Age and AGeism 101

What are we talking about when we talk about aging and ageism? 

Aging: Aging is the natural process of getting older.

Ageism: Ageism is prejudice or discrimination based on a person’s age. Ageism can occur in a lot of different shapes and forms. Some examples include patronizing people for their age, limiting advancement opportunities for older people, stereotypes such as ‘spoiled’ or ‘inexperienced’ for younger people and ‘difficult’ or ‘frail’ for older people. “Youngism” has been proposed as an alternative term for bias against younger people, with “ageism” used specifically for bias against older people [1].

Why do aging and ageism matter in healthcare?

Everyone gets older! It’s a natural process. In fact, the fastest-growing population is people over the age of 65 [1]. So how could there be discrimination against older people in the healthcare system? Unfortunately, one study showed 1 in 5 people over the age of 50 experience discrimination in the healthcare setting [2]. For example, some healthcare workers order fewer diagnostic tests for older patients under the assumption that speaking with older patients is more frustrating [3]. Providers were shown to be more dismissive of complaints from older individuals because the symptoms are a result of ‘normal aging’ [4]. These assumptions, whether intentional or not, lead to actions that harm older patients’ access to high-quality care. The earlier study also showed that this discrimination was associated with a higher chance of developing a disability [2].

During the COVID-19 pandemic, age was used as one criterion for ventilator allocation. This shows that the healthcare system viewed a young person’s life as more valuable than an old person’s. This could be based on the bias that older people do not contribute as much to society[4]. Instead, the mistreatment of older patients is costing society. One study found that just one year of age discrimination led to $63 billion in healthcare costs. They also found that ageism caused 17.04 million more cases of certain health conditions [5]. Discrimination against older patients is not only damaging their health but also hurting society as a whole.

What do we know about aging and ageism in medical and health professions education?

Scientific discoveries have allowed more and more people to live over the age of 50. Health profession education has not yet adapted to this growing population. As of 2022, 99% of U.S. medical schools require a pediatric rotation, but only 45% require a geriatric rotation [10, 11]. This imbalance does not reflect the reality that there are more people over the age of 65 than children younger than 17 years old [12]. A fourth year medical student noted that the commonly used teaching approach of a “textbook case study”, where a patient has one medical condition which is cured by a singular treatment, does not reflect the complex comorbidities that many older patients present. Many Canadian hospitals admit these patients under “acopia” (inability to cope with daily activity) instead of taking the time to fully unravel the symptoms [13].

Unfortunately, ageism runs deep in society. Many policies and healthcare practices segregate people based on age [6]. Physicians were less likely to recommend surgery for older lung cancer patients even though research has shown postoperative recovery does not depend on age. Many physicians also viewed depression and suicidal ideation as normal among older patients and were less likely to use therapeutic strategies [7]. One article claims the push for healthcare staff to have early discharges and to see patients faster facilitates a dismissive attitude toward older people with more complex needs who often require longer rehabilitation time [8]. As new health professionals are exposed to these workplace behaviors and implicit biases, they internalize them and pass them on to the next generation [13].

How does the Bias Checklist address aging and ageism in health professions education content?

The Bias Checklist first asks: 

  • “Does the content include any discussion of older adults or geriatric patients?”

If you answer no, you will be prompted to consider whether your content should mention aging or ageism. One consideration is whether the issue being taught often affects older people or manifests differently in older people. For example, content related to sexual health often fails to mention the interests and concerns of older patients; content related to disability may fail to acknowledge that disability is a common feature of aging, one that most people eventually experience to some degree. 

Below are some examples of common ways in which bias, shame, stereotype and stigma toward age and aging can manifest in health professions education content:

  • Focusing only on declining health and/or quality of life or on the need for advance directives and limitations of intervention later in life

  • Omitting positive portrayals of aging and geriatric care

  • Presuming that older adults are disabled and/or identify as disabled; some older adults will view disability as stigmatizing and will not identify as a person with a disability. Neglecting consideration of sexual health at all ages.

Last, the Checklist asks: 

  • “Could the content be perceived as promoting stereotypes, bias, shame or stigma?”

What can we do to address this problem?

  • Example: A presentation on diuretics makes no mention of how the effects might differ by age. If there are differences, the presentation could be revised to include this information.

Where can I go to learn more? 

I learn best by…

Reading

Watching

  • Ageism: Explained

  • Aging in the Health Care System (patient perspectives)

Listening

  • Have something that would fit here? See below and let us know!

Advocating

Need a consultation?

Although the Bias Checklist Collaborative does not yet have identified expert consultants in ageism, the resources below may be helpful with questions regarding your content:

Have something to add? 

Email us at biaschecklist@gmail.com with any of the following:

  • Recommendations for additional important content to include above, or suggested corrections or clarifications → use the subject header “Aging and Ageism 101 - Correction”

  • Suggestions for additional resources for learning more → use the subject header “Aging and Ageism  101 - Learn More”

  • Examples of curricular bias, including before and after versions of content → use the subject header “Aging and Ageism  101 - Example”

  • Your name, credentials, affiliation, area(s) of expertise, and brief biography or summary of qualifications if you are willing to serve as an expert consultant → use the subject header “Aging and Ageism 101 - Consultant”

References

  1. World Health Organization. Ageing: Ageism. Available online at: https://www.who.int/news-room/questions-and-answers/item/ageing-ageism. Last accessed: June 15, 2023. 

  2. United States Census Bureau. 65 and older population grows rapidly as baby boomers age. June 2020. Available online at: https://www.census.gov/newsroom/press-releases/2020/65-older-population-grows.html. Last accessed: June 15, 2023. 

  3. Rogers SE, Thrasher AD, Miao Y, Boscardin WJ, Smith AK. Discrimination in healthcare settings is associated with disability in older adults: health and retirement study, 2008–2012. Journal of General Internal Medicine. 2015 Oct;30:1413-20. Available online at: https://link.springer.com/article/10.1007/s11606-015-3233-6

  4. São José JM, Amado CA, Ilinca S, Buttigieg SC, Taghizadeh Larsson A. Ageism in health care: a systematic review of operational definitions and inductive conceptualizations. The Gerontologist. 2019 Mar 14;59(2):e98-108. Available online at: https://academic.oup.com/gerontologist/article/59/2/e98/3828302 

  5. Fraser S, Lagacé M, Bongué B, Ndeye N, Guyot J, Bechard L, Garcia L, Taler V, Adam S, Beaulieu M. Ageism and COVID-19: What does our society’s response say about us? Age and Ageing. 2020 Sep;49(5):692-5. Available online at: https://academic.oup.com/ageing/article/49/5/692/5831206

  6. Levy BR, Slade MD, Chang ES, Kannoth S, Wang SY. Ageism amplifies cost and prevalence of health conditions. The Gerontologist. 2020 Jan 24;60(1):174-81. Available online at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7182003/

  7. Mendez A, Lopez M, Rodriguez-Quintanilla K, Carrion B. Ageist no more: interprofessional training for undergraduate healthcare students. Geriatrics. 2022 Feb 7;7(1):17. Available online at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8872434/

  8. Ben-Harush A, Shiovitz-Ezra S, Doron I, Alon S, Leibovitz A, Golander H, Haron Y, Ayalon L. Ageism among physicians, nurses, and social workers: Findings from a qualitative study. European Journal of Ageing. 2017 Mar;14:39-48. Available online at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5550621/

  9. Kydd A, Fleming A. Ageism and age discrimination in health care: Fact or fiction? A narrative review of the literature. Maturitas. 2015 Aug 1;81(4):432-8. Available online at: https://www.sciencedirect.com/science/article/abs/pii/S0378512215006738 

  10. Warner-Maron A. The visibility of geriatrics in US medical schools. Annals of Long Term Care. November 18, 2022. https://www.hmpgloballearningnetwork.com/site/altc/commentary/visibility-geriatrics-us-medical-schools (see also: Dawson CM, Abiola AO, Sullivan AM, Schwartz AW, members of the GERI Team Research Group. You can't be what you can't see: A systematic website review of Geriatrics Online‐Visibility at US medical schools. Journal of the American Geriatrics Society. 2022 Oct;70(10):2996-3005.)

  11. Association of American Medical Colleges. Clerkship Requirements by Discipline. Available online at: https://www.aamc.org/data-reports/curriculum-reports/interactive-data/clerkship-requirements-discipline. Last accessed: June 15, 2023. 

  12. Administration for Community Living, United States Department of Health and Human Services. 2020 Profile of Older Americans. May 2021. Available online at: https://acl.gov/sites/default/files/aging%20and%20Disability%20In%20America/2020Profileolderamericans.final_.pdf 

  13. Stall N. Time to end ageism in medical education. Canadian Medical Association Journal. 2012 Apr 3;184(6):728-. Available online at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3314047/ 

Contributing Writer(s)

Madeline Lee, MD Candidate

Sophie Pollack-Milgate, BA  

last updated October 3, 2023

 

artwork by Audrey Li, 2023