As health care providers face an increasingly older population, an adjustment in terminology and mindset may help guide clinical decision making and provider-patient communication.

Rather than associate milestones such as “middle age,” “old” and “elderly” to date of birth, we might consider relating them to life expectancy, which has increased by 26 years over the past century. For example, one measure aligns the onset of middle age with a person’s odds of dying in the next year exceeding one percent; “old age” begins when the odds cross two percent, and “elderly” when they reach four percent. Under that definition, in 1920, “old age” began at 56 years for men (58 for women); today, it is age 70 for men (73 for women). Over the same timeframe, “elderly” has advanced from one’s mid-60s to nearly 80-years-old.¹ Factors such as race and financial status alter the expectations for certain demographic groups, but the shift has been dramatic for all Americans.

One consequence of this that impacts patient safety is a shift in patients’ self-assessment of symptoms (“I’m too young for this to be…”) and extended expectations for an active lifestyle (“I still want to…”). Clinical decisions that imply a patient has exceeded the upper age limit for certain procedures or cancer screenings need to consider more than just birth date. And, as more patients gain direct access to their medical records, notes that refer to a patient as “elderly” (or even “middle aged”) may not be well-received. While perceived “ageism” is an unlikely keystone for a malpractice action, a (perceived) objectionable categorization could weaken the provider-patient relationship that is so essential in shared decision making and—if something does go wrong—mitigating clinical missteps or misunderstandings.

*Includes reserves on open cases and payments on closed cases.

As the table above indicates, the bulk (41%) of medical malpractice claims and lawsuits are brought on behalf of patients ages 40–59, but cases involving older patients are not uncommon. More than one-quarter (30%) of all malpractice cases filed from 2007–2016 involved a patient age 60 or older. Although they account for a slightly smaller percent of total incurred losses (21%), these cases reflect an expectation for living longer, healthier, and more productively than previous generations—and the willingness of plaintiffs’ attorneys to work with older patients and their families.

Patients of all ages deserve their clinicians’ respect and understanding of their expectations for health care. But, as the patient population skews into higher age brackets, providers may want to take a moment to think twice about some hard-wired terminology and consider how a historical mindset about “old” might not align with many of today’s patients.

References

1. Shoven JB. New age thinking: alternative ways of measuring age, their relationship to labor force participation, government policies and GDP. Stanford Institute for Economic Policy Research Discussion Paper No. 08-56. Stanford University, August 2009. 
2. https://censusreporter.org/profiles/01000US-united-states/

Additional Material

• Mortality in the United States: Past, Present, and Future
• Independence Day: How Old Age is a (New) Number
• Growing Old in America: Experience vs. Reality