Dr. Robert N. Butler defined ageism as the “systematic stereotyping and discrimination against people because they are old.” Unfortunately, the health care system isn’t immune to instances of explicit or implicit ageism, which negatively affects the health and well-being of older patients.
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The Prevalence of Ageism in Health Care
A growing elderly population in the U.S. will force the health care industry to deal with the problem of ageism.
The Growing Elderly Population in the U.S.
According to the U.S. Census Bureau, “By 2060, nearly 1 in 4 Americans will be 65 years and older, the number of 95-plus will triple, and the country will add half million centenarians.” In 2016, there were 49.2 million children under 18 and 73.6 million adults 65 and older; by 2060, these numbers are predicted to grow to 80.1 million and 94.7 million, respectively. As the elderly population grows, the demand for health care will increase and potentially exacerbate ageist attitudes.
Ageism can be cognitive in the form of stereotypes, emotional in the form of prejudice, or behavioral in the form of discrimination. It may be also implicit or explicit, and manifest itself among individuals, within social networks, or via institutional policies or cultural traditions.
Examples of Ageism in Health Care
Care-related ageism manifests in numerous ways. Physicians may dismiss a treatable pathology as a feature of old age. Staff members may share ageist jokes or may have implicit ageist thoughts and behaviors toward elderly patients without conscious awareness. Providers may also treat the natural effect of aging as a disease.
Potential Causes of Ageism
One of the theories behind ageism is the terror management theory, which suggests that a negative bias against older individuals helps protect younger individuals for thinking about aging’s negative aspects. Another theory is the functional approach theory, which suggests that stereotypes serve individuals in the cognitive realm by helping them increase efficiency through categorizations and in the social realm by helping them identify with the social in-group. Being surrounded by elderly patients with severe health conditions, misconceptions regarding the hierarchy of treatment, and poor training are also perceived causes.
The Widespread Effects of Ageism
Ageism in health care impacts the quality of geriatric care and patient-provider communication, as well as the habits and behaviors of elderly individuals.
Effects of Ageism
Many conditions can be undiagnosed and undertreated, such as pain, fatigue, and depression. Conversely, conditions can be overtreated if medical providers offer health recommendations based on age without conducting proper assessments. This could be a costly issue – overtreatment can cost between $158 billion to $226 billion every year. It can also put the patient through a lot. For instance, overtreating conditions such as prostate cancer can lead to surgery, intensive care, overdiagnosis of benign tumors, or unnecessary harm.
Communication between physicians and elderly patients may be poor. With elderly patients, doctors may be less patient, less engaged, less responsive to patient-raised issues, and more likely to assume a patient is cognitively impaired and not explain the details of an illness. That said, communication may be complicated by a patient’s sensory deficits, cognitive impairment, or functional limitations.
Additionally, elderly patients may hold and exhibit ageist attitudes. Self-ageism can make patients less likely to seek health care, more likely to be undertreated, and less likely to engage in preventive behaviors such as regular exams, healthy eating, and exercising.
Taking Steps to Reduce Ageism in Health Care
Because ageism in health care exists across all levels, combating ageism will require implementing a strategy that involves training health care practitioners, revising institutional policies and procedures, and addressing ageist attitudes in elderly patients.
Challenges in Combating Ageism
It can be difficult to distinguish ageism from carefully reasoned clinical decisions. Indeed, ageism can be deeply embedded in daily procedures, and health care practitioners make decisions across multiple areas that impact clinical practice, such as screening, diagnostic tests, and treatment. Health care practitioners follow routine, familiarity, and evidence. Categorizing and stereotyping patients by risk or potential outcome may be necessary to make decisions. Following established practices makes it difficult for health care practitioners to embrace change.
Strategy to Eliminate Ageism
There are numerous key strategies health care professionals can use to mitigate ageism. These include adopting an individualized, person-centered treatment approach, defining non-ageist practices and attitudes, and acknowledging the need to eliminate ageism in practice.
Tips for Advanced Practice Nurses in Combating Ageism
Advanced practice nurses can also play a big role in minimizing ageism, and they can fight its presence through the deployment of several tactics. These include focusing on supporting the well-being of the whole person, educating elderly patients on the importance of adopting preventive habits, and helping elderly patients consider and establish their priorities.
Elderly patients deserve the same quality of care and attention from health care practitioners that younger patients receive. Once health care organizations identify ageism as an obstacle in providing quality care, leaders, managers, and advanced practice nurses will need to adopt an attitude that embraces change.