May 1, 2019

Ageism is an 'insidious problem.' Here's how providers are tackling it.

Daily Briefing

    Ageism, or discriminating against people based on their age, is prevalent in today's society, from health care biases to media depictions—and the discrimination can have lasting effects on older adults' physical and mental health, Paula Span reports for the New York Times.

    Cheat sheet: What you need to know about the geriatrics market

    The prevalence of ageism

    The prevalence of ageism caught Span's attention about a year ago, when she noticed an ad for a food delivery service that read: "When you want a whole cake to yourself because you're turning 30, which is basically 50, which is basically dead."

    The company eventually pulled the ad, but Span writes the marketing campaign—and others like it—"constitute mere microaggressions compared to the forms ageism often takes: pervasive employment discrimination, biased health care, media caricatures or invisibility."

    In health care, geriatric providers have observed the problem. Ronald Adelman, co-chief of geriatrics at Weill Cornell who developed the school's senior mentoring program, said he's recorded and analyzed a number of visits in which a spouse or adult child accompanies a senior and starts asking all of the questions related to the patient. "The older person, who is cognitively fine, is just excluded, referred to as 'he' or 'she,'" Adelman said. "It can undermine the relationship between the older patient and the doctor."

    Most medical research also excludes older adults, which Span has noted forces doctors to "make educated guesses about drugs and procedures, and how much they will help or hurt."

    Alana Officer, who is leading a World Health Organization campaign against ageism, said ageism is "an incredibly prevalent and insidious problem," which "affects not only individuals, but how we think about policies."

    How ageism affects health

    According to Becca Levy, a social psychologist at the Yale School of Public Health, "These stereotypes can have direct impact on older people's health and function."

    Levy, who is leading WHO's effort to review of studies on health consequences of ageism, has performed decades of research on the subject and determined that older adults who internalize ageist stereotypes are less likely to recover from disability than adults who view aging in a positive way.

    Older people who internalize the stereotypes also have a higher risk of dementia, according to Levy. "They have greater accumulations of plaques and tangles in the brain, the biomarkers of Alzheimer's disease, and a reduced size of the hippocampus," which is associated with memory.

    How to fight ageism

    On the other hand, adults who view aging on positive terms are more likely to practice preventive health measures, experience less anxiety and depression, and live longer, according to Levy. And existing research suggests interventions to combat ageism may be effective, Span writes.

    For example, she cites a soon-to-be-published research review by Cornell University researchers that found three types of anti-ageism programs that aim to change people's attitudes about ageism were effective:

    • Intergenerational programs, which were developed to increase contact between younger people and older people;
    • Educational programs, which taught facts about aging people in order to combat stereotypes; and
    • Programs that combined educational and intergenerational programs.

    Karl Pillemer, a gerontologist and senior author of the study, said the results suggest "[a]geist attitudes don't seem as baked in as we think." In fact, "they may be relatively malleable."

    In fact, some medical schools have launched senior mentoring programs that aim to bridge the gap between young doctors and their older patients. For example, at the Medical University of South Carolina and at the Icahn School of Medicine at Mount Sinai, students are matched up with elderly patients they follow throughout medical school.

    A future without ageism?

    That said, Levy noted that there are many unanswered questions about ageism and ways to combat the discrimination effectively.

    According to Span, the studies in Cornell's research review included very little data on how to combat internalized ageism in older adults. It also did not show whether the participants' change in attitudes toward older adults will lead to action. "Will less ageist citizens support stronger enforcement of laws against workplace age discrimination? Or defend Medicare and Social Security from heedless budget cutters?" Span asked.

    Even so, the programs still "move[d] the attitudinal needle." And while it's "not always easy to find the balance between shrugging off offensive messages and counterproductive scolding … individuals can speak up about ageist generalizations," Span writes (Span, New York Times, 4/26).

    Cheat sheet: What you need to know about the geriatrics market

    The United States Census Bureau projects the country's elderly population to double by 2050—and it's time for your geriatrics program to grow along with it.

    Download this cheat sheet for everything you need to know about starting and running a successful geriatrics program.

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