Helen Fernandez, MD, on Reframing Aging in Health Care Settings
For Caravan, the newsletter of the Reframing Aging Initiative
Volume 1, Issue 3
Helen Fernandez, MD, Professor of Geriatrics, Palliative Medicine, and Medical Education at Icahn School of Medicine at Mount Sinai in New York City, shares with our readers why she went through training to become a Reframing Aging Facilitator, and how health care professionals can learn to communicate more effectively with patients, caregivers, colleagues, hospital administrators, and community members.
Q: What drew you to the Reframing Aging Initiative? And what led you to take the time to be trained as a Reframing Aging Facilitator?
A: I was always drawn to geriatrics and working with older people because I wanted to improve care for older people. I found that even those of us with good intentions were using words that were fatalistic, like “loss of function” and focusing on frailty and decline. Many years ago, I myself once used the term “silver tsunami” during a broadcast interview, and the host said to me, “That’s not something I’d want to happen to me! I don’t want to be thrown into the tsunami!” Knowing that words matter, I was thrilled to learn a new way to talk about aging, with a more inclusive vocabulary that was more positive and would improve care.
Q: How can reframing aging help health care professionals?
A: The fact is, we have a very important role right now. Not only are we working hard to provide the best care we can for our patients with Covid-19 illness, we are doing so in the face of tremendous ageism. So we need to wear our communicator hats along with our stethoscopes and N95s. Most of us in the medical field don’t think of ourselves as communicators, but in fact, we communicate everyday with many different stakeholders: patients, caregivers, colleagues, hospital administrators, and community members.
Q: What has troubled you about the ageism that Covid-19 has exposed?
A: Resource allocation decisions that use age as a criterion for cutting off care are extremely concerning. Using age as a sole measure for treatment decisions completely disregards the context of who the person is, co-morbidities, and the wishes of the patient and their caregivers. The fact is there is more variety and diversity among older people than among individuals in any other age group.
Another example of ageism arose during the pandemic when our hospital was working to improve its capacity to deliver health care via telemedicine. The general assumption was that older people are digitally incompetent. In reality, the issue was mainly lack of access to the tools required – the iPhone, or tablet, or laptop – especially for marginalized groups. So we used our ingenuity and figured out a way to get used electronics to the patients: our paramedicine partners brought tablets and laptops to individuals and provided instruction on their use.
Q: Do you get much pushback when you suggest to your colleagues that there are better ways to talk about aging and older people?
A: I find that my colleagues come from a place of not having the time to focus on their words or their approach to the issue. It’s not that they are ageist themselves. When decisions need to be made in situations requiring urgency, they fall back on the patterns of thinking and talking that most of us have grown up with. That’s where my reframing aging training becomes so important – I model the reframed language that I want others to adopt. And I use repetition and try to raise awareness whenever I can, whether it’s with the students and fellows in my training programs or with my colleagues.