, higher education, lower levels of household wealth and being retired or not in employment. The correlates of age discrimination across the five discriminatory situations were similar.

Conclusion: understanding age discrimination is vital if we are to develop appropriate policies and to target future interventions effectively. These findings highlight the scale of the challenge of age discrimination for older adults in England and illustrate that those groups are particularly vulnerable to this form of discrimination.

Ageism in stroke rehabilitation studies

BACKGROUND

stroke is predominantly a disease of older people. While age bias has been demonstrated in studies of pharmacological therapeutic interventions in stroke, the extent of discrimination by age in stroke rehabilitation studies is unknown. The aim of this study was to systematically review the literature to assess the extent of ageism in stroke rehabilitation studies.

METHODS

all randomised control trials (RCT) on stroke rehabilitation entered in the Cochrane database which reported mean age were included. Patient gender and exclusion criteria were also recorded.

RESULTS

of 241 RCT's identified, 182 were eligible for inclusion. The mean age of all patients was 64.3, almost a decade younger than those seen by stroke physicians in daily practice in global terms, and 11-12 years younger than encountered in hospital practice in the British Isles. Almost half (46%) of trials excluded patients with cognitive impairment, almost one-quarter (23%) patients with dysphasia and one-eighth (13%) excluded patients with multiple strokes.

CONCLUSION

we have identified a clear difference in the mean age of those included in stroke rehabilitation studies compared with the international mean age of stroke. In addition, a quarter of trials excluded dysphasic patients which may indicate omission of more severe strokes. This means that the evidence base for stroke rehabilitation is deficient in terms of matching the characteristics of patients encountered in clinical practice, and a more representative sample of older people and those with significant disability must be included in future trials.

College students' ageist behavior: the role of aging knowledge and perceived vulnerability to disease

This cross-sectional study examined the associations among perceived vulnerability to disease, aging knowledge, and ageism (positive and negative) in a sample of undergraduate students enrolled in a human development course (N = 649; M age = 19.94 years, SD = 2.84 years). Perceived vulnerability to disease and aging knowledge were associated with self-reported ageist behaviors. Undergraduates who viewed themselves as more susceptible to disease and knew less about the aging process tended to report more negative ageist behavior. Sex moderated the association between aging knowledge and ageist behavior, indicating the association was stronger for males. Discussion focuses on implications for gerontology educators.

Ageism and clinical research

Despite being the most significant consumers of health care resources and medications worldwide, recent international research has highlighted the under-representation of older participants from clinical trials. This creates problems for physicians as the patients seen in clinical practice are not representative of those on which medical treatments and interventions have been trialled, and we need to consider whether results (both negative and positive) from these trials are applicable to these patients. Our aim was to gauge whether exclusion of older people was prevalent in research proposals submitted to Dublin teaching hospitals. We audited all clinical research proposals submitted to the Research Ethics committee (REC) covering the teaching hospitals attached to Trinity College Dublin (TCD) from July 2008 to July 2011 inclusive, recording exclusion of patients based on an arbitrary upper age limit. Of the 226 relevant trials studied, 31(13.7%) excluded participants based solely on an arbitrary upper age limit. 22 (9.8%) of the relevant trials were submitted by geriatricians, none of which excluded patients based solely on age. Over 50% (12 of 22) trials submitted by neurology/psychiatry excluded patients based on an upper age limit. The mean upper age limit used over all trials as a cut-off was 69.2 years of age. As well as this, the majority of the remaining trials also contained other exclusion criteria, especially those based on cognitive function which further limited participation of older people. While we found that a significant proportion of clinical trials submitted to the TCD REC still excluded patients based arbitrarily on an upper age limit, participation rates of older people seem to be higher in this Irish centre than that seen in international trials. Significant room for improvement still remains however and there needs to be a promotion of greater awareness of the need for developing, testing and licensing medicines so that it mirrors the consumer groups in which they will be used. Increased input from geriatricians around the testing and licensing of medicines, and in licensing agencies, would greatly help in this regard. It is both unhelpful for optimal healthcare as well as fundamentally unjust to exclude participants from clinical research based solely on an arbitrary age limit.