“Well, at your age, that’s to be expected.”
“How are we today sweetie?”
“Are we ready for our checkup?”
Those are comments older adults sometimes hear from medical professionals, and they reflect ingrained ageism, according to Andrew Steward, assistant professor of social work in the Helen Bader School of Social Welfare. His research focuses on the social justice issues involved in ageism as well as ways to counter implicit assumptions that affect older people.
His paper, “Age Discrimination in Healthcare” was published earlier this year in the Certified Senior Advisors Journal.
He talks about the paper and his work in this interview.
What made you decide to publish the paper?
I had worked with this journal previously on another article, and they suggested I write this piece. This journal is targeted to practitioners rather than academics. Unlike peer-reviewed journal articles which often have a paywall, it was easily accessible to those working in the field.
How are older patients impacted by ageism in health care settings?
In health care, ageism can be displayed in everyday conversations, physical spaces and policy choices. Making change means responding at each level.
Why is this important to understand?
Research has shown ageism in health care can literally have life or death implications, given that older patients who experience it have a higher probability of death than younger patients.
What are the issues around how medical professionals respond to older patients when they bring up concerns?
It’s not uncommon for doctors to say something like, ‘Well, at your age this is normal.” That can be very dismissive, especially in a health care setting where you need a service and the way the message is delivered is dismissing your concerns about your own health and dismissing potential interventions to stay healthy. Many times, older people have to go and get a second or third opinion, just to talk to a doctor who will talk to them and listen to them.
In the article you talked about “elderspeak.” What exactly is that?
Elderspeak is an infantilizing way of communicating with older adults based on stereotypes that assume older people lack competence or intelligence. It’s essentially “baby talk” with older people. Health care providers may speak in a in a high pitched or sing-songy voice. Or they may address patients as “honey” or “sweetie,” rather than using their names. That can be very patronizing. One study I mentioned in the article showed that 84% of health care workers interacting with older adults used elderspeak.
You also mentioned the use of “we” instead of “you” in making suggestions to older adults, especially in residential care settings.
A good example of that is saying, “we need to take our medications,” or “we need to take a bath, rather than simply saying “you need to take medications or take your bath,” or better yet asking the older adult when they would like to schedule these within their daily routine.
You talk about the issue of rationing health care, which can especially impact older people…
When providers are under pressure to decide who receives services, they may favor younger people due to an assumption that illness and death is more common or even considered more acceptable among older adults. Rationing of health care when resources are limited is a complex and nuanced issue and one I discuss with students. It’s been a debate for a long time, but in my view basing decisions on age alone should is too simplistic. We should be making decisions about allocating health care resources based on a variety of factors, including not only age but also need, equity, environmental factors and individualized care plans.
How was this issue highlighted during the Covid-19 pandemic?
As the virus was initially spreading, voices in the media and elsewhere expressed sentiments that the threat was not severe because it would primarily affect older people, that medical interventions should target younger generations, and that a targeted lockdown of older adults offered a promising solution to reopening the economy. When resources like ventilators were in short supply at the beginning of the pandemic, for example, the state of Alabama used age as a criteria in limiting their use, which was subsequently found to be a form of age discrimination.
How can health care systems improve the way they handle these issues?
It’s a matter of education and changing the culture. In long-term care, for example, some systems have changed the culture of nursing homes from cold, institutional settings to places where older people can feel at home and have a sense of community. These health care environments can give older people more autonomy and self-determination. I worked in Denver in an area that was really at the cutting edge of a culture change in nursing homes. One change in the philosophy of care – the Eden Alternative – has become a national and international model.
(Editor’s note: Anne Basting, UWM professor of English, has done innovative work with arts and the aging and their caregivers. That work has been recognized by a MacArthur Fellowship, an Ashoka Fellowship, a Rockefeller Fellowship and multiple major grants. Her latest book is “Creative Care.”)
What projects and research are you working on?
In my current work, I am partnering with several community organizations to pilot a 10-session anti-ageism peer support program for adults 50+ years of age called Aging Together. This program offers education about how ageism impacts health, and gives older adults the opportunity to tell their story of aging in a new way within a small, supportive peer group. In the research, we are exploring whether the Aging Together program may help to reduce internalized and relational ageism while enhancing self-efficacy, a sense of purpose in life, social connectedness and cognitive function. This is important since a lot of stereotypes about aging are so prevalent and insidious, and we all internalize them to some degree. But education and storytelling can be powerful ways to counteract the myths around aging and promote enhanced well-being for older adults.
Written by Kathy Quirk
Link to original story: https://uwm.edu/news/tackling-the-continuing-issue-of-ageism-in-health-care/