That has become painfully clear during the coronavirus pandemic, when elderly people with disabilities have difficulty accessing treatment and hundreds of thousands of people have died. Now, Ministry of Health and Human Services And that National Institutes of Health Targeting the failures that caused those problems.
One initiative is increasing access to medical care, equipment, and web-based programs for people with disabilities. Second, we recognize that people with disabilities, including older adults, are a population with special health concerns that require further research and attention.
Lisa Iezzoni, 69, a professor at Harvard Medical School who has suffered from multiple sclerosis since her early 20s and is widely considered to be the father of disability research, calls this development “a way to make health care better for people with disabilities.” “This is an important attempt at fairness.” ”
“For too long, health care providers have not been able to respond to changes in society, changes in technology, changes in the types of assistance that people need,” she says.
Some of Izzoni's notable discoveries in recent years include:
Most doctors are biased. According to the survey results Published in 2021Eighty-two percent of doctors admitted they believed people with serious symptoms. People with disabilities have a poorer quality of life than people without disabilities. Only 57% said they welcome patients with disabilities.
“It's shocking that so many doctors say they don't want to care for these patients,” said Eric Campbell, a professor of medicine at the University of Colorado.
Although this finding applies to people with disabilities of all ages, older people are more likely to live with a disability than younger people. According to the University of New Hampshire Disability Research Institute, about one-third of people over the age of 65, or nearly 19 million people, have a disability.
Doctors do not understand their responsibilities. 2022, Iezzoni, Campbell and colleagues 36 percent of doctors They had little or no knowledge of their responsibilities under the Americans with Disabilities Act of 1990, demonstrating an alarming lack of training. The ADA requires medical practices to provide equal access to people with disabilities and to accommodate their disability-related needs.
The practical impact is that few clinics are equipped with height-adjustable tables or mechanical lifts to allow frail or wheelchair-bound people to receive detailed medical examinations. Very few people have scales to weigh patients in wheelchairs. Also, most diagnostic imaging devices cannot be used by people with severe mobility limitations.
ill-equipped clinic
Iezzoni experienced these problems firsthand. She is dependent on her wheelchair and is unable to transfer to an examination table where her height is fixed. She hasn't weighed herself in years, she said.
The medical impact is that people with disabilities receive less preventive care, have poorer health, and have more co-occurring medical conditions than other people. Physicians too often rely on incomplete information when making recommendations.There is Additional barriers to treatmentpeople with disabilities, Low satisfaction with care they get.
Worse, at the height of the pandemic, when standards of care were developed, people with disabilities and the elderly were considered a low priority. These criteria were intended to allocate care as needed, taking into account the shortage of ventilators and other potentially life-saving measures.
There is no more striking example of the harmful convergence of prejudice against the elderly and people with disabilities. Unfortunately, older adults with disabilities routinely encounter these twin types of discrimination when seeking medical care.
Such discrimination will be clearly prohibited Based on rules proposed by HHS in September. This legislation is his first update in 50 years of Section 504 of the Rehabilitation Act of 1973, a landmark law that helped establish civil rights for people with disabilities.
The new rules set specific and enforceable standards for accessible equipment, including examination tables, scales, and diagnostic equipment. It also requires electronic health records, health apps, and websites to be accessible to people with a variety of disabilities, and eliminates stereotypes of treatment for people with disabilities, such as the standard of care during the coronavirus crisis. policy is prohibited.
“This is going to be a real game-changer for people with disabilities of all ages, especially older adults,” said Alison Berkoff, director of HHS's Office of Community Living. He expects the regulations to be finalized this year and the medical device provisions to take effect in 2026. Healthcare providers will incur additional costs associated with compliance.
Also in September, the NIH designated people with disabilities as a population with health disparities that requires additional attention. This will make new funding streams available and “should facilitate data collection that will allow us to more accurately examine the barriers and structural issues that have held back people with disabilities,” Johns Hopkins University on Disability said. said Bonnielyn Swenner, director of the Human Health Research Center. .
One of the key barriers for older people is that, unlike younger people with disabilities, many older people with disabilities do not identify themselves as disabled.
“Before my mother passed away in October 2019, she became blind from macular degeneration and deaf from genetic hearing loss. But she never said she was disabled.” said Iezzoni.
Similarly, older people who are unable to walk due to a stroke or severe osteoarthritis typically believe that they have a disease rather than a disability.
On the other hand, the elderly are not well integrated into the disability rights movement, which has been led by young and middle-aged people. They typically do not participate in disability communities that provide support from people with similar experiences. And they do not claim accommodations that they may be entitled to under the ADA or the Rehabilitation Act of 1973.
Many seniors don't even realize they have rights under these laws, Swenner said. “We need to think more inclusively about people with disabilities and ensure that older people are fully included in this really important moment of change,” she added.
KFF Health NewsFormerly known as Kaiser Health News or KHN, we are a national newsroom producing in-depth journalism on health issues and one of KFF's core operating programs.
