"If you are not already part of a group disadvantaged by prejudice just wait a couple of decades- you will be."

Changing the Narrative's 2023 Banner on "Imagine a World Without Ageism" https://changingthenarrativeco.org

Laura A. Robbins, an agesim expert and former Program Office for The John A. Hartford Foundation in Generations: Journal of the American Society on Aging, Vol. 39, No. 3, Ageism in America: Reframing the Issues and Impacts (Fall 2015), pp. 17-21

Wow! I can't believe it's been 2 months since I last posted anything on this site. I guess time flies when you're having fun. It's been a good & very busy 2 months I have to say.

In June, I presented a workshop on Ageism and Healthcare at the Center for Modern Aging Princeton's (https://cmaprinceton.org ) Inaugural Symposium on Aging. One of the sources I used in preparing for the presentation had this quote in it, and I think it's a very profound thought. Ageism, which is stereotyping, prejudice, & discrimination based soley on a person's age, affects ALL of us- regardless of skin color, gender, background, social status, sexual orientation, etc. In fact, it can add ON to all of those other issues which are used to discriminate against people. But, whether we like it or not, we will all likely face an ageist comment or action during our lives.

And the healthcare system is rampant with ageist beliefs

As a geriatrician, one of my goals in life is to look beyond chronological age and respect the individual patient in front of me as one individual patient- an older adult with his/her unique background, history, abilities, and priorities.

Soooooooo, let's talk about ageism and how we can hopefully combat it.

The basic definition is as I mentioned above- initially coined by the pioneering geriatrician, Dr. Robert Butler in 1969.

It is estimated to cost society about $63 BILLION due to its negative impacts on health, healthcare access, & healthcare delivery.

There are 3 basic types of ageism:

• Institutional- these are laws, policies, societal norms, & practices that restrict access and systematically disadvantage people based on their age. Think...

  • The lack of geriatricians in the United States because of poor reimbursement for doctors who specialize in this field.

  • The lack of older adults represented in medical & scientific research, often studying the very conditions that are more common as we get older.

  • Medical trainees get more exposure to OB/Gyn or pediatrics than geriatrics despite the fact that most physicians will treat older adults, not younger.

• Interpersonal- comes up during interactions between people. Think...

  • Providers attributing symptoms & complaints to agine rather than considering there may be true disease there

  • Elderspeak- infantalizing, dismissive, & demeaning way we speak to older adults

    • Using a loud voice, slow speech, & repeating yourself automatically when speaking with an older adult

    • "Honey," "Sweetie," "Dear"

    • Calling older adults "cute"

  • The faulty triad during an encounter with a doctor- doctors talk ABOUT a patient with his/her companion rathr than WITH a patient.

• Self-directed- biases & beliefs that are internalized. This can be the most damaging.

  • Feeling like decline & symptoms are inevitable due to age

  • Don't want to bother others - problem becomes ignored & grows

How does ageism impact healthcare?

• Reduces longevity

• Poor quality of life

• Leads to patients more likely to describe their health as "poor"

• Worsens physical illness - missed or delayed diagnoses

• Slower recovery from an illness or disability

• Undertreatment or overtreatment

• Increased ER visits & hospitaliztions

• Patient less likely to seek care out of fear of being belittled/dismissed

• Depression & Anxiety

• Cognitive Impairment

• Increased social isolation & loneliness

When given age alone, there was a study at The Johns Hopkins School of Medicine showed that medical students were more likely to treat pneumonia "aggressively" in a 10 year old girl vs an 85 year old woman.

So, how can we combat this issue?

We (providers & patients) should accept aging as a natural process that comes with "pros & cons," and understand what is considered normal aging vs abnormal.

We should also be mindful of our own biases & challenge them.

We should recognize the heterogeneity & diversity of the population of older adults- "When you've seen one 85 year old, you've seen one 85 year old."

We need more opportunities for intergenerational exposure- this has actually been shown to reduce ageism and ageist beliefs.

A great resource is the organization Changing the Narrative- https://changingthenarrativeco.org

They have many resources to help you understand how you can equip yourself to be empowered, speak up, & know the facts of ageism and aging.

And, of course, if you ever want a physician advocate to help you navigate the healthcare system, look to your local....GERIATRICIAN!