Inequitable access to interventions

We have explored how older people may or may not experience “ageism” using several different approaches. We examined the published academic literature to see how other researchers looked at whether health services and public health care was provided equitably. Much of the research had limitations, often because it used routine data which did not have all the relevant information. Some researchers may have over-interpreted their findings as evidence of ageism when in fact this may or may not be the case in some published papers. We were able to highlight some common issues that we believe need to be considered to improve future research. We then looked at how age was considered by the English National Institute for Health & Care Excellence (NICE) when producing their guidelines. Whilst age was often mentioned, usually in relation to the epidemiology of the condition, there was often no explicit recommendation concerning whether age did or did not affect the cost-effectiveness of any intervention. This left ambiguity for commissioners and providers. Similarly, lack of evidence should be a motivating factor for future research. We then looked at three case studies to see how age may influence access to care. We found that primary care doctors diagnose increasing depression in older people and offer conventional anti-depressant therapies, but the oldest age groups with new depression diagnoses and symptoms have fewer recorded referrals to psychological therapies, and were more likely to be treated with psychotropic drugs, which may or may not have been the most appropriate therapy. This suggests potential inequalities in access to psychological therapies. We also found that older smokers, despite being less addicted to nicotine, were less likely to be offered smoking cessation therapies such as nicotine replacement and counselling. Finally we found that older patients with colon cancer were less likely to receive surgery and/or chemotherapy, though there was some evidence that this gap may be reducing over time. Whilst some of these differences may reflect patient preferences and/or co-morbidity, it is important to ensure that healthy older people who are willing to undertake these treatments are not excluded merely on the basis of their age. This body of work collectively highlights the need to carefully consider are the potential reasons for inequitable access to care among older people and the need for careful monitoring to ensure services are sensitive to the needs of the older population.