What Is Ageism in Healthcare, and What Can We Do About It?
Key takeaways:
Ageism affects many older adults, who may receive lower-quality healthcare because of age-related bias.
When healthcare providers (HCPs) have fears related to mortality and aging, it can affect their interactions with older adults.
Older adults' treatment options are often limited by HCPs, who are attempting to avoid prolonging patients’ suffering.
Ageism is the practice of discriminating, being prejudiced, and stereotyping based on a person’s age. Ageism is highly prevalent in healthcare settings and impacts older adults’ quality of life and the quality of care they receive.
Many healthcare providers (HCPs) have biases from caring for older adults. Their experiences of treating frail individuals leads them to form opinions about older adults that are not always accurate. Even though HCPs’ behaviors may be unintentional and grounded in a desire to do good and show compassion for older adults, these behaviors deprive patients of their autonomy and diminish their sense of dignity.
HCPs’ ability to care for older adults fairly and compassionately is imperative. Adults over age 65 are the fastest-growing age group and the largest consumers of healthcare services and resources. Let’s explore the conscious and unconscious biases of ageism, the impact on older adults, and how we can find solutions.
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The effects of ageism
Ageism, or age-related discrimination, is problematic in many ways. In some instances, the practice of ageism creates ethical dilemmas. At times, HCPs apply cutoffs for treatment options and resource allocation based on age. These practices limit or create barriers to healthcare access for older adults.
The effects of ageism have been linked to many problems for older adults, including:
Decreased or delayed access to care
Decreased survival rates
Inadequate or inappropriate care
Increased cognitive and functional impairment
Increased medication noncompliance
More emergency room visits
More hospitalizations
Poorer quality of life
If HCPs lack awareness of the unique aspects and presentations of conditions in older adults, it can lead to missed or delayed diagnoses and serious health complications. Additionally, older adults’ access to preventative care and treatment is often limited by HCPs. Services like mammograms, colonoscopies, and vaccinations may not be recommended to older adults, depending on their age.
And participation in research studies and clinical trials is often denied based on age alone. Yet, older people are the largest users of approved drugs.
How HCPs show ageism
HCPs exhibit many forms of ageism. These behaviors can occur consciously (explicitly) or unconsciously (implicitly).
Some negative stereotypes that HCPs tend to hold regarding older adults include the beliefs that the elderly are:
Challenging to care for and work with
Cognitively impaired
Dependent
Depressed
Frail
Lazy
Unproductive
Sick
Weak
HCPs often believe that illness and death among older adults is more acceptable, and that healthcare resources should be prioritized for younger adults. Sometimes, HCPs ignore certain treatment or procedure recommendations based on a desire to help an older patient avoid suffering. However, withholding care and treatment recommendations presents an ethical dilemma of compassionate care versus undertreatment because of ageist beliefs.
Three main themes relating to older adults arise in situations in which HCPs exhibit ageism::
Discriminatory communication patterns
Provision of inappropriate care
Perceived difficulties of working with older adults
Specific behaviors often exhibited by HCPs include:
Avoidance of invasive medical procedures
Lack of emotional engagement
Less patience, respect, and optimism when speaking with older patients
Not including older patients in medical decisions
Patronizing speech, known as “elderspeak”
Ageism research findings
Evaluation of current research supports the above themes. Specific research examples include the following:
A study in Italy demonstrated that older adults were 29% less likely to have access to COVID-19 testing during the initial pandemic wave, when testing resources were considered scarce.
A video of nursing home staff-resident communication provided during care activities demonstrated the use of elderspeak in 84% of the interactions.
In a 2020 survey of older adults in Spain, over half of the participants felt that older adults had suffered age-related discrimination during the pandemic. Of those who reported personally experiencing discrimination, almost 62% indicated it occured when they were attempting to access specialized medical services.
It’s often assumed that older adults are not sexually active. Because of this, their sexual health needs are often not considered and they are excluded from HIV programs.
Anxiety as a driver of ageism
The reasons why HCPs exhibit ageism are fascinating and provide some clues as to how we can combat it.
Death anxiety is a phenomenon that occurs when HCPs associate age with mortality. Older age is associated with death, and being physically close to or even thinking about an older person triggers anxiety about one’s own mortality. Ageism becomes a defense mechanism and a way to disassociate from your own mortality.
Because nurses spend even more time than other HCPs in caring for the elderly, they tend to be particularly impacted by anxiety related to aging. Conversely, HCPs who prefer working with and have more knowledge of older patients have a more positive attitude about aging.
What can we do?
Addressing the issues created by ageism requires multidisciplinary collaboration between governmental agencies and HCPs.
The nonprofit Alliance for Aging Research has recommended addressing what they see as the five key dimensions of ageist bias. These are:
HCPs lack the training in geriatrics required to give proper care to older patients.
Older people are consistently excluded from clinical trials.
Older patients are less likely to receive preventative care.
Older patients often receive inappropriate or incomplete treatment.
Older patients are less likely to be tested or screened for diseases and other health problems.
Recommendations to address these issues include:
Advance geroscience by developing biological treatments that improve health and longevity in older adults.
Build age-friendly healthcare systems that include older adults, family caregivers, and geriatric experts.
Empower and educate older adults.
Increase inclusion of older adults in clinical trials.
Involve family caregivers in monitoring treatment and following up, to enhance communication and improve adherence.
Increase training and education for HCPs in the field of geriatrics.
Use appropriate screening and preventative measures for older adults.
Use interdisciplinary teams to provide person-centered care that meets the goals and preferences of the older adult.
Use interdisciplinary groups with geriatric expertise for complex decision-making that is based on the likelihood of survival rather than purely aged-based determinations.
Monitoring your own behavior for signs of ageism is a personal effort you can commit to. Consider if you routinely do or feel any of the following:
Consider age when making treatment recommendations and decisions
Ignore an older patient and instead direct conversation toward their family member
Make ageist jokes or generalized statements based on a person’s age
Have paternalistic feelings toward older patients, like believing you know what’s best for them without discussing their wishes
Use elderspeak
View older adults as less productive, out of touch, or stuck in their ways
The bottom line
Ageism in healthcare impacts how we care for older adults and their health-related outcomes. Even when HCPs believe they are providing compassionate care, the risk of undertreatment exists. Through examining our attitudes and beliefs, educating ourselves regarding geriatric care, and involving older adults and their caregivers in care decisions, we can increase appropriate levels of care and improve outcomes for older adults.
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