The Daily Telegraph
December 6th 1999

'People are just being written off by system'

By Celia Hall

THE testimony of powerless adults who have watched their parents die in hospital wards in pain, discomfort and without dignity is compelling evidence of age discrimination on the NHS.

The shocking accounts could be dismissed as anecdote, or exceptional cases, were it not for the experiences reported by doctors. These are backed by research carried out by physicians and various relevant charities.

Treatment of cancer, heart disease, strokes and mental health, priorities in Labour's plans to modernise the NHS, each provide plenty of proof that older people do not receive equal treatment.

A series of studies in the mid-Nineties showed that in 20 years the mean age at which people are diagnosed with lung cancer had risen from 65 to 68. Researchers said that by next year 40 per cent of all patients with lung cancer would be over 75.

One study showed that only 39 per cent of patients over 75 had active treatment for their lung cancer compared to 79 per cent under 65. More than half were seen by a geriatrician instead of an expert in lung disease.

Dr Mike Pearson, spokesman for the British Thoracic Society, said: "Nothing has changed since then and new evidence is being published shortly which will show this. How lung cancer is treated is a particularly good example of how age makes a difference to what you get.

"The elderly are still less likely to be referred to a chest specialist and more likely to be treated on a geriatric ward. This is good for rehabilitation but not good for the assessment of lung cancer."

Chronic obstructive pulmonary disorder (COPD) is a classic condition of old age. It makes breathing very difficult but only two to three per cent of the 12 per cent of eligible patients are given non-invasive ventilation, a system of blowing air in through a mask, under pressure, Dr Pearson says.

He said: "Anyone who was independent and active, out and about doing the shopping, before they come into hospital should be eligible for this but not every hospital even has the equipment. We have been recommending this for COPD since 1997.

"People are just being written off. There is a difference between a person's biological age and their chronological age. If you are young biologically, you will do just as well from intensive care whether you are 60 or 80."

There is also clear evidence in the treatment of breast cancer that younger women get a better deal even though the condition is essentially a disease of older women. The risk of breast cancer for a woman of 20 is one in 43,000. By the time she is 50 the risk has risen to one in 56. At 60 it is one 25, at 70 one in 16 at 80 one in 12 and at 85 one in 11.

In the National Breast Screening Programme women are automatically invited for X-rays between 50 and 64. Older women can have this free screening but only if they request it.

Elizabeth Davies, director of the Breast Cancer Coalition is campaigning for the age limit to be removed. She said: "It has just given the impression to older women that their risk actually goes down over the age of 64 when in fact it goes up.

"All we know is that an assumption was made right at the beginning of the programme that there would be poor take-up over the age of 64 and that it would not therefore be cost-effective to invite older women for screening."

Pilot studies are in progress to test response in older women but even these only go up to the age of 69. "Nonetheless, interim results from one of them shows that the take-up is very good," said Mrs Davies. Overall take-up was 75 per cent for women aged 65 to 67 and 73 per cent for women aged 68 or 69. The overall rate for women aged 50 to 64 is 80 per cent.

Mrs Davies said: "Another issue that we hear about regularly is that radiotherapy is not offered to older women after they have had their mastectomy or lumpectomy. Assumptions are made that is is 'too far to travel'. They are not given the chance."

A signal example of how ageism is at work in the NHS is in the treatment of Alzheimer's disease. A Royal Commission on long term care specifically noted that people with Alzheimer's who lived at home were means tested before care was delivered.

"It is an extraordinary anomaly in the system that puts older people at particular disadvantage," said Harry Cayton, chief executive of the Alzheimer's Society. "It is unthinkable that a young person with CJD, another form of dementia, would be means tested for their care."

Historically, dementia has been seen as an inevitable consequence of old age and it seems that attitudes have not changed even though there are now drugs that alleviate the symptoms of Alzheimer's.

Unfortunately, although licensed for NHS use, they are not being prescribed. The main drug, Aricept, works for 50 to 60 per cent of patients but only half the health authorities in the country are prepared to provide the budget for it.

Yet more evidence of how the elderly get a poor NHS deal can be seen in the treatment of strokes, another condition where the incidence rises steeply with age. Up to the age of 44, strokes are suffered by an average of fewer than one in 1,000 people each year. By the age of 74 that has risen to 6.9 and by 84 to 13.39 per 1,000.

It is the third most common cause of death and disability in Britain. But stroke care is haphazard, unfair and unkind. "Stroke care is neglected just because people are old and there is no miracle cure," said Sue Knight, of the Stroke Association. Last month the Royal College of Physicians published its own study of stroke care in NHS hospitals. It found "major failings" and called for urgent action.

Perhaps its most telling finding was that only half of stroke patients had their ability to swallow assessed on arrival at hospital, one of the most basic tests of a person's ability to breath and eat.