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Conceptualizing surgical ageism to address age-based discrimination.

Alessandro Cucchetti1,2, Giammauro Berardi3,4, Giuseppe Maria Ettorre5

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Ageism in surgery negatively impacts older adults

Keywords:
AgeismCognitive biasesDiscriminationFrailtyRisk assessmentSurgery

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Area of Science:

  • Gerontology
  • Surgical Ethics
  • Health Equity

Background:

  • Ageism compromises older adults' equity, autonomy, and health outcomes.
  • Age-based assumptions lead to underutilization of procedures and delayed interventions.
  • Surgical ageism is an underrecognized form of discrimination.

Purpose of the Study:

  • To conceptualize ageism in surgery by exploring its cognitive, systemic, and ethical underpinnings.
  • To propose actionable strategies to mitigate ageism's impact on surgical decision-making and patient care.

Main Methods:

  • Synthesized data from epidemiological studies, clinical trials, systematic reviews, and health policy reports.
  • Utilized a conceptual framework to analyze cognitive biases, systemic inequities, and ethical considerations.
  • Included evidence from over 149,000 participants across more than 30 studies on cognitive biases.
  • Incorporated data from over 24,000 participants and multiple reviews on systemic inequities.

Main Results:

  • Cognitive biases significantly skew surgical decision-making for older adults.
  • Systemic inequities in transplant referral, clinical trial exclusion, and resource allocation perpetuate surgical ageism.
  • Educational strategies and anti-ageism measures can effectively mitigate ageism in surgery.

Conclusions:

  • Surgical ageism arises from cognitive, structural, and cultural factors.
  • Addressing ageism drivers and implementing inclusive policies promotes person-centered care.
  • Mitigating surgical ageism upholds the dignity and rights of older adults, aligning with global health equity goals.