Age Is Not a Diagnosis

My father was 73 when doctors started explaining away his abdominal pain. First pancreatitis, then inflamed mesentery. The pain never stopped, but no one kept looking for the cause. Then came the piercing backaches, the weight loss, and the rash. Still, no one put the symptoms together until a magnetic resonance imaging scan showed cancer in his liver. 

The doctor delivered the pancreatic cancer news to me, not to my father, though he was sitting right there. He died a month later, at 76.

I know pancreatic cancer is hard to catch and harder to cure. But pancreatitis can signal it, inflamed mesentery can mimic it, and my father was diabetic and a bladder cancer survivor. The warning signs were all there. 

What I recognized in his care, through my work in aging, was the more dangerous reflex: doctors mistaking age for diagnosis. That's ageism. It stole three years from my father before cancer took his life. When age becomes a proxy for health, too many people are denied care.

Americans age 55 and older account for 57 percent of health spending and 79 percent of hospital inpatient expenses, yet health care takes its primary customer for granted. A Yale review of 422 studies in 45 countries found ageism linked to worse health outcomes in 96 percent of studies, including denied treatment in 85 percent of studies. Older patients with cancer are often less likely to be offered lifesaving surgery or treatment; similar undertreatment appears in cardiac care and resuscitation decisions. When the same bias shows up in cancer care, cardiac care, and end-of-life decisions, the problem is the system.

When age becomes a proxy for health, too many people are denied care.

Part of that problem is training. Health-care workers with less education in aging show more ageist attitudes and discrimination. Yet geriatric training is limited: Family medicine residents receive about 100 hours over three years, and internal medicine requirements have weakened since 2022 from four dedicated weeks to an unquantified “clinical experience.” Meanwhile, specializing in aging comes with a massive pay cut. Geriatricians average $233,000 a year, less than half the pay of cardiologists or radiologists, leaving fewer than 7,000 board-certified specialists, down from 10,270 in 2000 as the 65-plus population grew 75 percent.

This is not simply a workforce problem. Older adults are far less represented in cancer drug trials than their share of diagnoses, according to a study of nearly 400 trials. To keep data “cleaner,” older adults are excluded because of common later-life conditions. In pancreatic cancer, the bias is especially dangerous: The median age at diagnosis is 70, yet drug trials enroll patients with a median age of 61 to 65. For patients like my father, the health-care system has already determined that older lives are less worth studying, treating, or saving.

And the problem doesn’t stop with health care. The same bias runs through every social determinant of health: older female job applicants receiving 47 percent fewer callbacks, less than 4 percent of US homes supporting changing mobility needs, and media stereotypes that foster isolation with a mortality risk equivalent to smoking 15 cigarettes a day. It’s all ageism, and it explains why Americans live more years burdened by disease than people in over 180 countries. 

That’s unacceptable, but it’s fixable if we stop treating age as a shortcut for health. We need better data that separate outcomes across later life instead of burying three decades inside a single “65-plus” category, and clinical tools that measure a patient’s actual function, risk, and goals. We need stronger laws that make age-inclusive policymaking the norm and give age-discrimination claims real force. And we need to put money where the patients are: training clinicians in aging, reimbursing time-intensive care, scaling proven social-determinant supports, and mobilizing philanthropy, government, public markets, and private capital around our current demographic reality.

For three years, no one found the cause of my father’s pain. At 76, he didn’t need special treatment because of his age. He needed equal treatment. So will all of us.