Adopted by the 73rd WMA General Assembly, Berlin, Germany, October 2022
The ageing of the population due to increased life expectancy is one of the main challenges of many health systems given the increasing amount of resources needed to provide healthcare for the elderly population. This puts a strain on these systems, since ageing often causes a higher demand for care, with a high dependence on medical, pharmaceutical and hospital services. On the other hand, older people are perceived as recipients of help, care and financial support, which is inaccurate, as they make significant contributions to the well-being of their environment, which has a high social value.
The increase in longevity must be accompanied by appropriate quality-of-care standards, promoting health, reducing risk factors, and providing accessible and sustainable quality health and social services that are accessible, affordable, sustainable and which are of quality.
Biological age should never be used as a basis for discrimination, although it can be a relevant factor in medical decision-making. Reference to age can therefore be professionally sound.
Health discrimination in elderly patients
Elderly individuals experience all kinds of discrimination with one of the main types of discrimination being related to health. The elderly may be perceived as a burden on the healthcare systems and their financial sustainability. Elderly individuals are not uniquely responsible for the increase in healthcare costs in developed countries. There are other factors that play a key role in healthcare costs, such as the improvement in standards of living, accessibility to health services, quality of care and the use of new technologies.
Rationing of certain costly and time-consuming diagnostic or therapeutic procedures or particular settings that have a certain more expensive intensity of care is more common in the elderly population. Clinical trials often exclude patients of a certain age, even if they meet the criteria for enrolment.
Age has become a barrier when putting patients forward for certain interventions. The reasons tend to be physical; however, these may be underpinned by economic motivations, such as the recovery time being higher which increases the length of hospital stay, or by arguing that there are scarce resources and that elderly people have a shorter life expectancy.
There is consensus that from a physiological and psychological point of view, the determining factors for health in ageing patients are intrinsically linked to gender; therefore, the solutions need to address the differences between genders in order to reduce inequalities.
Health discrimination experienced by elderly individuals may have a negative impact on their physical, mental and social well-being and contributes to deterioration in their quality of life, loss of autonomy, confidence, safety and an active lifestyle, in turn, decreasing their levels of health. Is therefore a complex topic that requires the involvement of professionals, institutions, healthcare systems and authorities. Dealing with such discrimination requires awareness and coordination aided by moral and legal principles.
The need for a holistic approach
Healthcare systems do not always adapt to the changing population needs, as may occur with some hospitals, designed to care for adult patients with acute illnesses yet not elderly patients with chronic illnesses.
An increase in longevity must be accompanied by the highest quality-of-care standards, and should promote health, reduce risk factors, and provide accessible, sustainable and quality health and social services. Emphasis should be on patient-focused medicine that heals, cares for, alleviates and comforts.
The ethical duty of physicians
In line with the WMA Declaration of Geneva, physicians must strive to improve the health, well-being and quality of life for all patients without any forms of discrimination towards the elderly.
To governments, medical associations and physicians
- As priority actions, to defend the human rights and health of all individuals, including the elderly, as well as to ensure that their dignity is respected;
- Develop appropriate and non-discriminatory healthcare policies for the elderly based on the efficient use of available healthcare resources;
- To establish measures to eradicate discrimination against elderly individuals in healthcare;
- Provide sufficient resources which ensure adequate healthcare for elderly individuals;
To the WMA, its members and the medical profession in general
- To commit to eliminating all forms of discrimination due to health and age;
- Promote training for primary care physicians on how to approach health problems in elderly individuals;
- Promote development of the geriatric specialty or supplementary post-graduate training and increase of the number of physicians in this field, an increase of the number of physicians in this speciality and an adequate number of geriatric departments in hospitals and consultants, in order to ensure the availability of comprehensive care for elderly individuals;
- Raise awareness and take action against discrimination of elderly individuals;
- Promote ethical, responsible, effective and efficient practices for treating the elderly;
- To set ethical standards that aim to prevent discrimination against any individual due to age;
- To actively try to include elderly patients in medical scientific research;
- Not limit or impede patients’ autonomy on the basis of their age;
- Provide healthcare of scientific and human quality according to good medical practice to all patients, without any discrimination;
- Not apply limitations solely based on age in protocols for diagnosis and treatment;
- To report any discrimination against the elderly that is observed in healthcare.