As mentioned in one of our previous blogs, disparities in healthcare can be very damaging for many populations in the United States, especially for older adults. The inequalities within the U.S. healthcare system can lead to hesitation when asking for care, and when receiving care, older patients may not be given the same attention, fair treatment, or opportunities as younger generations. This is called ageism, which is the discrimination against an individual based on their age, and unfortunately, it is still very prevalent in the healthcare setting.

Older adults that are subjected to ageism are more likely to have cognitive and physical issues, such as memory and balance problems. Furthermore, those who are subjected to negative aging stereotypes tend to have a more pessimistic outlook on aging. Studies have shown that older people with a more optimistic attitude about aging have the potential to outlive those who are more negative about aging by more than seven years.

In the healthcare environment, ageism can present implicitly (unconsciously) and explicitly (consciously). Implicit ageist behaviors may include a lack of patience and respect when interacting with older patients, exclusion from medical decision-making, and the use of condescending speech known as “elderspeak.” Explicit ageism becomes evident when older populations face discrimination to prioritize younger ones, as witnessed during the COVID-19 pandemic when some states implemented crisis standards of care that favored younger patients.

Elderspeak 

“Elderspeak” is a specific example of ageism wherein healthcare providers and caregivers communicate with older patients in a patronizing manner. This way of speaking infantilizes patients, using oversimplified language, terms of endearment, and sometimes even increasing the pitch of the voice. Although some believe this way of speaking helps with effective communication, it is condescending and can lead to an unequal power dynamic between older adults and their caregivers. Some examples of elderspeak include: 

“It’s time to take your pills now, sweetie.”

“Hey, chief, are you ready to go to your physical therapy appointment?”

“Let’s go potty now, honey.”

“Oh Honey Bun, you want to go to bed, don’t you?”

“Is our tummy hungry for some foodie?”

Using elderspeak makes older adults feel disrespected and incompetent. It can also lead to patients with dementia becoming more aggressive and resistant towards their care providers. This not only jeopardizes the quality of care but also places additional stress on caregivers, potentially leading to burnout. It is imperative to maintain professionalism when addressing older adults to ensure they do not experience discrimination and receive the care they require.

Crisis standards of care

As previously mentioned, an example of explicit ageism in the field of healthcare is seen in crisis standards of care, which guide how the medical community should allocate scarce resources, such as ventilators or emergency beds, when a patient’s needs exceed available resources.

These standards have, at times, prioritized younger patients over older adults. During the pandemic, states including Idaho, Alaska, and Montana began implementing crisis standards that emphasized younger patient care over older patients, due in part to the unfortunate idea that younger lives are more valuable because they presumably have more years left to live. Such policies during the pandemic had devastating consequences for older individuals, particularly those in nursing homes. Unfortunately, this has led to many people internalizing ageism, which increases self-doubt and makes them less likely to seek care.

The pandemic highlighted the need for reform, prompting the Office for Civil Rights at the U.S. Department of Health and Human Services to revise crisis standards of care, preventing discrimination based on age or disabilities.

Changing the Narrative

These instances of implicit and explicit ageism underscore the importance of raising awareness about ageism in healthcare. Campaigns, such as Changing the Narrative, are actively combatting ageism using evidence-based strategies, strategic communications, and innovative public-facing campaigns.

Changing the Narrative envisions a world without ageism in all different aspects, such as relationships, culture, work, policy, and healthcare. In a healthcare landscape without ageism, care partners are respected and well-compensated, while older adults are treated with dignity and are not deemed expendable. Age would not be a criterion for treatment.

However, despite these efforts, challenges persist in healthcare. Changing the Narrative aims to empower providers and patients to combat ageism by providing practical solutions. For example, in cases where healthcare providers primarily engage with care partners and ignore the older patient, it is essential for the patient to assert themselves and request direct communication. Likewise, caregivers must prioritize addressing the patient directly and involving them in their health conversations.

You can learn more about Changing the Narrative by watching this Healthy Aging Speaker Series presentation by Kris Geerken and Gilliane Lee from Dec. 2022: