By Cassie LaJeunesse
Aging and disabled populations face special challenges in the healthcare arena, both as patients and as practitioners. To shed light on how doctors of chiropractic can work more effectively with these groups, Karen Konarski-Hart, DC, MSDPEM, FACO, FICC, DAAPM, will present a webinar on June 8 at 1 p.m. entitled “Do You See ME? Ableism and Ageism in Healthcare” through LearnACA, ACA’s online learning platform.
“More than 25 percent of adults in the United States have some form of disability,” Dr. Konarski-Hart explained. “Two in five people over the age of 65 have a disability, and by 2030, one in five U.S. residents will be 65 years of age or older.”
While their ranks may be growing, discrimination against people within these populations is common, according to Dr. Konarski-Hart. She cited that 82 percent of adults age 50-80 say that they have experienced ageism in daily life. Dr. Konarski-Hart noted that ageism and ableism exist across health care, especially in situations where healthcare professionals may lack the education or awareness to understand issues that aging and disabled populations face.
For nine years, Dr. Konarski-Hart served on the Council for Chiropractic Education (CCE). During that time, she noticed that chiropractic education is lacking when it comes to patients who are aging or disabled. “In chiropractic and across the board in health care, unless someone’s going into a specialty in geriatrics, there really is minimal in-depth coursework or even textbooks regarding geriatric or disability issues,” she said.
“There is, to my knowledge, no required actual interaction with a geriatric population or a population of people with disabilities, and there is no specific required degree of education in that subject,” she added. This is one reason why Dr. Konarski-Hart wants to educate her fellow chiropractic professionals about these populations.
Medicare Bill Would Increase Seniors’ Coverage of Chiropractic Care
ACA’s advocacy for updated Medicare coverage of chiropractic also sparked Dr. Konarski-Hart’s interest in these issues. “Most patients of age or those that have disabilities are Medicare recipients and vice versa, so we would be getting a large influx of people in the demographic that I’ll be talking about in this webinar,” she said.
“Just like pediatric patients aren’t little adults, many Medicare patients have other issues that make them different—they have comorbidities, they have polypharmacy, they have multiple providers managing aspects of their health usually,” she continued. “And that’s not even touching on potential cognition, their living environment, whether or not they have caregivers, or end-of-life discussions or healthcare decisions. All that lumped together made me feel that we need to raise this as a topic and explore it somewhat.”
During the webinar, Dr. Konarski-Hart will discuss the populations most affected by ableism and ageism and educate attendees about the challenges they face. “I’m hoping that at least it might raise a little more awareness of these issues with our patients,” she said. “Particularly in light of the Medicare initiative we are pushing, we need to get ourselves ready. We need to look at our own practices and the ways we engage with people to see if we can somehow have discussions about how to enhance their access, their communication with us, and their healthcare experience, so they truly feel that they are being cared for. If that happens, I would be thrilled.”
Different Needs, Different Approaches
According to Dr. Konarski-Hart, one of the most important things to recognize when treating aging and disabled patients is that each patient has different needs that may require different approaches, whether in communication or in diagnosis and treatment. “We can work on zeroing in on how this patient best understands and best learns and tailoring how we interact with the patient to how they best understand and respond to our interaction,” she explained. “Some people are very visual, some people are very auditory, some are very hands-on, some need something repeated or written down, some need a caregiver or a family member to come with them to help reinforce whatever the doctor is telling them. It means that we have to be more aware.”
“The first rule of addressing these situations is ‘nothing about us, without us,’” Dr. Konarski-Hart said. “You need to involve those people and their caregivers and the healthcare workers who deal with people with disabilities or advancing age. We need to involve them in the conversation and let them make suggestions.”
She sees chiropractic as an excellent place for this increased awareness in health care to begin, as chiropractic is already a very person-focused healthcare profession. “We have a step up to begin with, but we need to make sure that we are very aware of the differences that we will be facing in people that have disabilities or people that are aging, and we must know that there are things we will need to expand on in our own repertoire — both in diagnosis and treatment options and with history-taking and the examination.”
It’s important to remember that while aging and disabled populations might require more or different medical attention, the end goal of treatment is often the same as with any other patient: to restore quality of life. “One of the things that I think we need to be really aware of is that we should not look at people with disabilities or of advancing age as just needing palliative care,” Dr. Konarski-Hart said. “Most of the people that fall into that demographic want to be active; they want to contribute. We can help these people with their goals, help them become everything they want to be.”
Dr. Konarski-Hart, who was a member of the ACA Board of Governors for nine years and was selected as ACA’s 2021 Chiropractor of the Year, now serves on the ACA Committee on Equity, Diversity and Inclusion, which aims to better understand and address topics of diversity and inclusion within the chiropractic profession. “As members of the ACA CEDI, we explore differences or challenges that people of various demographic minorities face,” Dr. Konarski-Hart said. “Hopefully by exploring that, we can develop awareness of how we, as chiropractic physicians, can serve those people as our patients.”
To register for Dr. Konarski-Hart’s webinar and learn more about ageism and ableism in health care, visit learn.acatoday.org.
Cassie LaJeunesse is an associate in ACA's branding and communications department.