2. Goals
• Elicit self reflection about own perceptions of older
persons
• Define age discrimination broadly
• Examine types of age discrimination in healthcare
• Context: Examine the social and economic history that
produced current naturalized beliefs about the elderly
– How older people embody stereotypes--> medical
relevance
• Educate about the medical relevance of discriminatory
behavior
• Explore physician role in age discrimination and ways
to improve attitudes
4. Activity
• List ten words to describe the elderly in general
• Describe your relationship with an older individual.
• Think of the last conversation you had with an older person-
how did you talk to them, what did you talk about?
• What are some of the major barriers that the elderly face in
day to day living? What are some solutions to these barriers?
• How should healthcare prioritize the elderly?
• Do you know of how any other culture perceives death? How
might that change their attitude towards the elderly?
6. A process of systematic stereotyping, prejudicial
attitudes and direct or indirect discrimination
against people because they are old”
- Robert Butler
“Age prejudice in this country is
one of the most socially-condoned
and institutionalized forms of
prejudice, such that researchers
may tend to overlook it as a
phenomenon to be studied”
-- Nelson 2005
7. What is Ageism
Labor: Failure to hire or promote qualified
older persons
Care: Absence of appropriate care of older
persons in long term care institutions
Language: Abusive language (crone, old-
fart), condescending/patronizing language
(little old lady)
Communication:
Insensitivity, impatience, incorrect
assumptions about cognitive functioning
Abuse: Physical, emotional, financial, sexual
abuse
10. Types of Ageism
Personal
Ageism
Bias
against persons
or groups
based on their
older age.
• Exclusion/ig
noring older
person
based on
stereotype
• Physical
abuse
• Stereotype
about
persons
Institutional
Ageism
Missions, rules, and
practices that
discriminate against
individuals and or
groups because of
their older age.
• Mandatory
retirement
• Absence of older
persons in
clinical trials
• Devaluing of
older persons in
cost-benefit
analysis
Intentional
Ageism
Practices carried
with knowledge of
bias: take
advantage of the
vulnerabilities of
older persons.
• Marketing and
media that use
stereotypes of
older workers
• Targeting older
workers in
financial scams
• Denial of job
training based
upon age
Unintentional ageism
Practices in which
perpetrators unaware
of bias against persons
or groups based on
their older age
• Absence of procedures
to assist older persons
in their own in
emergency
• situations
(e.g., flood, heat wave)
• Lack of built-
environment
considerations
(ramps, elevators, han
drails)
• Language used in the
media
11. Examples of Age Discrimination
Direct
Systematic
Policy
Access
Social/cultural
Physician attitudes
15. Stereotypes
• like all stereotypes, the stereotype of a typical
older person exaggerates the importance of a
few characteristics and the society assumes
these characteristics to be true for all older
people
• Though human body loses resilience with
age, the extent to which these physical
changes occur varies widely from person to
person and stigma associated is often
unwarranted
16. Stereotypes
• 64% of adults >65 report no limitation in
major activity
• Only 20% report they need assistance with
basic daily activities
• Rates of disability continue to decline
17. What do you expect at your age?
• Attributing ageing to physical decline assumes
that age itself is the cause of decline when in
fact illness is often the cause
– Unwarranted prognostic pessimism
– Incorrect or missed diagnosis
– Miss past exposures or behavioral factors
– Drug interactions can cause dementia/delirium
can be missed for ‘normal ageing”
– Over medication due to assumption that patients
are ‘stuck in their ways’
18. Stereotypes
• memory loss and dementia are not natural
byproducts of aging
– people who continue to learn and regularly
exercise maintain cognitive abilities
20. Examine the social and economic
history that produced current
naturalized beliefs about the elderly
21. Naturalization of
the social role of the elderly
Rooted in Historical and
Economic Context:
• The Printing Press
• The Industrial Revolution
• Advances in life expectancy
• The nuclear family, nursing homes
22. Cross Cultural Perspective
• American sentiment
• Old age as a negative time- decline in physical attributes, mental acuity
• Increasing dependence on others Individuality and control over the
body
• Death as the end of self
• Influencing factors: western culture, capitalism, individualistic values
• Contrast with a belief system in which
• Hugely variable for just for consideration of another mindset:
• Ones self has no fixed ending, Spirit lives on
(spiritually, reincarnation, etc.)different view of life.
• Death is not feared; welcome relief from life’s travels
• Death is seen as a passage to a different spiritual existance
• Less anxiety about death- old adults revered: special status and power
• Intergenerational reciprocity
23. Cross Cultural Perspective
• Americans of Chinese, Japanese, and Korean
descent, researchers found that Korean
Americans are the “most pious” in supporting
older family members.
– However, in a separate study, Moon and Benton also
learned that older Korean Americans who were
victims of elder abuse were more likely to blame
themselves and less likely to report the abuse.
– Only one-third of those interviewed were aware of an
agency to which they could go for help
– Parenthetically, a majority of Caucasians were aware
of such a resource.
24. What factors promote ageism?
• Absence of adequate national health
insurance/pensions systems.
• Absence of life long education, job
enhancement, training, (reduced skills)
• Absence of effective national health
promotion and disease prevention
• Stereotyping/scapegoating of the elderly
25. …cute little old lady
adorable
sweetie
darling
Verbal Ageism
• A self-fulfilling message that older people
are incompetent, frail and feeble
• Older people exposed to negative
stereotypes associated with
ageing, reinforced by belittling phrases and
condescending attitudes, performed
markedly worse in memory and balance
tests than peers who were not.
You don’t want to upset your family
“overly polite, speaking louder and slower
Exaggerating their intonation,
talking in simple sentences”
(Giles, Fox, Harwood, and Williams 1994)
26. Stereotyping Embodiment Theory
• Internalization of Stereotypes Across the Life Span
• Unconscious Operation of Age Stereotypes
• Salience Gain from Self-Relevance
• Utilization of Multiple Pathways
– psychological
– behavioral
– physiological
27. Internalization of Stereotypes Across
the Life Span
“When negative age stereotypes are
encountered by individuals before they
are directed at themselves, there is
unlikely to be a felt need to mount
defenses against them;
hence, susceptibility is maximized.”
(Levy 2009)
‘‘Attributes associated with the ‘typical old
person’ tend to become incorporated into
the elderly person’s current and future self-
views’’ (Rothermund, 2005, p. 232).
28. Internalization of Stereotypes Across
the Life Span
At best older persons are portrayed as being
sweet, childlike, peaceful, comical, absentminded or
befuddled.
At worst they are repulsive, feeble, irrational or out of
touch with reality.
Absentminded and confusedGrumpy and rude
29. Unconscious Operation of Age
Stereotypes
Stereotypes activated unconsciously when primed (Levy 2000)
Negative age stereotypes Positive Age Stereotype words
Priming with word associations
Handwriting rated as:
senile, shaky,
Handwriting rated as:
younger, ‘confident’, wise
30. Unconscious Operation of Age
Stereotypes
Stereotypes activated unconsciously when primed (Levy 2000)
Negative age stereotypes Positive Age Stereotype words
Priming and presentation with scenario of potentially fatal illness
Reject life prolonging
Medical interventions
Choose life prolonging
medical intervention
even when it resulted in two types of
costs: losing their savings and extensive
care by family members.
31. Salience Gain from Self-Relevance
Artificial demarcation (subjective)
objective legitimization
Forced group identification
32. Utilization of Multiple Pathways
Psychological Behavioral
Physiological
subliminal-age-stereotype priming groups
Beliefs Performance
Eg. Health problems inevitable
part of getting old – regard
healthy practices as futile
Reduced self efficacy- Taking medication,
Healthy lifestyle habits,
handwriting exercise,Decision making
Systolic Blood Pressure Diastolic Blood Pressure
Skin conductance:
Sympathetic response
Poorer health outcomes
Direct stress response
33. Physical Impact
• Poorer health outcomes
• Direct stress response
• Increase in cardiovascular events
• Self care
– decreasing activity, poor diet, and not seeking
adequate medical treatment
– Or: exploit time/money spent on false treatments not
FDA approved/regulated- to avoid wrinkles, plastic
surgery, fad diets, anti-ageing, etc
• 18 percent of all suicide deaths in 2000
36. Medical Relevance
• Participants with more positive self-perceptions
of aging at baseline had better functional health
over the course of the study and lived an
average of 7.5 years longer than those with
more negative self-perceptions of aging
(Levy, Slade, & Kasl,2002; Levy, Slade,Kunkel, & Kasl, 2002)
• German study: Germans followed over a 6-year
period, demonstrated that age stereotypes were
a significantly better predictor of health than
vice versa (Wurm, Tesch-Ro mer, & Tomasik, 2007).
37. Words Medical Students Use To
Describe Patients
• Ineffective
• Dependent
• Unacceptable
• Disagreeable
• Inactive
• Socially undesirable
• Socially withdrawn
• Emotionally ill
• Economically burdensome by
acting as a drain on public
resources
38. The Physician and Aging Patient
• Physicians:
– Many regard the older patient as
“depressing, senile, untreatable, or rigid” (Reyes-Ortiz, 1997, p.
831).
• Medical Students:
– express reluctance to working with older patients present
because of belief that they have health concerns that are less
amenable to treatment, even with little basis for that
assumption other than a stereotype about aging and health
issues (Madey & Gomez, 2003).
• Mental health personnel:
– don’t want to work with older clients because they believe that
older people often don’t have any serious psychological issues
that merit therapy, and that they are just lonely and want to
exploit the therapist as a captive listening ear.
39. Facts on Med School
• 10% of American medical schools requiring
course work or rotations in geriatric medicine;
• <3% of medical school graduates take elective
course in geriatrics
• approximately just 7,600 geriatric physicians
available for a 35+ million population that is
projected to double to 70+ million by 2030.24
40. Medical Relevance
• Autonomy:
– Use of condescending language compromises the
physician/patient relationship
– Infantilizing patients-
– shielding elders from confusing or upsetting information-
reduces autonomy and self efficacy
• Future patients will not accept this behavior: Baby
boomer population more educated generation, social
activism, entitlement
• Proper care:
– Disease NOT ageing
– Sexual health!
41. Physician role and improving attitudes
• Learning about physiology of aging
– as to not conflate age with disease
• Promoting autonomy
– Older persons who have higher cognitive and
social functioning regard secondary baby talk as
disrespectful, condescending, and humiliating
– Connotes dependency, mental disability
42. Why Address This Now?
– GP ageist attitudes can be a barrier to
implementing evidence based guidelines in
treating older people
– Inaccurate assumptions about the needs and
capabilities of older people can lead to ineffective
and improper care
– Demographic changes necessitate it
45. Goals
• National healthcare goals
– Develop interventions that will maximize the
influence of older individuals’ positive age
stereotypes in their everyday life
– Reduce age discriminatory behavior by healthcare
providers- to improve quality of care and
outcomes
– Improve upon geriatric education
Hinweis der Redaktion
These cues are prevalent because, as distinct from other forms of prejudice and discrimination (e.g., racism and sexism), ageism does not tend to be proscribed by political correctness. Initially, these cues may be thwarted by a state of denial, but their prevalence tends to overcome resistance (Levy & Banaji, 2002). Unlike those who have been stigmatized since birth and consequentl may acquire coping strategies from their subgroup, individuals tend to enter old age unprepared to resist negativeage stereotypes.
Journal of Social Issues, Vol. 61, No. 2, 2005, pp. 207--221Ageism: Prejudice Against Our Feared Future SelfTodd d nelson 2005
Exclusion or ignoring older persons based on stereotypic assumptions· Physical abuse· Stereotypes about older persons and old age
Have students list some they can think ofanti-aging products
List some negative stereotypes Despondent, shrew, recluse, nosy neighbor, bag lady, vulnerable, severely impaired, crotchety, rude, depressed
senile old man with a long beard and ear horn and the timid and unthreatening “granny” sitting inthe corner with her knitting.
64 percent of adults 65+ report no limitation in major activities,18 and only 20 percentreport that they need assistance with basic daily activities.19 Rates of disability continue todecline for persons 65 and older
64 percent of adults 65+ report no limitation in major activities,18 and only 20 percentreport that they need assistance with basic daily activities.19 Rates of disability continue todecline for persons 65 and older
These cues are prevalent because, as distinct from other forms of prejudice and discrimination (e.g., racism and sexism), ageism does not tend to be proscribed by political correctness. Initially, these cues may be thwarted by a state of denial, but their prevalence tends to overcome resistance (Levy & Banaji, 2002). Unlike those who have been stigmatized since birth and consequentl may acquire coping strategies from their subgroup, individuals tend to enter old age unprepared to resist negativeage stereotypes.Paradoxically the people who lIKE old people are more likely to engage in over accomodatinglnaguage
Ageism is Rooted in Historical and Economic ContextBrief anthropological context: the changing role of the elderly The invention of the printing press (loss of role in oral history)The Industrial Revolution (mobility from home, loss of land ownership) Concurrent advances in medical technology and life expectancy Naturalization of uselessness (based on social/economic context and subsequent value judgments) stereotypes of older persons as physically, mentally, and emotionally unfit, miserly, and incapable of providing aesthetic beauty to the world, reinforce the belief that they lack the ability to be active or involved in the community. The myth that older persons add little or no value to the community has led some to the misguided conclusion that they deserve minimal services, for if they contribute nothing they are deserving of nothing.
In the absence of comprehensive national health insurance and pension systems, employersconfront high costs that increase as workers grow older, discouraging employersfrom hiring and retaining older workers.2. In the absence of adequate lifelong continuing education that encourages and supportsenhancement of job skills and development of new skills that keep pace with the jobmarket, it is difficult for older workers to acquire the skills employers seek.3. In the absence of an effective national health promotion and disease prevention program,and a modest investment in biomedical and behavioral research, conditions suchas frailty and dementia among older people result in avoidance and uneasiness about oldage, reinforcing stereotypes.
http://www.telegraph.co.uk/health/3256340/Talking-down-to-the-elderly-is-bad-for-their-health-medical-study-finds.htmlveraccommodation becoming overly polite, speaking louder and slower, exaggerating their intonation, and talking in simple sentences (Giles, Fox,Harwood, & Williams, 1994). identical. These speech styles derive from our stereotypes about olderpersons as almost child-like in their level of cognitive functioning and dependencyon younger adults.Some older adults find this comforting when they are very sick or very ill but some people talk to the elderly like this indiscriminanatlyPeople who ‘like’ older adults tend to do this more
Levy, B. (2009). Stereotype embodiment: A psychosocial approach to aging. Current Directions in Psychological Science, 18(6), 332-336
Attitudes and views toward aging are introduced during preschool yearsattitudes. In today’s mobile society,with families moving away from older relatives, children may not have an opportunity to experience“grandparenting” and never have had the opportunity to relate to an older personParentsmay perpetuate this virtual and actual distance between grandchildren and grandparents by notmaking an effort to visit and communicate regularly in a meaningful way.3 Fear of aging and itsaccompanying illness can also engender ageism in a family. Caring for an aging parent can be a frigthening experience
Risk in this is that
Older participantswere subliminally exposed to the primes and, afterbeing presented with scenarios describing a potentially fatalillness, were asked if they would choose a life-prolongingmedical intervention, even when it resulted in two types of costs:losing their savings and extensive care by family members.Those in the positive-age-stereotype group tended to accept thelife-prolonging intervention, while those in the negative-agestereotypegroup tended to reject it (Levy, Ashman, & Dror,2000).
Aging is often viewed as a personality homogenizer, as though at some point people lose their individuality and fall into a single category: the elderly. Yet when we look at our own lives, we see many differences -- large and small -- between ourselves and our peers. These individual traits don't disappear when people turn 65 (or 75, or 85). Subsequent stereotypes harder to id, groups self identify, groups havent had long time to learn resistance mechanism and self advocate,
(Levy & Myers, 2004)Levy, Hausdorff, Hencke, & Wei, 2000herefore, ifthesympatheticbranchoftheautonomicnervoussystemishighlyaroused, thensweatglandactivity will also increase, which in turn increasesskinconductance. In thisway, skinconductancecanbeusedas a measureof emotional andsympatheticresponses.The older person on the receiving end of this demeaning communication often ends up with a reduced sense of self, lower self-esteem, and perceptions of low self-competence, which enforces existing stereotypes (ageism in america)
Levy,Slade, & Kasl,2002; Levy, Slade,Kunkel, & Kasl, 2002
Encyclopedia of AgeismErdman B. Palmore
Negative ageist stereotypes may also explain why older patients receive less medical information from physicians than do younger patients, and the increasing unwillingness of general internists and family physicians to provide primary care services to the older population
Ageism in america
Older persons who have higher cognitive and social functioning regard secondary baby talk as disrespectful, condescending, and humiliatingConnotes dependency, mental disability,
