University of Wisconsin–Madison School of Nursing Assistant Professor Kristen Pecanac, PhD, RN studies interactions among healthcare practitioners, patients, and family members as they make treatment decisions in hospital settings.
She says the peer review process has provided her with clear examples of ageism.
“I did a study where I looked at conversations between physicians and older adults during daily rounds,” says Pecanac.
“There was one conversation where there were really, really long pauses. The physician would ask the patient a question and they weren’t responding. I was in the room, so I could take notes. I could see the patient falling asleep. Early in the conversation, asked how they were doing, they said, ‘I couldn’t sleep, I was really anxious.’”
“When I submitted the paper for publication, I received a lot of interesting comments from reviewers,” says Pecanac. “They said this wasn’t a great example because ‘obviously, the patient doesn’t have the cognitive capacity to engage in this conversation.’ When even in the transcript that I provided, the physician said, ‘I know we’re bothering you when you’re really tired.’”
“Everything was centered around the patient being tired. But the reviewers were saying, ‘That’s another issue with older adults—how much can they actually engage in these conversations?’”
It’s not the only example Pecanac has of ageist reactions to her research. And she’s not the only School of Nursing faculty member whose research challenges ageist assumptions.
“Part of my work has been to show that the cognitive changes that occur with aging are not such that people aren’t able to follow medication regimens, lifestyle regimens, or other treatment,” says Associate Professor Lisa Bratzke, PhD, RN, ANP-BC, FAHA. “But reviewers have assumed that older adults are not going to be compliant.”
“I’ve also had reviewers say that older adults aren’t able to do MRIs, because they can’t lie still and understand what they’re supposed to do,” says Bratzke. “That they couldn’t lie flat for 45 minutes due to arthritis or heart failure or whatever. When in reality, claustrophobia has been a much bigger deterrent from MRIs than any aging-related issues.”
Their experiences illustrate the broad reach of ageism, from health research to care provision, to health policy and funding decisions, to the dearth of providers specializing in older adult care.
Psychiatrist Robert Butler, MD, who coined the term ageism in 1969, defined it as “a personal revulsion to and distaste for growing old, disease, disability; and fear of powerlessness, ‘uselessness,’ and death.”
Studies by Yale School of Public Health Professor Becca Levy, PhD and others have shown that holding negative age stereotypes decreases health-promoting behaviors, worsens health outcomes, and increases healthcare spending.
Ageism can also obscure the dangers of supposedly vetted treatments.
“I was taking care of a woman in her 80s who became depressed,” says Louise Aronson, MD, MFA, a professor of medicine at the University of California, San Francisco and author of Elderhood: Redefining Aging, Transforming Medicine, Reimagining Life. She was speaking during a webinar on “Confronting Ageism in Health Care,” organized by Kaiser Health News and The John A. Hartford Foundation.
“I was a relatively new doctor. I prescribed her one of the new medicines,” says Aronson, referring to SSRI antidepressants. “The big excitement was that these were newer and safer. They didn’t have side effects!”
“So I gave [an SSRI prescription] to her. She got worse and worse,” says Aronson. “The medicine I had given her had lowered the sodium in her blood—something that we now know commonly happens with these medicines, but that we didn’t know happened at that time because there were no older people in the studies of these drugs.”
Ageism can also decrease quality of care.
“There are numerous examples of health consequences of ageism from the healthcare provider side,” says School of Nursing Clinical Professor Sarah Endicott, DNP, PMHNP-BC, GNP-BC. “Neglecting to ask patients about their sexual lives or substance use based on ageist ideas can have very real, detrimental health effects. These include missed treatment opportunities, delayed care, drug interactions, and missed diagnoses.”
“I see it from the patient side, too,” says Endicott. “When I worked in primary care, I’d have older adult patients come in and dismiss their own symptoms for so long, thinking it was normal due to their age. We then miss a crucial window of time to intervene early, before people suffer lasting consequences. For example, a patient who ignores or dismisses shoulder pain may end up with a frozen shoulder or chronic osteoarthritis, when intervening early with therapy may have prevented functional decline.”
Ageism can also skew funding priorities.
“We can’t give people the strengthening exercises that would prevent falls, but if you fall and have a fracture, you can get emergency care that will cost many thousands,” says Aronson. “You will get a surgery that will cost tens of thousands. You will have hospital and rehab stays, driving the bills to hundreds of thousands. Whereas the actual rehab you needed to prevent not all but many falls would have just cost hundreds of dollars.”
“Then there’s the famous argument that older people use up too much of the healthcare dollar,” adds Aronson. “It’s life stage appropriate. We have three major stages of life: childhood, adulthood, and elderhood. When have you ever heard someone say, ‘Those children are using up too much of the education dollar. Why are they all so stupid? Why do they require so much education?’”
While ageism can take many forms, its impact on individual and community health, the healthcare system, and research is always negative.
The FrameWorks Institute, a social science research firm and part of the Reframing Aging Initiative, suggests three strategies to counter ageism, based on their research:
- Appeal to values of justice, pointing out that older people often aren’t treated as equals in our society;
- Give examples of ageism and positive responses, such as older patients’ pain not being taken seriously, which could be addressed by expressing concern and asking about potential underlying causes or ways to alleviate symptoms; and
- Use language that emphasizes shared interests, such as “as we age” or “what we need when we’re older.”